Home Diseases Varicocele (varicose veins on the testicles): origin, risks

Varicocele (varicose veins on the testicles): origin, risks

by Josephine Andrews
Published: Last Updated on 391 views

varicocele (varicocele testis) is a varicose vein formation in the scrotum. The venous network at this point is tactilely or visibly dilated. Pain and a feeling of heaviness on the affected side of the testicle can occur, but do not have to. The varicocele can usually be treated with a small operation. Find out here about the causes, symptoms, diagnosis and treatment of varicocele!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

I86

Varicocele: description

The varicocele is a varicose vein-like enlargement of the venous network (plexus pampiniformis) of the testicles. In almost 90 percent of cases, the enlargement is on the left side of the testicle. The main causes of a varicose vein rupture are a weakness in the venous valves, which are supposed to prevent blood from flowing back, or an obstruction to the outflow. In addition to this so-called primary form of varicocele, there is also a secondary (or symptomatic) form that is an expression of another disease, such as a tumor.

The testicular vein (Vena spermatica or V. testicularis) drains the blood from the testicles into the inferior vena cava with its left and right branches – either directly (right testicular vein) or indirectly via the left renal vein (left testicular vein). If this drainage is disturbed at any point, the blood accumulates in the testicles. This dilates the blood vessels and creates a varicose vein.

Testicular varicose veins can lead to infertility if left untreated. A third of all infertility cases are caused by a varicocele.

Varicocele: frequency

Overall, 30 percent of men have a varicocele. Men aged 14 to 25 are particularly affected. In childhood, varicocele is rather rare. In older patients with a varicocele, a precise diagnosis is necessary, since these are usually so-called secondary or symptomatic varicoceles. In this case, a tumor must be ruled out as the cause of the varicose vein rupture.

Varicocele: Symptoms

The varicocele is often asymptomatic and an incidental finding on examination.

Some of those affected also show the typical varicocele symptoms: a (felt) heavy, tense and full scrotum. The varicocele pain is particularly intense when standing. Worm-like swellings appear on the scrotum, which are visible either with or without increased abdominal pressure when straining. The testicle on the affected side may be smaller due to stunted growth, especially in children. This is an indication of impaired sperm production. In extreme cases, no sperm are produced at all (complete infertility).

Varicocele: causes and risk factors

Doctors distinguish between a primary and a secondary varicocele.

Primary (idiopathic) varicocele

The primary (idiopathic) varicocele is hereditary. It accounts for the vast majority of all cases of varicose vein rupture and occurs primarily on the left side. The reason: The left testicle vein flows at right angles into the left renal vein (which then leads on to the inferior vena cava), which impedes blood flow and promotes backflow. The right testicular vein, on the other hand, flows directly into the inferior vena cava at a more acute angle (the acute angle is more favorable for blood flow).

A common cause of blood backlog is a defect in the venous valves in the testicular vein or a congenital weakness of the vascular wall. A venous outflow disorder as a result of increased vascular pressure can also lead to a primary varicocele. The increase in pressure can be caused by the left renal vein being pinched between two large arteries (nutcracker phenomenon). The resulting backlog of blood can affect the veins in the testicles.

Secondary (symptomatic) varicocele

The secondary or symptomatic varicocele can be bilateral. It is usually caused by a tumor-related drain blockage. This is, for example, a tumor of the kidney , the renal pelvis or the ureter. A blood clot (thrombus) or tear (rupture) in the testicular veins is also a possible cause of a secondary varicocele.

infertility

In the primary as well as in the secondary form, there is a reduced return flow of blood from the testicles. The blood in the testicles flows more slowly. This causes the testicles to heat up, affecting sperm production and quality. Infertility can develop.

In addition, the axis of the testicular-associated hormones (such as FSH – follicle-stimulating hormone) can be disturbed. On the other hand, hormones from the adrenal glands can get into the testicles due to the backlog of blood or even blood reflux and cause damage there.

Varicocele: investigations and diagnosis

The urologist is a specialist in diseases of the testicles and thus also in varicoceles. In a conversation with the patient (anamnesis), he first records the symptoms. Possible questions are for example:

  • Does your testicle feel heavy or swollen?
  • Are the symptoms worse when standing?
  • Do you have pain?

