-- Varicocele --
Written by DrShailesh Doshi
Varicocele is an abnormal enlargement of the vein that is in the scrotum draining the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Up-ward flow of blood in the veins is ensured by small one-way valves that prevent backflow. Defective valves, or compression of the vein by a nearby structure, can cause dilatation of the veins near the testis, leading to the formation of a varicocele.
The term varicocele specifically refers to dilatation and tortuosity of the pampiniform plexus, which is the network of veins that drain the testicle. This plexus travels along the posterior portion of the testicle with the epididymis and vas deferens, and then into the spermatic cord. This network of veins drains into the gonadal, or testicular, vein. The right gonadal vein drains into the inferior vena cava, while the left gonadal vein drains into the left renal vein at right angle to the renal vein, which then drains into the inferior vena cava.
The small vessels of the pampiniform plexus normally range from 0.5 - 1.5mm in diameter. Dilatation of these vessels greater than 2mm is called a varicocele.
...... Etiology ......
The idiopathic varicocele occurs when the valves within the veins along the spermatic cord do not work properly. This is essentially the same process as varicose veins, which are common in the legs. This results in back-flow of blood into the pampiniform plexus and causes increased pressures, ultimately leading to damage to the testicular tissue. Varicoceles develops slowly and may not have any symptoms. They are most frequently diagnosed when a patient is 15â€“25 years old, and is rarely developed after the age of 40. They occur in 15-20% of all males, and in 40% of infertile males. 98% of idiopathic varicoceles occur on the left side, apparently because the left testicular vein runs vertically up to the renal vein, while the right testicular vein drains directly into the inferior vena cava.
A secondary varicocele is due to compression of the venous drainage of the testicle. A pelvic or abdominal malignancy is of definite concern when a varicocele is newly diagnosed in a patient older than 40 years old. One non-malignant cause of a secondary varicocele is the so-called "SMA" (superior mesenteric artery), a condition in which the superior mesenteric artery compresses the left renal vein, causing increased pressures in left renal vein to be retrograded into the left pampiniform plexus. The most common cause is hypernephroma then retroprotiniem adhsion.
...... Symptoms ......
...... Symptoms of a varicocele may include ......
- Dragging-like or aching pain within scrotum.
- Feeling of heaviness in the testicle(s)
- Atrophy (shrinking) of the testicle(s)
- Visible or palpable (able to be felt) enlarged vein, likened to feeling a bag of worms.
- Infertility (Although no formal correlation has been established linking infertility with varicocele, many suggest that the increased temperature within the testes is the main cause in cases found with infertility.)
Varicocele is usually harmless except in cases of infertility.
An inguinal hernia can sometimes be misdiagnosed as a Varicocele and Infertility. Recently several scientific researches have shown that in over 90% of the cases in male infertility the main cause is bilateral varicocele that leads to persistent hypoxia in the testicular tissues that causes, with time, deterioration in the quantity and quality of production of the sperms. All other factors like genetic problems, obstruction of sperm transport system due to inflammation in the pelvis, include not more than 5-10% of all male infertility cases. This was found by Dr Yigal Gat and Dr Menahem Goren in one of their massive studies on varicocele which was published in the renowned medical journal - Human Reproduction.