WHAT CAN CAUSE VARICOCELE?
Testicular veins have a system of valves inside that prevent blood reflux. When the individual has varicocele, this system does not work properly, causing retention of venous blood in the scrotum, with consequent dilatation of the testicular veins and thickening of the muscle wall in the region.
Other situations that can cause varicocele they are:
Genetic inheritance, especially first degree;
Congenital absence of spermatic valves;
Obstruction or compression of the venous system.
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The incidence of varicocele can vary according to age, being 7.2% for patients between 2 and 19 years old, 10% to 25% for men over 20 years old and 42.9% for elderly patients. It is important to note that childhood varicocele cases are rare and considered serious. The condition usually arises during puberty.
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THE varicocele it can be bilateral—that is, affecting both the left and right testicles—or unilateral. In the latter case, most varices in the scrotum occur on the left side due to the anatomy of the left gonadal vein.
WHAT ARE THE TYPES OF VARICOCELE?
The classification of varicocele it will depend on the degree of development of the condition, with three different levels. Are they:
Subclinical: detected by imaging exams;
Grade I: when the scrotal varices are small and palpable only after the Valsalva maneuver, in the office;
Grade II: when the condition is easily palpable without the maneuver;
Grade III: when it is possible to identify the presence of the varicocele visually and with palpation.
WHAT ARE THE SYMPTOMS OF VARICOCELE?
Although the condition does not present specific signs in the patient in most cases, the individual may notice some signs and symptoms that may indicate the presence of the problem. The main symptoms of varicocele they are:
Discomfort in the testicle region;
Increased scrotal volume;
Pain in the testicles, which can vary between mild and intense and is only present in the more advanced degrees of varicocele;
Feeling of heaviness in the scrotal region;
Presence of swelling in one or both testicles;
Asymmetry of one testicle in relation to the other.
HOW CAN VARICOCELE CAUSE INFERTILITY?
Infertility by varicocele it occurs due to excess heat in the testicle region caused by the condition. Because of this, there is an increase in the production of free radicals that cannot be properly fought by the antioxidant systems, leading to testicular and seminal oxidative stress.
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During this process, Sertoli cells—responsible for forming sperm—and Leydig cells—responsible for producing testosterone—are directly affected, resulting in a considerable reduction in sperm production and quality.
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It is essential to emphasize that being diagnosed with varicocele it does not mean that the patient will automatically be considered infertile. However, the chances of the individual having difficulty getting his partner pregnant will be relatively higher when compared to men who do not have the condition. On average, 40% of infertile men have been diagnosed with varicocele.
HOW IS THE DIAGNOSIS CARRIED OUT?
The main test performed to diagnose the varicocele it is the physical, performed in the andrologist's office at a non-cooled temperature to help relax the scrotal musculature – the patient must remain standing while being examined. To confirm the diagnosis, the andrologist may request some tests, the main ones:
Color eco-doppler;
Doppler stethoscope;
Sperm vein venography;
Seminal analysis (spermogram);
Sperm function tests.
WHAT ARE THE TREATMENTS FOR VARICOCELE?
With the diagnosis in hand, the andrologist establishes which medical protocol is the most suitable for each case. The main treatments for varicocele they are:
Microsurgical correction of varicocele: this surgical procedure is minimally invasive and allows not only the reestablishment of man's fertile potential but also preserves testicular health. It has less than 1% chance of recurrence and can improve sperm count in approximately 60% of cases;
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Annual follow-up with andrologist: when there is presence of varicocele, but there is no compromise in sperm production and quality.
HOW IS VARICOCELE CLASSIFIED?
The classification of varicocele it will depend on the degree of involvement of the disease. There are three different degrees:
Subclinical: detected by imaging exams;
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Grade I: when the scrotal varices are small and palpable only after the Valsalva maneuver, in the office;
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Grade II: when the condition is easily palpable without the maneuver;
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Grade III: when it is possible to identify the presence of the varicocele visually and with palpation.