Varicocele: Complications, Diagnosis, Risk Factors and Treatment

Varicocele is the swelling of the veins within the scrotum. This type of vein is known as pampiniform plexus. It occurs only in the scrotum and very similar to the varicose veins that occur in the leg. It often results in decreased sperm count and quality, which can ultimately result in infertility. In some cases, if the condition gets worse, it can also shrink the testicles.

Varicoceles can be found in around 15% of the adult male population and 20% of adolescent males. It is prevalent in males aged 15 to 25. This condition develops during puberty and can be found on the left side of the scrotum. The anatomy of both sides of your scrotum is different. Even though varicoceles may occur on both sides, it's sporadic. Moreover, not all varicoceles affect sperm count and quality.

Varicoceles Symptoms :

Varicoceles rarely cause pain and discomfort. However, when they do, the pain will likely:

1. To be worse when standing or during physical activities
2. Worsen over days
3. Differ from sharp to dull pain
4. Decrease when you are sleeping or resting on your back

Varicoceles will often go unseen, but your doctor may identify them during a medical examination. In any case, a person should immediately take medical advice if they notice:

1. Swelling in the scrotum
2. Any change in the size, shape, or appearance of the testes
3. Veins that appear abnormal, such as large or twisted
4. A lump
5. Fertility problems

Complications :

In few people, a varicocele may result in complications.

1. Fertility Problems

Infertility is one of the most serious complications of varicocele. It is more likely to occur when the increased amount of blood in the region raises the temperature of the testicles. Approximately 35 to 44% of men with primary infertility are diagnosed with this condition. Primary fertility is when a couple has not successfully conceived after 12 months of trying.

Around 45 to 81% of men with secondary infertility have varicocele. This is when a couple has been able to successfully conceive at least once but are not able to. According to a 2016 research study, from 7,035 healthy young men who participated in the survey between 1996 and 2010, nearly 15.7% had varicoceles. Those who were diagnosed with varicocele had poor quality of semen.

2. Testicle Shrinkage

A varicocele can result in testicular atrophy or shrinkage. Tubules responsible for producing sperms make up the bulk of the testicle. In case they get damaged, the testicle might shrink and become softer.

3. Hormonal Imbalances

As the cells react to changes in pressure, it may result in hormonal imbalances. There may be increased levels of luteinizing hormone (LH). This hormone is present in both men and women but is found in higher levels in women. Moreover, there may be higher levels of testosterone.

Varicoceles Diagnosis :

There are three grades of varicocele, including:

1. Grade I: This is the smallest type of varicocele and is not always visible. However, your physician can feel it during a physical examination using a Valsalva Maneuver.
2. Grade II: Although it is not visible, it can be felt without using a Valsalva Maneuver.
3. Grade III: In this type, the varicocele is visible.

If the varicocele is large enough, it may feel like a soft “bag of worms.”

On the other hand, a subclinical varicocele is a condition that can be diagnosed through imaging tests, including scrotal thermography test and Doppler reflux test. An ultrasound test will also help narrow down the other possible causes of varicocele, including a tumor on or close to the spermatic vein.

Other tests include semen analysis and other hormone tests to diagnose low testosterone levels and high follicle-stimulating hormone (FSH). These tests will be carried out if the physician suspects a testicular dysfunction.

Causes of Varicocele :

One major cause of varicoceles could possibly be when the valves in the spermatic cords — which carry blood to and from the testicles — stops working correctly. The reason for this is not entirely known, but it is similar to what happens when varicose veins happen in the leg.

One-way valves in the veins should always function properly in order for the blood to reach the heart. Abnormal values can disrupt the blood flow. The buildup of blood results in the vessels to dilate. Just like any other organ, faulty values can eventually stop it from working correctly.

Varicoceles can be categorized as:

1. Shunt Type: Severe buildup of blood results in damage to the spermatic vein and other veins, thereby causing a larger, grade II or III varicocele.
2. Pressure Type: Buildup of blood in the spermatic vein results in grade I varicocele.

The left testicle is more likely to get affected due to the buildup of blood. Nevertheless, even if one side is affected by varicocele, this can impact sperm production on both sides.

