Varicocele
What is a varicocele?Dr. Kuang recently co-authored an online summary of Varicoceles to help other doctors.
Click here to see this published article on the Internet.
A varicocele is the most commonly identifiable lesion seen in men with male infertility that can be surgically corrected. A varicocele is when the veins that drain your testicle become enlarged and engorged. It is very similar to the varicose veins that some people have on the back of their legs. A varicocele is a very common finding. While it is present in 15% of all men in the community at large, it is found in 40% of men who present with infertility.
Why do varicoceles occur?
In your legs, the veins have valves that prevent blood from pooling due to gravity along the veins that run superficially under your skin. When the valves are not working properly, blood will gather in these superficial leg veins making them large and prominent which are called varicose veins. For cosmetic reasons, some people have these veins surgically “stripped” to remedy the situation.
Similarly in your scrotum, if the veins that drain your testicle are defective, then blood will pool in these veins making them large and readily visible through the skin in some cases. These varicoceles can prevent a man’s testicles from functioning at full capacity.
Varicoceles happen mostly just on the left side. Why? Also can they occur on both sides?
Most varicoceles occur on the left since the left vein is longer and travels along a different course within the body as compared to the right vein. These anatomical differences cause the left side to be more prone to varicoceles.When there is only one varicocele, it is on the left side 85% of the time. A varicocele on both sides of the scrotum is found in only about 20% of the men. While the exact mechanism is unclear, it has been found that a varicocele on one side can actually affect sperm production on the other side that does not have a varicocele.
How do you diagnose a varicocele?
Most varicoceles can be diagnosed with a gentle and careful examination of the scrotum. Some varicoceles can actually be seen by the naked eye through the skin of the scrotum creating a tubular appearance that resembles a “bag of worms.” Others will actually be more “sponge-like” where there is a fullness or plumpness to the skin above the testicle. These findings often disappear or are greatly reduced when a standing man is asked to lie down.
In certain cases, a scrotal ultrasound has been found to help confirm the presence of a varicocele. The ultrasound does not harm your testicles and can be performed in the comfort of an office setting. The ultrasound allows us to actually look at the flow of blood and see to what degree the veins from the testicle become dilated and engorged.
Ultrasound will show an abundance of veins above the testicle...
that fill with blood and "light up like fireworks" when you stand up or increase your abdominal pressure by bearing down.
Why do varicoceles hurt a man’s fertility potential?
A varicocele is the single most common identifiable cause of male factor infertility. Its adverse effect on sperm function and a man’s reproductive capacity is well documented in the medical literature. The predominant explanation for infertility is that the engorged veins allow for warm blood to pool near the testicle. Since sperm production within the testicle is felt to be temperature-sensitive, the pooled blood increases the scrotal temperature which makes the testicle a “sweat shop” for sperm production. Under such harsh conditions, sperm numbers can go down, the sperm motility (“how well they move”) can be hindered and the sperm morphology (“how they look”) can also be impaired.
Your testicle works very hard as a factory for sperm production. It is said that more than a thousand sperm are made with every beat of a man’s heart. It is such a challenging task that the factory must operate at a specific temperature range which is cooler than the rest of your body.
The large and dilated veins of a varicocele are filled with warm blood that increases the temperature at which the factory must function. In essence, the varicocele converts the factory into a “sweatshop.” Under these hostile conditions, the testicular factory functions suboptimally, and this can lead to a significant decrease in quality and quantity of sperm produced. The exact mechanism by which this occurs remains unknown. In some men, if the testicles are subjected to these grueling conditions for too long, then the factory can begin to shut down, and the testicles can actually start to shrink.
Alternative theories that include the harmful exposure to adrenal toxins, reactive oxygen species and altered testosterone levels have been postulated. Much work remains to be done to further substantiate these other theories.
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