Physical examination

Then the doctor will first examine the testicle while standing. Due to gravity, the varicocele is usually clearly visible. If this is not the case, the patient is asked to increase the pressure in the abdomen by pressing or tensing the abdominal muscles. This often makes the swelling of the vessels easier to see.

In the next step, the patient lies down. In the case of a primary varicocele, lying down will spontaneously reduce the vascular markings on the testicles, which means that the vessels will empty due to gravity. If this is not the case, the suspicion arises that it is a secondary varicocele.

ultrasound examination

Another important diagnostic step for a varicocele is an ultrasound examination (sonography) of the testicles. The doctor can assess the varicocele more precisely. In addition, the kidneys and the abdominal cavity should be examined with ultrasound – in search of possible explanations for the drainage disorder. In order to confirm blood congestion or even reflux, an examination using Doppler sonography, a special form of ultrasound examination, should be carried out.

Hormones and sperm tests

If you wish to have children or if you suspect infertility, further examinations should be carried out. It is therefore advisable to determine hormones and to examine the state of the sperm more precisely ( spermiogram ) is therefore recommended for patients with testicular varicose veins. Testicles play an essential role in fertility.

Vascular X-ray (phlebography)

If there is a suspicion of a vascular malformation, a so-called phlebography is carried out: With the help of X-ray contrast medium, an X-ray image of the vessels is made in order to examine their course and condition.

Varicocele: classification of severity

A varicose vein on the testicle can be divided into three degrees of severity:

  • Grade I: palpable enlargement of the venous network in the testicles when pressing while standing; Vessel size < 1 centimeter.
  • Grade II: vasodilation palpable even without additional pressure; Vessel size 1 to 2 centimeters.
  • Grade III: tactile and visible clusters of vessels; Vessel size > 2 centimeters.

Varicocele: treatment

Treating a varicose vein in the testicle is important for several reasons. On the one hand, the symptoms can be very uncomfortable, on the other hand, there is an increased risk of infertility.

There is no medication for a varicocele. Instead, the therapy of choice is usually a minor surgical intervention. It should be performed when:

  • there is repeated pain
  • the testicular volume has decreased
  • It is a grade III varicocele
  • the varicocele is perceived as a disability

There are a number of different procedures to treat primary varicocele. The therapy of the secondary varicocele depends on the underlying disease, for example the tumor.

Varicocele Sclerotherapy

The dilated vessels in the testicles can be sclerosed. This means that a substance is injected into the vessels, which “destroys” them. The blood can drain well through other blood vessels.

The sclerosing agent can be introduced via a catheter. In the so-called retrograde transcatheter sclerosis, you push under local anesthesiavia a groin vein and renal vein to the venous network in the testicles. Then the sclerosing agent is injected through the catheter. In around 30 percent of cases, however, this form of varicocele therapy is unsuccessful.

You can also make a small incision at the level of the base of the penis and insert the catheter directly into the vein network. Again, a sclerosing agent is injected here. This is then called antegrade or anterograde sclerotherapy .

Vessel occlusion by embolization

Another treatment option for a varicocele is to artificially close the affected vessel. To do this, you can either insert a tissue adhesive into the vessel or use a tiny spiral .

Operational Procedures

The last treatment option for a varicocele is surgical procedures. The affected vessel is tied off and severed. This can be done, for example, as part of a larger, open varicocele operation or by means of buttonhole surgery (laparoscopy): In this case, only several small incisions are made through which the surgical instruments are inserted.

Varicocele: disease course and prognosis

An early and therefore timely start of therapy is very important in the case of a varicocele. The prognosis after successful treatment is usually good. Although increased vigilance is required, the risk of infertility is mostly averted.

An untreated varicocele leads to severe damage to sperm production, reduced testicular volume and reduced testicular cell function (Leydig cell function). However, symptomless varicoceles that do not affect sperm quality do not have to be associated with these complications.

If sperm damage is already severe (azoospermia, oligo-astheno-teratozoospermia), surgical therapy is not promising. In these cases, alternative fertilization techniques should be discussed.

Good treatment of the varicocele leads to freedom from pain and an increase in the volume of the testicles in over 80 percent of patients. It is assumed that the sperm quality also increases again.

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