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Varicocele

January 01, 1970

A varicocele is, in a male person, an abnormal enlargement of the pampiniform venous plexus in the scrotum; in a female person, it is an abnormal painful swelling to the embryologically identical pampiniform venous plexus; it is more commonly called pelvic compression syndrome. In the male varicocele, this plexus of veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Varicoceles occur in around 15% to 20% of all men.[3][4] The incidence of varicocele increase with age.

Varicocele
Varicocele on the person's left testicle. Notice the swelling and slight enlargement of the left testicle, which is marked by an arrow.
Pronunciation
SpecialtyUrology

Signs and symptoms edit

Varicocele might be noticed as soft lumps, usually above the testicle and mostly on the left side of the scrotum.[5] Right-sided and bilateral varicocele does also occur. Men with varicocele can feel symptoms of pain or heaviness in their scrotum.[5] Large varicoceles present as plexus of veins and may be described as a "bag of worms".[6][7] Varicocele is sometimes discovered when investigating the cause of male infertility.[8][9]

Cause edit

 
Cross section showing the pampiniform venus plexus

There are three main theories as to the anatomical cause; the first has to do with the geometry of the veins, wherein the vein on the left side connects to the larger outflowing vein at a right angle, which tends to fail; the second is that testicular valves that are supposed to prevent backflow fail (venous insufficiency) leading to swelling and compression of the valveless pampiniform plexus; the third is due to excessive pressure in upstream veins, created by nutcracker syndrome.[10]

Pathophysiology edit

Often the greatest concern with respect to varicocele is its effect on male fertility. The relationship between varicocele and infertility is unclear. Some men with the condition are fertile, some have sperm that are normal in shape and move normally but are compromised in function, and some have sperm with abnormal shapes or that do not move well.[10] Theories as to how varicocele affects sperm function include damage via excess heat caused by the blood pooling and oxidative stress on sperm.[4][10][11][12]

Tobacco smoking and mutations in the gene expressing glutathione S-transferase Mu 1 both put men at risk for infertility; these factors may also exacerbate the risk that varicocele will affect fertility.[10]

Diagnosis edit

Following discovery of the sign of swelling comprising a mass, varicocele can be confirmed with scrotal ultrasound, which will show dilation of the vessels of the pampiniform plexus to be greater than 2,3 mm.[13]

  •  
    Varicocele in ultrasound (left: testicle)
  •  
    Varicocele

Criteria edit

A universally accepted system for categorizing varicoceles does not exist, but according to the classification criteria established in 1970 by Dubin and Amelar, most commonly varicoceles are clinically assessed and categorized into three grades as follows:[14][15]

  1. Grade 1 Varicocele: Characterized by the palpability of the varicocele only when the individual is in a standing position during the Valsalva maneuver.
  2. Grade 2 Varicocele: The varicocele is palpable not only during the Valsalva maneuver but also at rest while standing.
  3. Grade 3 Varicocele: The most severe grade, where the varicocele is not only palpable but also visible through the scrotal skin, without any additional maneuvers.

In the Sarteschi (1993) classification system, varicoceles are categorized into five grades:[16]

  1. Grade I: Reflux occurs solely at the groin level during the Valsalva maneuver, without evident scrotal deformation or testicular atrophy.
  2. Grade II: Reflux is limited to the proximal segment of the pampiniform plexus during the Valsalva maneuver, without scrotal deformation or testicular atrophy.
  3. Grade III: Reflux occurs in the distal vessels located at the lower scrotum exclusively during the Valsalva maneuver, and there is no scrotal deformation or testicular atrophy.
  4. Grade IV: Spontaneous reverse blood flow is present and intensifies during the Valsalva maneuver, resulting in scrotal deformation and the potential for testicular atrophy.
  5. Grade V: Resting reflux is evident within the dilated pampiniform plexus, possibly escalating during the Valsalva maneuver, and is consistently accompanied by testicular atrophy.

