Varicocele is the the abnormal dilatation the pampiniform venous plexus in the scrotum. It is caused by the venous valvular failure, venous valvular incompetence and venous hypertension of the pampiniform venous plexus. Venous blood stasis affect the normal venous blood returning to the heart, dilatating the veins of the testicles and spermatic cords. After prolonged standing or prolonged sitting (unchanged posture), patients with varicocele will feel dragging pain in the scrotum. As the scrotal temperature rises for the veinous blood stasis, high temperature affects sperm formation, causes premature death of sperm and leads to male infertility. Rarely, intra-abdominal tumor compressing the promixal vein can cause varicocele.
Varicocele usually occurs unilaterally and in the left side of the scrotum in most patients. But, bilateral varicoceles can occurs in the same patient simultaneously or one sided varicocele occurs first and the other sided varicocele occurs later. Patients with unilateral scrotal varicocele are usually visible from a distance and often being described as "a bag of worm ". The dilated varicocele is compressible and is more obvious with Valsalva Manouvre. Patients usually feel scrotal pain or heaviness after prolonged standing or sitting.
Preoperative color doppler ultrasound scan can confirm the diagnosis.
Varicocele is nearly always due to venous valvular incompetence. The treatment usually involves ligation and excision of the diseased varicocele.
- Surgery comparison
There are several methods of varicocele surgery:
Traditional open varicocelectomy Microscopic minimal access varicocelectomy Lararoscopicvaricocelectomy Anesthesia General / Spinal anesthesia General / Spinal anesthesia General anesthesia Operating time 45-60 minutes 30-60 minutes 30-60 minutes Wound size Single groin incision (5cm-8cm) Lower medial single groin incision (1cm-2cm) 1- 3 lower abdominal incisions (0.5cm-1.5cm) Post operative Pain Moderate to severe Mild Mild Post operative hospital stay 24 hrs 24 hrs 24hrs Post operative sick leave 7 - 14 days 2 - 7 days 2- 7 days Hospital charges Relatively less Relative less Relative more Risks and complications Surgery and anesthetic risks of less than few % Surgery and anesthetic risks of less than few % Surgery and anesthetic risks of less than few % Remarks During surgery, there is no increase in intra-abdominal pressure and majority of varicose veins were removed, varicocele is nearly completely gone immediately after surgery. During surgery, there is no increase in intra-abdominal pressure and majority of varicose veins were removed, varicocele is nearly completely gone immediately after surgery. During surgery, there is increase in intra-abdominal pressure and majority of varicose veins were not removed, varicocele is more obvious after surgery; it may take few weeks to months to reduce in size.