What are varicoceles?
Varicoceles occur when the veins that drain blood from the testicles become dilated. This can affect the functions of the testicles, seriously affecting male fertility, as it decreases the ability to produce sperm, can damage the testicular tissue and affect the size of the testicles.
What are the symptoms of a varicocele? How are they diagnosed?
Most varicoceles do not present symptoms. The most common way to diagnose them is by physical examination of the scrotum, with inspection of the tissues and the scrotal wall. New technologies also allow for examination of the area by:
- Doppler ultrasound
- Venography - occasionally used to examine veins in the scrotum and conduit area.
- Thermography - used to determine the intrascrotal temperature. This is rarely used.
How are they treated?
The treatment is called microsurgical subinguinal varicocelectomy. This technique consists of locating the dilated testicular veins to tie them off and cut them to preserve the arteries, the lymphatic vessels and the vas deferens that carry sperm.
What is the expected outcome?
Results indicate that improvement is obtained in 60-70% of men, with the rate of pregnancies achieved in the range of 20-65%; an average of 35%. Using this technique is also very important because it halts deterioration in testicular function by preventing future damage to testicular hormonal function.
What are the possible complications?
- Hydrocele. With an incidence of 4-33%, this is the accumulation of serous fluid in a cavity which, in this case, occurs at the spermatic cord, leading to the risk of inguinal hernia. To avoid this complication, it is important to use magnification lenses to ensure preservation of the lymph vessels.
- Damage to or ligation of the testicular artery. The testicular artery usually measures between 0.5 and 0.8 mm. In 40% of cases, the artery is attached to the dilated spermatic vein and in 20%, it is surrounded by a fine network of veins and mainly spasmodically contracted, thereby hampering dissection and preservation, leading to the risk of testicular atrophy. The risk can be reduced with the use of magnification lenses or a microscope.
- Failure or persistent varicocele despite surgery.