Varicocele is classically defined as an unusual dilatation of venous plexus of testicles usually leading to a loss of testicular function. Clinical presentation is similar to that of calf varices and when testicles are finally affected, it may even lead to infertility.
Varicocele is the most common reason for male infertility. 30-40% of men diagnosed with infertility are also diagnosed with varicocele. The long-standing presence of blood in defected venous plexus will increase the testicular temperature and toxic ingredients will damage testicles and sperm production.
Because of the length of left testicular vein, it is more commonly observed on the left side while it may also be present on both sides. Infertility problems and pain radiating from testicles to groin may be common signs. Testicular volume loss may be present in patients with a long history of varicocele and there is a reduction in testosterone production. This will lead to the loss of sexual desire and erectile dysfunction. A long history of standing, heavy exercise, sexual intercourse or long periods of walking may aggravate the pain.
The disease is diagnosed by considering the patient’s history and with ‘’Scrotal Doppler Ultrasonography’’. Three degrees of varicocele are defined. The 1st degree is characterized observing palpable veins after straining or coughing, in the 2nddegree dilated veins can be detected through manual palpationwithout any increase in intraabdominal pressure and the 3rd degree is characterized with the evident visibility of dilated veins even without palpation. If needed, “Scrotal Doppler Ultrasonography” may identify retrograde blood flow and the degree of venous dilatation. Spermiogram is a test used to identify any changes in sperm count, any abnormal sperm morphology and any decreases in sperm motility.
For individuals suffering from pain in the presence of normal spermiogram parameters, surgery is not recommended because of potential postoperative pain. Surgical treatment is strongly recommended for those who would like to have children and for those with any progression risk of varicocele that may end up with testicular volume loss. Persistant testicular and inguinal pain may be associated with varicocele operation.
An incision of 3-4 cm is performed on the groin region and testicular vessels are explored. Dilated veins are ligated and dissected. During the operation, testicular artery, tubule containing sperms (vas deferens) and testicular lymphatics must be spared. Microscopic approach has higher success and lower complication rates. Lymphatic ligation may lead to lymphatic fluid accumulation around testicles, called ‘’hydrocele’’.
Patients can return to their normal daily lives on postoperative day 1. Normal sexual intercourse is possible approximately 2 weeks later, while it is possible to engage in exercise 4 weeks later. In postoperative month 3, a control spermiogram is recommended. For individuals with improvements in postoperative month 6, greater improvements are expected on spermiogram parameters in post-op months 9 and 12. As a result, additional treatment modalities should be considered for those with inadequate improvements on post-op month 6 spermiogram.