Varicocele is characterized by enlargement of the venous network of the spermatic cord of the testicle. It usually appears on the left and is attributed to the absence of a valve of the internal spermatic vein, the vertical outlet of the left internal spermatic vein to the left renal vein. Possible mechanisms of damage to the testicle are:

• The increase in the temperature of the scrotum.
• Testicular hypoxia due to reduced blood flow.
• The reflux of renal and adrenal metabolites.
• The reduced secretion of gonadotropins and androgens.
• Increase in oxidative stress.

 

As a result, the following damages occur:

• Inability of contralateral testis to grow and develop
• Pain
• Infertility
• Hypogonadism

 

Varicose veins are diagnosed clinically and sonographically. Next step after the diagnosis is to perform a spermogram. Annual follow-up is indicated for a normal spermogram, while for a pathological one, a new spermogram is recommended in three months.

 

Indications for surgical treatment are:

• Infertility and abnormal spermograms
• Pain annoying in everyday life
• Atrophic testis
• Grade III varicocele
• The operation to repair the varicocele can be done with an inguinal or infrainguinal incision, laparoscopically (higher cost and longer surgical time) or with embolization of the internal spermatic vein (radiation exposure).

 

All screening is done with Triplex scrotum and sperm count repeated in one trimester. On affected spermatozoa, the varicocele is repaired under a microscope, ensuring the ligation of all the branches of the internal spermatic vein as well as the protection of the arterial branches that irrigate our testicle and are not visible to the naked eye.

Varicose veins are recommended to be operated on at younger ages when diagnosed, because a greater improvement was observed postoperatively. However, even in infertile men of a young age, varicocele repair has increased the chances of conception.

References:

http://uroweb.org/guideline/male-infertility/#5

https://www.huanet.gr/wp-content/uploads/2017/12/04_MALE-INFERTILITY_Zachariou.pdf

http://www.imop.gr/uroinfo-varicocele