Varicocele: Diagnosis and Treatment
Diagnosis of varicocele
A physician usually diagnoses varicocele after a physical examination during which you will be examined standing up and lying down. Varicocele may be easier to feel or see when you are standing up, since the veins are more likely to fill and expand when you are standing. “Bearing down” can also increase the size of a varicocele, so your doctor may ask you to perform this maneuver. If you have a lump on your testicles, a scrotal ultrasound will be used to measure the size of the spermatic veins. This will allow accurate classification of the varicocele into a clinical category. Ultrasound allows measurement of the diameter of the spermatic cord and the veins that serve the testicles. The most accurate type of scrotal ultrasound study is a color Doppler study, which is indicated if the diagnosis is uncertain after physical examination. The color in this ultrasound image demonstrates the direction of the blood flow, which may include reverse flow in the varicocele. Grade 1 varicocele is the smallest and Grade III is the largest varicocele. This may correspond to the size of your testicular lump. Other methods are rarely necessary to determine the diagnosis, but they include venography and CT scans, which are useful to identify any tumors that are obstructing the testicular veins. Blood tests may be useful to determine if there has been an injury to the testicle. These tests include measurement of levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH.) However, these test are rarely of interest unless fertility is a concern.
Treatment of a varicocele is not always necessary. Small varicoceles may not cause any problems, but as they grow larger, they may result in problems with testicular function, including sperm production. Earlier treatment in these cases is recommended, to prevent permanent damage. Some patients may only need a small amount of additional support from tight underwear or a jock strap, to alleviate any pain or discomfort. However, if symptoms progress, surgical intervention may become necessary.
There are two primary procedures for treatment of a varicocele. A varicocelectomy is a procedure done in a hospital or surgical center. The urologic surgeon will make an abdominal incision to expose abnormal veins and place clamps that will result in redirecting flow to healthy veins. General anesthesia is usually required for this procedure, which carries similar risks to other surgical procedures, including bleeding and infection. Another procedure used to treat varicocele is embolization, which is less invasive. The surgeon inserts a small catheter through a vein in the groin or in the neck, which allows placement of a coil into the varicocele, preventing blood from passing into abnormal veins.
Treatment of varicocele has been demonstrated to improve sperm concentration, motility, and morphology, which refers to the characteristics of the sperm. However, it can result in unintended adverse effects, which include infection and bleeding; the testicles may atrophy, which means they will become small and function will diminish. Over the counter pain medications can be helpful for relief of minor symptoms, but if you are experiencing significant discomfort or swelling, call an experienced urologist to discuss your treatment options.