Varicocele Treatment in Bangalore | Varicocele is a condition in which there is an enlargement of veins draining the testicles. This condition is seen in about 15-20% of the males but in about 30% of the males with infertility. This is the commonest correctable cause of male infertility.
Presentation:
This disease may manifest in two ways.
- Symptomatic: There is a dull or dragging type of pain in the testicles. The pain is usually mild in intensity and increases in standing or exercise. The patient may also notice swelling in the scrotum which brings him to the urologist. This can occur at any age but is more common in young people.
- Asymptomatic: Many males are detected to have varicoceles when they are undergoing evaluation for infertility. This is detected on ultrasound but there are no symptoms.
Cause:
Varicocele occurs whenever there is a blockage of veins draining the testicles. This could be an incomplete or complete blockage. Developmental problems like absent valves in the Internal Spermatic vein which causes backup of blood in the veins of the testis called pampiniform veins or compression of the vein in the abdomen due to the nutcracker effect are the common causes. It also could be due to acquired causes like renal cell carcinoma and IVC thrombus.
Pathophysiology:
The mechanism by which varicocele causes infertility is by causing stagnation of blood in the testicles which increases the temperature of the testis leading to impaired spermatogenesis. It also decreases the production of testosterone which is the male sex hormone by damaging Leydig cells which synthesise testosterone.
Evaluation:
The most important way to diagnose varicocele is by clinical examination. The urologist feels a full or swollen hemiscrotum which is diagnostic of varicocele. This can be confirmed by doing ultrasound and Doppler of the testis.
Treatment of varicocele:
There are 3 grades of varicocele. In grade I varicocele there is no need of any treatment. If the patient has pain, the treatment is by wearing tight underwear and analgesics. However, in grade II and III varicoceles, many times surgery is needed. This is especially so when the patient has presented with infertility and deranged semen parameters. The surgery involves short anesthesia and a small cut is made in the groin. The dilated veins are ligated and divided under magnification using a loupe or microscope. This is called microscopic varicocelectomy. The patient can go home on the same day or the next day. He can resume most of the activities in 3-4 days. There are other techniques also to treat varicocele. These are the laparoscopic methods wherein small cuts are made in the abdomen and surgery is performed. The newer technique is a minimally invasive technique called varicocele embolization where an interventional radiologist blocks the veins by doing angiography of the gonadal vein.
Outcomes:
There is an improvement in semen parameters in 60-70 % of the patients. This means there is an increase of the number of sperms, improved motility, and morphology. This results in better fertility rates.