Varicoscele
Varicosele is a varicose condition of veins of the spermatic cord or the ovaries, forming a soft tumor.
Related: Varicosele
Overview
Varicocele is a mass of enlarged veins that develops in the spermatic cord, which leads from the testicles (testes ) up through a passageway in the lower abdominal wall (systeminguinal canal) to the circulatory system. The spermatic cord is made up of blood vessels, lymphatic vessels, nerves, and the duct that carries sperm from the body (vas deferens). If the valves that regulate bloodflow from these veins become defective, blood does not circulate out of the testicles efficiently, which causes swelling in the veins above and behind the testicles.
A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left testicle. The left spermatic vein drains into the renal vein between the superior mesenteric artery and the aorta; these two arteries can compress the renal vein and thus impede bloodflow from the spermatic vein. The right spermatic vein drains into the vein that returns blood to the heart (vena cava) and develops varicocele less often. A one-sided (unilateral) varicocele can affect either testicle.
Because of the impaired circulation of blood created by a varicocele, the blood does not cool as it does normally. The increased temperature of the blood raises the temperature of the testes, which is believed to contribute to infertility, as heat can damage or destroy sperm. The increased temperature may also impede production of new, healthy sperm.
Incidence and Prevalence
Incidence of varicocele is 10-20% and is highest in men between the ages of 15 and 25. The sudden appearance of varicocele in an older man may indicate a renal tumor blocking the spermatic vein.
Approximately 40% of infertile men have a varicocele and among men with secondary infertility—those who have fathered a child but are no longer able to do so—prevalence may be as high as 80%.
Causes
A varicocele develops when the valve that regulates bloodflow from the vein into the main circulatory system becomes damaged or defective. Inefficient blood flow causes enlargement (dilation) of the vein.
Signs and Symptoms
Most men who have a varicocele have no symptoms. Asymptomatic (i.e., symptom-free) cases are often diagnosed during a routine physical examination. Signs and symptoms may include the following:
Testicular pain Feeling of heaviness in the testicle(s) Infertility Shrinkage (atrophy) of the testicle(s) Visible or palpable (able to be felt) enlarged vein
Recurrent or constant discomfort or pain in the genital region should be reported to a urologist or primary care physician to determine the cause.
Diagnosis
Large varicoceles may be seen with the naked eye. Medium-sized varicoceles may be detected during physical examination by feeling (palpating) the area. A patient suspected of having a varicocele should be examined while standing up, as a varicocele is more prominent in this position than in the supine (i.e., lying down, face up) position. Small varicoceles may be discovered by a physician using one of the following procedures.
Treatment
If the patient is asymptomatic or the symptoms are mild and infertility is not an issue, the condition can be managed by wearing an athletic supporter or snug-fitting underwear to provide the scrotum with support.
Surgery
If the varicocele causes pain or atrophy, if it damages the testicle(s), or if the condition is causing infertility, surgery may be recommended. Most varicoceles can be corrected through a surgical procedure called varicocelectomy (i.e., surgically "tying off" the affected spermatic veins). The following methods are used.
Surgical ligation usually requires general or reginal anesthesia. In this procedure, a 2- to 3-inch incision is made in the groin or lower abdomen, the affected veins are located visually, and the surgeon cuts the veins and ties them off above the varicocele to reroute the blood through unaffected veins. A incision in the groin (transinguinal) is commonly used and a lower abdomen (retroperitoneal) incision is used in patients with scar tissue from a prior varicocelectomy or hernia repair. Surgery can be performed on an in- or outpatient basis. The patient typically can resume light activity within a week and strenuous activity in about 6 weeks.
Embolization is a nonsurgical procedure that takes about an hour and a half. A small tube (catheter) is inserted into a small incision in the groin to block the flow of blood to the varicocele. Venography is used to highlight the varicocele on x-ray and to visually guide the catheter. The catheter is then used to push tiny coils into place to block the blood flow to the dilated vein. This eases the pressure, reduces enlargement, and restores normal circulation. Light sedation, sometimes called "twilight anesthesia," is used during the procedure; the patient does not lose consciousness. Stitches are not needed. Normal activity is usually resumed within 2 days.