Risk Factors For Varicocele :

There are no particular risk factors for this condition. However, the risk factors for varicocele start appearing during puberty. Being overweight is likely to lower the risk of developing this condition, while being taller may increase it.

Previously, it was thought that once a man has fathered a child, it was impossible for him to become infertile. However, in 1993, researchers stated that this is not unlikely to occur. Rather, they mentioned that the risk of infertility is more likely to increase over time.

If this condition develops in a man more than 40 years of age, it is more likely to be because of a blockage in a larger vein in the abdominal region. This could likely be a symptom of a kidney tumor.

Treatments For Varicocele :

A varicocele does not usually require treatment unless there is:

1. A low sperm count
2. Pain and discomfort
3. Infertility issues that have been persistent for more than 2 years and are otherwise unexplained

In such cases, your doctor may ask you to undergo surgery.

Varicocele Surgery :

Some of the surgical procedures undertaken to treat a varicocele include:

1. Varicocelectomy:  Your surgeon will perform an open surgery under local or general anesthesia. He will access the region through the groin or through the stomach or upper thigh. Through an ultrasound or surgical microscopes, they will close the affected veins. Moreover, they can also reroute the blood through other healthier vessels. Pain following the surgery is normal, and the patient can get back to normal activities.

2. Laparoscopic Surgery: The surgeon will make a small incision in the stomach and pass a tiny surgical instrument through the opening.

3. Percutaneous Embolization: The surgeon will insert a tube or catheter into the body through the neck or groin. Then, he will pass an instrument through the tube and use coils or chemicals to block the vein by scarring it. Patients are expected to recover very soon following this procedure. This type of surgery is also known as a minimally invasive intervention.

Risk of Surgery :

Surgeries are usually safe; however, there are certain risks. These include:

1. Infection
2. Artery damage
3. Abdominal pain
4. Testicular atrophy
5. Bruising, swelling, or a buildup of fluids in the area

In rare cases, a renal vein thrombosis may occur that can affect the kidney and may require further surgery. At times, the veins through which the blood passes following a surgical procedure are likely to enlarge. This would require additional treatment procedures.

Grocare’s Ayurvedic Treatment For Curing Varicocele :

Ayurvedic treatment for varicocele made with the richness of natural herbs, Oronerv®, Activiz®, and Acidim® are natural Ayurvedic medicines that work in harmony to regulate the blood flow and strengthen valves within the veins, thereby reducing inflammation in the veins of the scrotum.

Herbs such as Commiphora Mukul and Pluchea Lanceolata are mixed to make Oronerv®, which strengthens the valves and inner linings of the veins, thereby improving the blood flow. The product also repairs and synchronizes the neurovascular system with the body. The ingredients used to formulate this product possess anti-inflammatory properties, which can help reduce excess pressure in the valves and ultimately reduce the symptoms of varicocele.

Activiz® is another useful product in the Varicocele Kit that is marketed in the form of tablets (850g). The product acts as a catalyst to the healing process by improving and synergizing the internal systems. At the same time, it helps maintain a healthy sperm count. 

Acidim® is another essential Ayurvedic medicine in the kit that reduces the production of free radicals in the body as well as detoxifies the body, which helps in relieving the pressure in the valves and enables it to function correctly. Embellia Ribesis is an important constituent of this medicine that helps with increasing the blood flow throughout the body.

Together, Oronerv®, Activiz®, and Acidim® help in treating varicocele naturally over time.

Proper Dosage :

Two tablets of Oronerv® should be taken twice a day (post breakfast and dinner), two tablets of Acidim® should be taken a day thrice (post breakfast, lunch & dinner), and two tablets of Activiz® should be taken twice daily (post breakfast and dinner), respectively. The tablets should be taken for 4-6 months or as prescribed by the doctor. If taken within the prescribed dosage, Oronerv®, Activiz®, and Acidim® do not cause any known side-effects.

In case of the occurrence of symptoms such as constipation, irregular bowel movement, or acidity, Grocare India recommends patients to take a Xembran® tablet after breakfast and two tablets post-dinner. Individuals can see the benefits within a few weeks of the kit's usage, in the form of symptomatic relief. Results may vary depending on the severity of the condition, age, diet, and lifestyle. Patients are provided with a diet chart along with the Varicocele kit.