Imaging edit

Manual examination of scrotum is required for proper interpretation of ultrasound images. During ultrasound examination, diameters of veins in pampiniform plexus are measured and regurgitation is measured. The subject is then instructed to stand up and Valsalva maneuver is performed. The diameter is then measured and changes in blood flow direction is recorded to assess any regurgitation.[17]

Treatment edit

 
Wound after microsurgical varicocelectomy

The two most common surgical approaches are retroperitoneal (abdominal using laparoscopic surgery), infrainguinal/subinguinal (below the groin) and inguinal (groin using percutaneous embolization).[4] Possible complications of this procedure include hematoma (bleeding into tissues), hydrocele (accumulation of fluid around the affected testicle), infection, or injury to the scrotal tissue or structures. In addition, injury to the artery that supplies the testicle may occur, resulting in a loss of a testicle.[4]

Prognosis edit

Whether having varicocele surgery or embolization improves male fertility is controversial, as good clinical data is lacking.[9] There is tentative evidence that varicocelectomy may improve fertility in those with obvious findings and abnormal sperm;[4] however, this has a number needed to treat of 7 for varicocelectomy and 17 for embolization.[18][19] There are also studies showing that the regular surgery has no significant effect on infertility.[9] A 2012 Cochrane review (updated in 2021) found tentative but unclear evidence of improved fertility among males treated for varicocele.[20] Evidence for sclerotherapy is unclear as of 2015.[21]

Epidemiology edit

Around 15% to 20% of all adult males, up to 35% to 40% of men who are evaluated for male infertility, and around 80% of men who are infertile due to some other cause, have varicocele.[3][4][9]

External links edit

  • Video of a microsurgical repair of grade 3 left varicocele

References edit

  1. ^ "Varicocele". Merriam-Webster.com Dictionary. Retrieved 2016-01-21.
  2. ^ . Lexico UK English Dictionary. Oxford University Press. Archived from the original on 2020-12-04.
  3. ^ a b White, Wesley M.; Kim, Edward David; Mobley, Joe D (2 January 2019). "Varicocele: Epidemiology". Medscape. Retrieved 18 September 2019. Although varicoceles appear in approximately 20% of the general male population, they are much more common in the subfertile population (40%).
  4. ^ a b c d e f Kupis, Ł; Dobroński, PA; Radziszewski, P (2015). "Varicocele as a source of male infertility - current treatment techniques". Central European Journal of Urology. 68 (3): 365–70. doi:10.5173/ceju.2015.642. PMC 4643713. PMID 26568883.
  5. ^ a b "Testicular lumps and swellings - Causes - NHS Choices". NHS Choices. 7 October 2014.
  6. ^ Cannarella, Rossella; Calogero, Aldo E.; Condorelli, Rosita A.; Giacone, Filippo; Aversa, Antonio; La Vignera, Sandro (8 September 2019). "Management and Treatment of Varicocele in Children and Adolescents: An Endocrinologic Perspective". Journal of Clinical Medicine. 9 (8): 1410. doi:10.3390/jcm8091410. PMC 6780349. PMID 31500355.
  7. ^ Leslie, Stephen W.; Sajjad, Hussain; Siref, Larry E. (7 October 2019). Varicocele. StatPearls [Internet]. PMID 28846314. Retrieved 20 January 2020.
