Varicocele
Introduction
Varicocele is an abnormal dilatation of the veins located in the scrotum, above the testicles. It is often compared to varicose veins in the legs, and can cause pain, discomfort or even fertility problems.
⚠️ Untreated varicocele can affect sperm quality and reduce the chances of conception.
💡 Good news: solutions do exist! Appropriate treatment can relieve symptoms and improve male fertility.
What is a varicocele?
Varicocele is caused by malfunctioning valves in the spermatic veins, leading to reflux of blood and stagnation of warm blood in the testicles.
📌 A few figures:
✅ 15% of men are affected by varicocele.
✅ 40% of infertile men have a varicocele.
✅ It often appears in adolescence and progresses gradually.
✅ It is more common on the left (80-90% of cases).
What are the symptoms of a varicocele?
In 80% of cases, varicocele is asymptomatic and discovered by chance during a medical examination or infertility test.
- Sensation of heaviness or discomfort in the scrotum
- Testicular pain (aggravated by standing or physical exertion)
- Testis smaller on affected side
- Fertility problems (altered sperm count: reduced sperm count and quality)
- Visible or palpable veins in the scrotum ("bag of worms")
📌 Symptoms often worsen at the end of the day or after standing for long periods.
What causes varicocele?
Varicocele is mainly due to poor venous circulation in the testicles. Factors favoring its appearance :
- Congenital venous valve defects (favoring blood reflux).
- Compression of the spermatic veins (anatomy of the left kidney favoring accumulation of blood).
- Excessive abdominal pressure (intense physical effort, chronic constipation, etc.).
📌 Varicocele often appears at puberty, but can develop silently over several years.
Impact on fertility and men's health
Untreated varicocele can cause :
- Sperm alteration (fewer, less mobile spermatozoa).
- Increased testicular temperature (impairment of spermatogenesis).
- Decreased testosterone levels (fatigue, reduced libido, erectile dysfunction).
- Testicular hypotrophy (reduced testicular volume).
- Annoying chronic pain.
💡 Treatment restores better sperm production and improves fertility.
What solutions exist?
1️⃣ Monitoring and drug treatment (mild cases)
- NSAIDs (anti-inflammatories): relieve pain.
- Wearing support briefs: reduces the feeling of heaviness.
- Avoid prolonged standing and excessive exertion.
📌 Indicated if varicocele is asymptomatic and does not affect fertility.
2️⃣ Varicocele Embolization (Mini-Invasive Treatment)
- Technique performed under local anaesthetic on an outpatient basis.
- A catheter is inserted into a vein to block the dilated spermatic vein and redirect blood to other healthy veins.
- No incision, rapid recovery (1-2 days).
📌 Recommended in cases of persistent pain or impaired fertility.
3️⃣ Varicocele surgery (Varicocelectomy)
- Performed under general or local anaesthetic.
- Ligation of abnormal veins to stop blood reflux.
- Two main techniques:
- Microsurgery (reference technique): small incision, rapid recovery.
- Laparoscopic surgery: used in certain more complex cases.
- High success rate (90%) and improved fertility in 40-60% of cases.
📌 Recommended if varicocele causes infertility or significant pain.
Why consult a specialist?
A urologist can :
- Confirm the diagnosis with a clinical examination and testicular Doppler ultrasound.
- Evaluate the impact on fertility with a spermogram.
- Determine whether treatment is necessary based on symptoms and desire for children.
📌 An early check-up can help avoid aggravation and preserve fertility.
Do you suffer from testicular pain or unexplained infertility?
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