Relationship Between Varicoceles and Male Infertility

Varicoceles are abnormally dilated veins in scrotum.

Varicocele can be primary that is because of incompatibility or improper function of valve in vein that prevents backflow of blood flow. Secondary that is usually due to compression of vein that can be because of any pelvic tumor. Non malignant cause of secondary varicocele is when superior mesenteric artery compresses left renal vein consequently there is increase in retrograde pressure in left testicular vein causing dilatation.

Signs and symptoms are following:
 Aching pain in scrotum
 Heaviness in testis
 Infertility (low sperm count)
 Atrophy or shrinkage of testis
 Visible or feeling of dilated vein
Diagnosis: Diagnosis is usually made on the base of clinical features and positive valsalva maneuver that is on standing there’s increase in dilatation of vein. However, ultrasound Doppler is done for measuring pressure and blood flow through vein.

Treatment: In varicocele infertility is usually due to atrophy of testis that leads to low sperm count and improper motility of sperm. Surgery is mainstay of treatment that is varicocelectomy, removal of varicocele. Other modality is retrograde venous embolization that is non-invasive treatment. In this modality through a catheter vein is obstructed and increased abdominal pressure is not transmitted to testis. However, testicular blood supply is maintained by collateral artery and vein. That leads to normalization of temperature of testis and improves production of sperm.

However, the main modality of treatment is always surgical. But for patients who are not ready or not fit to undergo surgery or when there’s recurrence of varicose even after surgery then treatment modality of choice is retrograde venous embolization.

Usually, after treatment there’s good outlook and resolving of disease and its symptoms.

Patients having varicocele are advised to apply scrotal support (e.g. jockstrap, briefs) and to avoid any kind of strenuous activity that may increase pressure in abdomen.

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