  8. ^ "Low sperm count". NHS Choices. 2 August 2016.
  9. ^ a b c d Baazeem, Abdulaziz; Belzile, Eric; Ciampi, Antonio; Dohle, Gert; Jarvi, Keith; Salonia, Andrea; Weidner, Wolfgang; Zini, Armand (2011-10-01). "Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair". European Urology. 60 (4): 796–808. doi:10.1016/j.eururo.2011.06.018. PMID 21733620.
  10. ^ a b c d Eisenberg, Michael L.; Lipshultz, Larry I. (2011-01-01). "Varicocele-induced infertility: Newer insights into its pathophysiology". Indian Journal of Urology. 27 (1): 58–64. doi:10.4103/0970-1591.78428. ISSN 0970-1591. PMC 3114589. PMID 21716891.
  11. ^ Hayden, Russell P.; Tanrikut, Cigdem (2016-05-01). "Testosterone and Varicocele". The Urologic Clinics of North America. 43 (2): 223–232. doi:10.1016/j.ucl.2016.01.009. ISSN 1558-318X. PMID 27132580.
  12. ^ Dabaja, Ali; Wosnitzer, Matthew; Goldstein, Marc (2013-08-01). "Varicocele and hypogonadism". Current Urology Reports. 14 (4): 309–314. doi:10.1007/s11934-013-0339-4. ISSN 1534-6285. PMID 23754533. S2CID 5477034.
  13. ^ Salam, MA (2013). Principles and Practice of Urology. New Delhi 110 002, India: Jaypee Brothers Medical Publishers. p. 752. ISBN 978-93-5025-260-4.{{cite book}}: CS1 maint: location (link)
  14. ^ Bertolotto, Michele; Cantisani, Vito; Drudi, Francesco Maria; Lotti, Francesco (September 2021). "Varicocoele. Classification and pitfalls". Andrology. 9 (5): 1322–1330. doi:10.1111/andr.13053. ISSN 2047-2919. PMC 8596817. PMID 34038625.
  15. ^ A. Hamada; et al. (2016). Varicocele and Male Infertility (PDF). SpringerBriefs in Reproductive Biology. doi:10.1007/978-3-319-24936-0. ISBN 978-3-319-24934-6. S2CID 5203944.
  16. ^ Namdev, Rupesh. "Varicocele grading on color Doppler | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved 2023-10-04.
  17. ^ Lorenc T, Krupniewski L, Palczewski P, Gołębiowski M (December 2016). "The value of ultrasonography in the diagnosis of varicocele". Journal of Ultrasonography. 16 (67): 359–370. doi:10.15557/JoU.2016.0036. PMC 5269523. PMID 28138407.
  18. ^ Kroese, A. C. J.; Lange, N. M. de; Collins, J. A.; Evers, J. L. H. (2013-07-01). "Varicocele surgery, new evidence". Human Reproduction Update. 19 (4): 317. doi:10.1093/humupd/dmt004. PMID 23515200.
  19. ^ Li, Fuping; Yue, Huanxun; Yamaguchi, Kohei; Okada, Keisuke; Matsushita, Kei; Ando, Makoto; Chiba, Koji; Fujisawa, Masato (2012). "Effect of surgical repair on testosterone production in infertile men with varicocele: A meta-analysis". International Journal of Urology. 19 (2): 149–54. doi:10.1111/j.1442-2042.2011.02890.x. PMID 22059526. S2CID 20329833.
  20. ^ Persad, Emma; O'Loughlin, Clare Aa; Kaur, Simi; Wagner, Gernot; Matyas, Nina; Hassler-Di Fratta, Melanie Rosalia; Nussbaumer-Streit, Barbara (2021-04-23). "Surgical or radiological treatment for varicoceles in subfertile men". The Cochrane Database of Systematic Reviews. 2021 (4): CD000479. doi:10.1002/14651858.CD000479.pub6. ISSN 1469-493X. PMC 8408310. PMID 33890288.
  21. ^ Macleod, R; Biyani, CS; Cartledge, J; Eardley, I (13 July 2015). "Varicocele". BMJ Clinical Evidence. 2015. PMC 4500994. PMID 26168774.