Laparoscopy is a technique in which the surgeon inserts a tiny camera attached to a long cylindrical tube into the abdominal cavity through a small incision. Using the camera to locate the varicocele, the surgeon then inserts other instruments through the same incision to isolate and tie off the dilated veins. This technique requires a smaller incision than surgical ligation and is sometimes regarded as less invasive. The laparoscope, however, can sometimes damage abdominal organs, which is not a risk factor in open surgery. The procedure takes about 2 hours and recovery about 2 days.
Prognosis
Between 5% and 20% of patients experience a recurrence. In such cases, the procedure usually is repeated. Another 2% to 5% develop a condition called hydrocele, a fluid-filled cyst that forms around the testicle. Minor surgery is used to correct this problem.
About 50% of men who undergo varicocelectomy to correct infertility father children within the first year. It takes about 90 days for a sufficient quantity of new sperm to be produced to permit fertilization. Semen analysis usually is done at 3- and 6-month intervals after the operation. (see Male Infertility).
* Doppler ultrasonography uses ultrasound echos to detect the characteristic sound of the backflow of blood through the valve.
* Thermography uses infrared sensing technology to detect pockets of heat caused by pooled blood.
* Venogramis an outpatient procedure performed under local anesthesia. The physician makes a small puncture in the groin and then injects a special dye into the spermatic vein. The dye in the bloodstream enables the physician to see the anatomy in the vein on x-ray and detect the presence of a very small varicocele.
If the patient is being examined for suspected infertility, the physician usually performs a comparative analysis of semen samples. Infertility caused by a varicocele typically produces a consistent pattern of incompletely developed, damaged, dead, or dying sperm.
Naturopathic Treatment
A low fiber, highly refined diet—one that relies heavily on white flour products, sugar, and processed foods rather than fresh vegetables, whole grains, and fruits—is thought to be a contributing factor to varicocele formation. A lack of dietary fiber may slow down the bowels and contribute to constipation by hardening and drying the stool. Constipation stresses the pelvic floor by putting pressure on the veins when the bowels move. This repeated pressure strains the vessel walls and may damage vessel tissue.
Another contributing factor to varicocele formation is the lack of flavinoid-rich foods. Flavonoids, which are found in abundance in fresh vegetables and fruits, have been shown to contribute to the structural integrity of blood vessels.
Diet Recommendations
* Include: Eat a "whole foods" diet that focuses on fresh vegetables and fruits (lots of
richly pigmented berries to strengthen vessel walls); whole grains; fish and poultry; flax
seed oil or other EFAs (essential fatty acids) found in fish oil, olive oil and nuts; and
drink plenty of fresh water. Choose organically raised foods when possible.
* Avoid: Processed foods, fast foods, junk foods, animal fats, hydrogenated oils and margarine,
sugar and white flour products, alcohol and caffeine.
* Extra fiber: Add 1 tablespoon psyllium seed husk fiber and/or 6 to 8 tablespoons flax seed
meal and/or a cup oat bran daily to diet. Remember to increase water intake to 2 to 3 liters
daily.
Supplemental Nutrition
* Bioflavonoids: 1000 mg daily * Vitamin C: 1000 mg 3 times a day with meals * Zinc: 30 mg daily * Vitamin E: 400 IU daily
Herbal Therapeutics
Herbal remedies usually do not have side effects associated with regular use at the suggested doses. Rarely, an herb at the prescribed dose causes stomach upset or headache. This may reflect the purity of the preparation or added ingredients such as synthetic binders or fillers. For this reason it is recommended that you use only high quality, standardized extract formulas.
If possible, consult with a natural health practitioner such as a holistic medical doctor or licensed naturopathic physician before starting any alternative treatment plan. As with all medications, more is not better and overdosing can lead to serious illness and, in rare cases, death.
The following herbs may tone, strengthen, and improve the function of veins:
* Horse Chestnut (Aesculus hippocastanum) – 50 mg escin standardized extract daily. * Butcher's Broom(Ruscus aculeatus) – 10% ruscogenin standardized extract, 100 mg 3 times a day. * Bilberry (Vaccinium myrtillus) – 25% anthocyanoside, 150 mg 3 times a day.
Physical Medicine
Kegel exercises to improve blood flow and muscle tone.