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:
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Ache in the
testicle |
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Feeling of
heaviness in the testicle(s) |
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Infertility
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Shrinkage
(atrophy) of the testicle(s) |
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Visible or
palpable (able to be felt) enlarged vein
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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.
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.
Venogram is 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.
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).
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. Flavinoids, 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.
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Supplemental
Nutrition |
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Bioflavinoids:
1000 mg daily |
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Vitamin C:
1000 mg 3 times a day with meals |
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Zinc: 30 mg
daily |
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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:
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Horse
Chestnut (Aesculus hippocastanum) — 50 mg escin
standardized extract daily. |
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Butcher’s
Broom (Ruscus aculeatus) — 10% ruscogenin standardized
extract, 100 mg 3 times a day. |
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Bilberry (Vaccinium
myrtillus) — 25% anthocyanoside, 150 mg 3 times a day. |
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Physical
Medicine |
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Kegel
exercises to improve blood flow and muscle tone.
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