January 01, 1970
varicocele, varicocele, male, person, abnormal, enlargement, pampiniform, venous, plexus, scrotum, female, person, abnormal, painful, swelling, embryologically, identical, pampiniform, venous, plexus, more, commonly, called, pelvic, compression, syndrome, male. A varicocele is in a male person an abnormal enlargement of the pampiniform venous plexus in the scrotum in a female person it is an abnormal painful swelling to the embryologically identical pampiniform venous plexus it is more commonly called pelvic compression syndrome In the male varicocele this plexus of veins drains blood from the testicles back to the heart The vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis Varicoceles occur in around 15 to 20 of all men 3 4 The incidence of varicocele increase with age VaricoceleVaricocele on the person s left testicle Notice the swelling and slight enlargement of the left testicle which is marked by an arrow Pronunciation ˈ v aer ɪ k oʊ ˌ s iː l k e 1 2 SpecialtyUrology Contents 1 Signs and symptoms 2 Cause 3 Pathophysiology 4 Diagnosis 4 1 Criteria 5 Imaging 6 Treatment 7 Prognosis 8 Epidemiology 9 External links 10 ReferencesSigns and symptoms editVaricocele might be noticed as soft lumps usually above the testicle and mostly on the left side of the scrotum 5 Right sided and bilateral varicocele does also occur Men with varicocele can feel symptoms of pain or heaviness in their scrotum 5 Large varicoceles present as plexus of veins and may be described as a bag of worms 6 7 Varicocele is sometimes discovered when investigating the cause of male infertility 8 9 Cause edit nbsp Cross section showing the pampiniform venus plexus There are three main theories as to the anatomical cause the first has to do with the geometry of the veins wherein the vein on the left side connects to the larger outflowing vein at a right angle which tends to fail the second is that testicular valves that are supposed to prevent backflow fail venous insufficiency leading to swelling and compression of the valveless pampiniform plexus the third is due to excessive pressure in upstream veins created by nutcracker syndrome 10 Pathophysiology editOften the greatest concern with respect to varicocele is its effect on male fertility The relationship between varicocele and infertility is unclear Some men with the condition are fertile some have sperm that are normal in shape and move normally but are compromised in function and some have sperm with abnormal shapes or that do not move well 10 Theories as to how varicocele affects sperm function include damage via excess heat caused by the blood pooling and oxidative stress on sperm 4 10 11 12 Tobacco smoking and mutations in the gene expressing glutathione S transferase Mu 1 both put men at risk for infertility these factors may also exacerbate the risk that varicocele will affect fertility 10 Diagnosis editFollowing discovery of the sign of swelling comprising a mass varicocele can be confirmed with scrotal ultrasound which will show dilation of the vessels of the pampiniform plexus to be greater than 2 3 mm 13 nbsp Varicocele in ultrasound left testicle nbsp Varicocele Criteria edit A universally accepted system for categorizing varicoceles does not exist but according to the classification criteria established in 1970 by Dubin and Amelar most commonly varicoceles are clinically assessed and categorized into three grades as follows 14 15 Grade 1 Varicocele Characterized by the palpability of the varicocele only when the individual is in a standing position during the Valsalva maneuver Grade 2 Varicocele The varicocele is palpable not only during the Valsalva maneuver but also at rest while standing Grade 3 Varicocele The most severe grade where the varicocele is not only palpable but also visible through the scrotal skin without any additional maneuvers In the Sarteschi 1993 classification system varicoceles are categorized into five grades 16 Grade I Reflux occurs solely at the groin level during the Valsalva maneuver without evident scrotal deformation or testicular atrophy Grade II Reflux is limited to the proximal segment of the pampiniform plexus during the Valsalva maneuver without scrotal deformation or testicular atrophy Grade III Reflux occurs in the distal vessels located at the lower scrotum exclusively during the Valsalva maneuver and there is no scrotal deformation or testicular atrophy Grade IV Spontaneous reverse blood flow is present and intensifies during the Valsalva maneuver resulting in scrotal deformation and the potential for testicular atrophy Grade V Resting reflux is evident within the dilated pampiniform plexus possibly escalating during the Valsalva maneuver and is consistently accompanied by testicular atrophy Imaging editManual examination of scrotum is required for proper interpretation of ultrasound images During ultrasound examination diameters of veins in pampiniform plexus are measured and regurgitation is measured The subject is then instructed to stand up and Valsalva maneuver is performed The diameter is then measured and changes in blood flow direction is recorded to assess any regurgitation 17 Treatment edit nbsp Wound after microsurgical varicocelectomy The two most common surgical approaches are retroperitoneal abdominal using laparoscopic surgery infrainguinal subinguinal below the groin and inguinal groin using percutaneous embolization 4 Possible complications of this