Diagnosis
Very often, to diagnose a varicocele it is sufficient to subject the individual to a questionnaire relating to symptoms and a thorough physical examination .
The doctor uses more specific tests, such as scrotal ultrasound and abdominal ultrasound, in cases of doubtful diagnosis or when he suspects the presence of a pelvic / abdominal tumor.
SURVEY
To the patient with suspected varicocele (and generally to anyone with a swollen testicle), doctors ask questions such as:
- Do you feel discomfort or pain? If so, where, for how long and what is the intensity of the sensation?
- Do you suffer from other disorders, such as pain during urination, general malaise and / or fever?
- Have you recently had a scrotum or groin injury?
Through this questionnaire the doctor can exclude, from the list of possible causes of swollen testicle, morbid conditions considered more serious than varicocele; among these conditions we remember: testicular torsion and inflammation of the testicle ( orchitis ) or of the epididymis ( epididymitis ).
EXAMINATION OBJECTIVE
During the physical examination, the doctor will:
- Analyze the size of the testicles.
- Evaluate the position of the testicular swelling.
- Touch the swollen testicle and the exact point where the bulge resides, to see if the patient feels pain or not.
- If the suspected varicocele is mild, have the patient perform the so-called Valsalva maneuver .
- Evaluate if the swollen area has a hard or soft consistency.
This last point (the evaluation of the consistency of the swollen testicle) is important to exclude the possibility that it is a testicular tumor .
SCROTAL ECOGRAPHY
Ultrasound is a sufficiently comprehensive and completely harmless imaging diagnostic test.
For its realization, an ultrasound probe is needed, which, resting on the patient's skin, projects the organs and internal tissues present in the considered area onto a monitor.
In case of suspected varicocele, the ultrasound of the scrotum (or scrotal) is very useful, because it allows us to clarify the precise cause of the swelling.
Abdominal ultrasound and varicocele
As previously discussed, a varicocele can be caused by an abdominal or pelvic tumor, especially in adults around the age of forty. Therefore, in some cases, the doctor may prescribe an abdominal ultrasound in order to clarify this possibility as well.
DIAGNOSIS OF VARICOCELE AND FERTILITY TEST? MALE
Sometimes, the dilation of the testicular veins is so slight that the varicocele goes unnoticed and the affected person remains unaware of the disorder he is suffering from.
Therefore, in situations like these, the diagnosis (when it occurs) is random and, often, subsequent to a male fertility test, carried out by the patient after having encountered difficulties in having children.
Treatment
Most patients with varicocele do not need any specific treatment and lead a normal life .
If, however, varicocele is accompanied by pain, testicular atrophy and / or reduced fertility, it may become essential to undergo specific surgery.
The purpose of surgery is to isolate or block the dilated testicular veins and force the venous blood to take an alternative path (NB: the testicular veins are more distinct canals and, in the case of varicocele, not all are affected by the disorder).
See also: Varicocele cure drugs
SURGERY
There are at least 3 possible surgical approaches for treating varicocele .
Each approach has specific advantages and disadvantages. The illustration to the patient of the pros and cons of each operation takes place, obviously, before the intervention and, to deal with it, it is generally the operating surgeon.
Coming to the 3 possible intervention methods, these consist of:
- Traditional or "open" surgical procedure .
Main features: performed under general or local anesthesia, the traditional surgical procedure involves a skin incision of several centimeters near the groin and the isolation of the dilated testicular veins.
The incision can be made in several alternative locations: at the inguinal level, at the abdominal level (or retroperitoneal level) or at the subinguinal level.
In order to correctly isolate only the dilated veins, the surgeon uses a surgical microscope or an ecodoppler.
Once the operation is concluded, the incision is closed with different stitches and the patient must wait a few hours before leaving.
Recovery time: after 2 days the patient can already return to the lighter daily life activities. It takes at least 2 weeks for the heaviest activities (such as sport).
Sexual activity: the patient must wait several weeks before resuming normal sexual activity. Moreover, for a concrete improvement of fertility to take place, it seems that a wait of about 3 months is necessary.
Post-intervention drug therapy: after surgery, the patient may experience pain at the operated area. In these cases, the doctor recommends taking some pain medication, such as paracetamol or ibuprofen.
- Laparoscopic surgical procedure .
Main features: the operation is performed in laparoscopy.
Recovery times: since the incisions are smaller, compared to those made for a traditional surgery, recovery times are shorter.
Sexual activity: the less invasive operation allows to resume normal sexual activity in faster times, compared to what happens for traditional surgery.
Post-intervention drug therapy: as in the case of the traditional procedure, if the patient feels some pain, he is asked to take painkillers such as paracetamol.
- Percutaneous embolization procedure .
Main features: performed under local anesthesia, percutaneous embolization consists of blocking the dilated testicular veins, using special embolizing substances or small metal spirals (NB: "embolizing" means "creating an embolus"; an embolus is any substance or body, unable to dissolve in the blood and which blocks blood flow in the vessels in which it is located).
The introduction of the clamping material takes place by means of a special catheter; this catheter is first introduced into a vein in the arm or groin and then led to the desired point under the guidance of an X-ray instrumentation.
Discharges usually occur once the effects of local anesthesia have ended.
Recovery time: the procedure does not include engravings, therefore recovery times are very rapid; in fact, the patient can return almost immediately to everyday life.
Unfortunately, surgery (regardless of the type of procedure adopted) is not always conclusive: in some cases, in fact, a recurrence could take place, or the formation of another varicocele (this time for the "new" venous vessels). testicular to which the blood circulation was returned to the heart).
In case of recurrence, a second surgical procedure must be used.
Risks and possible complications of varicocele surgery
- Relapse
- Accumulation of a transparent fluid around the testicle ( hydrocele )
- Testicular atrophy
- Infections of various kinds
- Damage to a testicular artery
OTHER THERAPEUTIC REMEDIES
In the case of varicoceles not particularly serious (therefore characterized by a slight discomfort and not associated with tumors in the abdominal / pelvic area), doctors could prescribe underwear designed specifically for subjects with varicocele, and painkillers such as, for example, paracetamol .
VARICOCEL IN THE YOUNG: SOME THERAPEUTIC ADVICES
Even in the absence of obvious symptoms, teenagers with varicocele doctors advise to periodically monitor the size and growth of the testicles, as the affected testicle could grow less quickly or not grow at all.
In case of no growth or slower than normal growth, it is advisable to contact your doctor immediately.
Prognosis
Most varicoceles have a positive prognosis.
However, it is good to never underestimate the situation and, as soon as symptoms or signs never appeared before, undergo a specialist medical examination ( visit urology ).
VARICOCELE INTERVENTION AND FERTILITY
It has not yet been fully established whether varicocele surgery restores a man's normal fertility or not.
In fact, the various scientific studies on the subject have provided conflicting results: some have shown that the production of sperm significantly improves; others showed no noteworthy improvement.
However, it is reiterated again that male varicocele infertility is a very rare complication.
