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Varicoceles are a relatively common condition that affect approximately 10 percent of men. Most of the time, these varicoceles cause no symptoms and are harmless. But sometimes a varicocele can cause pain, infertility or atrophy (shrinkage) of the testicle.
Normally, blood flows to the testicles through an artery, and flows out via a network of tiny veins that drain into a long vein that goes up through the abdomen. The direction of blood flow in this vein should always be up, toward the heart. A series of one-way valves in the vein prevent the reverse flow of blood back to the testicles. These one-way valves sometimes fail. The reverse flow of blood stretches and enlarges the tiny veins around the testicle to cause a varicocele, a tangled network of blood vessels, or varicose veins
Because of the impaired circulation of blood created by a varicocele, the blood does not cool as it does in a normal vein. The increased temperature of the blood raises the temperature of the testes, which is believed to contribute to infertility, as heat can damage or destroy sperm. The raised temperature may also impede production of new, healthy sperm. A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left testicle. Varicocele is the most common cause of infertility.
Most men who have a varicocele have no symptoms and asymptomatic (symptom-free) varicocele are often diagnosed during a routine physical examination. Signs and symptoms may include the following:
Varicoceles may be detected during physical examination by palpating (feeling) the area. A male suspected of having a varicocele should be examined while standing up, as a varicocele is more prominent in this position than in the supine (lying down, face up) position.
Doppler ultrasonography may be used to detect the characteristic sound of the backflow of blood through the valve.
If the patient is being examined for suspected infertility, the urologist usually an analysis of the patient’s semen. Infertility caused by a varicocele typically produces a pattern of incompletely developed, damaged, dead, or dying sperm. In addition sperm motility is also diminished.
Surgery: If the varicocele causes pain or atrophy or if is causing infertility, surgery may be recommended. Most varicoceles can be corrected through a surgical procedure called varicocelectomy (surgically “tying off” the affected spermatic veins).
About 50% of men who undergo varicocelectomy to correct infertility father children within the first year. It takes about 90 days for a sufficient quantity of new sperm to be produced to permit fertilization. Semen analysis usually is done at 3- and 6-month intervals after the operation.