procedure include hematoma bleeding into tissues hydrocele accumulation of fluid around the affected testicle infection or injury to the scrotal tissue or structures In addition injury to the artery that supplies the testicle may occur resulting in a loss of a testicle 4 Prognosis editWhether having varicocele surgery or embolization improves male fertility is controversial as good clinical data is lacking 9 There is tentative evidence that varicocelectomy may improve fertility in those with obvious findings and abnormal sperm 4 however this has a number needed to treat of 7 for varicocelectomy and 17 for embolization 18 19 There are also studies showing that the regular surgery has no significant effect on infertility 9 A 2012 Cochrane review updated in 2021 found tentative but unclear evidence of improved fertility among males treated for varicocele 20 Evidence for sclerotherapy is unclear as of 2015 21 Epidemiology editAround 15 to 20 of all adult males up to 35 to 40 of men who are evaluated for male infertility and around 80 of men who are infertile due to some other cause have varicocele 3 4 9 External links editVideo of a microsurgical repair of grade 3 left varicoceleReferences edit Varicocele Merriam Webster com Dictionary Retrieved 2016 01 21 Varicocele Lexico UK English Dictionary Oxford University Press Archived from the original on 2020 12 04 a b White Wesley M Kim Edward David Mobley Joe D 2 January 2019 Varicocele Epidemiology Medscape Retrieved 18 September 2019 Although varicoceles appear in approximately 20 of the general male population they are much more common in the subfertile population 40 a b c d e f Kupis L Dobronski PA Radziszewski P 2015 Varicocele as a source of male infertility current treatment techniques Central European Journal of Urology 68 3 365 70 doi 10 5173 ceju 2015 642 PMC 4643713 PMID 26568883 a b Testicular lumps and swellings Causes NHS Choices NHS Choices 7 October 2014 Cannarella Rossella Calogero Aldo E Condorelli Rosita A Giacone Filippo Aversa Antonio La Vignera Sandro 8 September 2019 Management and Treatment of Varicocele in Children and Adolescents An Endocrinologic Perspective Journal of Clinical Medicine 9 8 1410 doi 10 3390 jcm8091410 PMC 6780349 PMID 31500355 Leslie Stephen W Sajjad Hussain Siref Larry E 7 October 2019 Varicocele StatPearls Internet PMID 28846314 Retrieved 20 January 2020 Low sperm count NHS Choices 2 August 2016 a b c d Baazeem Abdulaziz Belzile Eric Ciampi Antonio Dohle Gert Jarvi Keith Salonia Andrea Weidner Wolfgang Zini Armand 2011 10 01 Varicocele and male factor infertility treatment a new meta analysis and review of the role of varicocele repair European Urology 60 4 796 808 doi 10 1016 j eururo 2011 06 018 PMID 21733620 a b c d Eisenberg Michael L Lipshultz Larry I 2011 01 01 Varicocele induced infertility Newer insights into its pathophysiology Indian Journal of Urology 27 1 58 64 doi 10 4103 0970 1591 78428 ISSN 0970 1591 PMC 3114589 PMID 21716891 Hayden Russell P Tanrikut Cigdem 2016 05 01 Testosterone and Varicocele The Urologic Clinics of North America 43 2 223 232 doi 10 1016 j ucl 2016 01 009 ISSN 1558 318X PMID 27132580 Dabaja Ali Wosnitzer Matthew Goldstein Marc 2013 08 01 Varicocele and hypogonadism Current Urology Reports 14 4 309 314 doi 10 1007 s11934 013 0339 4 ISSN 1534 6285 PMID 23754533 S2CID 5477034 Salam MA 2013 Principles and Practice of Urology New Delhi 110 002 India Jaypee Brothers Medical Publishers p 752 ISBN 978 93 5025 260 4 a href Template Cite book html title Template Cite book cite book a CS1 maint location link Bertolotto Michele Cantisani Vito Drudi Francesco Maria Lotti Francesco September 2021 Varicocoele Classification and pitfalls Andrology 9 5 1322 1330 doi 10 1111 andr 13053 ISSN 2047 2919 PMC 8596817 PMID 34038625 A Hamada et al 2016 Varicocele and Male Infertility PDF SpringerBriefs in Reproductive Biology doi 10 1007 978 3 319 24936 0 ISBN 978 3 319 24934 6 S2CID 5203944 Namdev Rupesh Varicocele grading on color Doppler Radiology Reference Article Radiopaedia org Radiopaedia Retrieved 2023 10 04 Lorenc T Krupniewski L Palczewski P Golebiowski M December 2016 The value of ultrasonography in the diagnosis of varicocele Journal of Ultrasonography 16 67 359 370 doi 10 15557 JoU 2016 0036 PMC 5269523 PMID 28138407 Kroese A C J Lange N M de Collins J A Evers J L H 2013 07 01 Varicocele surgery new evidence Human Reproduction Update 19 4 317 doi 10 1093 humupd dmt004 PMID 23515200 Li Fuping Yue Huanxun Yamaguchi Kohei Okada Keisuke Matsushita Kei Ando Makoto Chiba Koji Fujisawa Masato 2012 Effect of surgical repair on testosterone production in infertile men with varicocele A meta analysis International Journal of Urology 19 2 149 54 doi 10 1111 j 1442 2042 2011 02890 x PMID 22059526 S2CID 20329833 Persad Emma O Loughlin Clare Aa Kaur Simi Wagner Gernot Matyas Nina Hassler Di Fratta Melanie Rosalia Nussbaumer Streit Barbara 2021 04 23 Surgical or radiological treatment for varicoceles in subfertile men The Cochrane Database of Systematic Reviews 2021 4 CD000479 doi 10 1002 14651858 CD000479 pub6 ISSN 1469 493X PMC 8408310 PMID 33890288 Macleod R Biyani CS Cartledge J Eardley I 13 July 2015 Varicocele BMJ Clinical Evidence 2015 PMC 4500994 PMID 26168774 Portal nbsp Medicine Retrieved from https en wikipedia org w index php title Varicocele amp oldid 1216355617, wikipedia, wiki, book, books, library,

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