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Home|Varicocoeles

Varicocoeles

Varicocoeles 3

Varicocoeles?

A varicocele is an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum). It’s similar to a varicose vein you might see on your leg. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility.

Varicoceles generally form during puberty and are more commonly found on the left side of the scrotum because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles.

Most varicoceles don’t cause any discomfort, and they often don’t need any treatment. If a varicocele causes symptoms, it often can be repaired surgically or by a keyhole method.

  • Symptoms may include:
    A lump in one of your testicles
  • Swelling in your scrotum
  • Visibly enlarged or twisted veins in your scrotum, which are often described as looking like a bag of worms
  • A dull, recurring pain or ache in your scrotum

Causes and risk factors

While the exact cause is not always clear, there are a few common factors that may contribute to the development of varicoceles. Here are some possible causes:

  • 1. Faulty valves: One of the main causes is faulty valves in the veins that prevent proper blood flow. When these valves fail to function correctly, blood pools in the veins, leading to their enlargement.
  • 2. Genetic predisposition: Some individuals may have a genetic predisposition to developing varicoceles. If your family members have had varicoceles, you may have a higher risk of developing them as well.
  • 3. Obstruction: Sometimes, a blockage or obstruction in the veins can cause blood to accumulate, leading to varicocele formation. This can occur due to factors like previous surgery or injury.
  • 4. Hormonal imbalance: Hormonal imbalances, particularly in the testosterone levels, may contribute to the development of varicoceles. The exact mechanism is not fully understood, but hormonal factors might play a role.
  • 5. Intra-abdominal pressure: Increased pressure in the abdomen, such as from heavy lifting or straining during bowel movements, can lead to the formation of varicoceles.

Association between a varicocole and testicular cancer

There is a slight association between varicocele and an increased risk of testicular cancer, but the risk is generally considered to be low. Varicoceles are quite common, affecting about 15% of men, while testicular cancer is relatively rare. It’s important to note that the majority of varicoceles do not lead to cancer.

However, some studies have suggested a slightly higher incidence of testicular cancer in men with varicoceles compared to those without. The exact reason for this association is still not fully understood. It’s possible that both conditions share some underlying factors, such as hormonal imbalances or genetic predisposition.

It’s important to remember that the risk of developing testicular cancer, even with a varicocele, is still relatively low. Regular self-examinations of the testicles and routine check-ups with a healthcare professional can help detect any potential issues early on.

Investigations and work up

When investigating a varicocele, a healthcare professional will typically perform a thorough physical examination and may order additional tests to evaluate the condition. Here are some common investigation methods for varicoceles:

  • 1. Physical Examination: The healthcare professional will perform a physical examination, typically while the patient is standing, to assess the size and feel of the varicocele. They may ask the patient to bear down or perform a Valsalva maneuver to increase the visibility of the varicocele.
  • 2. Ultrasound: An ultrasound is a commonly used imaging test to evaluate varicoceles. It uses sound waves to create images of the affected area, allowing the healthcare professional to assess the size, location, and blood flow within the varicocele.
  • 3. Doppler Ultrasound: A Doppler ultrasound is a specialized type of ultrasound that can assess the blood flow within the varicocele. It can help determine if the blood flow is abnormal, which can be useful in diagnosing and classifying the severity of the varicocele.
  • 4. Blood Tests: In some cases, blood tests may be ordered to evaluate hormone levels, such as testosterone and follicle-stimulating hormone (FSH). These tests can help identify any hormonal imbalances that may be contributing to the varicocele or its associated symptoms.
  • 5. Semen Analysis: If there are concerns about fertility, a semen analysis may be recommended to assess sperm count, motility, and morphology. Varicoceles can sometimes impact fertility by affecting sperm quality, and a semen analysis can provide valuable information in such cases.

Treatment Options

The treatment of varicoceles depends on various factors such as the severity of symptoms, the presence of fertility issues, and the patient’s preferences. Here are some common treatment options for varicoceles:

  1. Observation: If the varicocele is small and not causing any symptoms or fertility problems, the healthcare professional may recommend a “wait-and-see” approach. Regular monitoring through physical examinations and ultrasound can be done to ensure that the varicocele does not worsen over time.
  2. Lifestyle Changes: In some cases, lifestyle modifications can help alleviate symptoms and prevent the progression of varicoceles. These may include avoiding prolonged standing or heavy lifting, wearing supportive underwear, and practicing regular exercise to improve blood flow.
  3. Medications: Medications are not typically used as a primary treatment for varicoceles. However, pain management medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate discomfort.
  4. Surgical Repair: Surgical intervention is often recommended if the varicocele is causing significant pain or discomfort, affecting fertility, or if it is progressively worsening. The two main surgical options are:
    • Varicocelectomy: This is a surgical procedure in which the varicocele is surgically ligated or tied off. It can be performed through an open incision (open varicocelectomy) using a microscope or using minimally invasive techniques such as laparoscopy or robotic-assisted surgery.
    • Embolization of varicocele is a minimally invasive procedure used increasingly to treat varicoceles, especially those which are recurrent in nature. During the procedure, a small catheter is inserted through a tiny incision, usually in the groin, and guided to the affected vein. Once in place, small coils or a special solution is used to block or “embolize” the vein, redirecting blood flow to healthier veins, causing the varicocoele to shrink.

The success rate of embolization of varicocele is generally very high. Studies have shown that the procedure is successful in resolving symptoms and improving fertility in the majority of patients.

The success rate can vary depending on factors such as the severity of the varicocele, and the individual patient’s circumstances. However, overall success rates are typically reported to be around 90% or higher.

Embolization of varicocele is a safe and effective alternative to surgical treatment. It offers benefits such as shorter recovery time, minimal scarring, and reduced risk of complications. The procedure is usually performed on an outpatient basis, meaning you can go home the same day.

Fibroids shrinkage after UFE

Varicose veins screening package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
  • Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
  • $588 + GST

Spider veins screening package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
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  • $588 + GST

Varicose veins and spider veins package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
  • Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
  • 1 session spider vein laser treatment (additional session 450 + GST)
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  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check circulation, biomechanics of foot arch, sensory loss
  • Ankle brachial pressure index (lab) – to check blood flow in legs
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  • $388 + GST

Diabetic foot screening (extensive)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check circulation, biomechanics of foot arch, sensory loss
  • Ankle brachial pressure index (lab) – to check blood flow in legs
  • Blood test – to check average sugar levels in 3 months
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  • X-ray one foot – to check bone infection
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Cardiovascular screening (normal)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – full cardiovascular examination including the heart and limb arteries
  • Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
  • Blood tests (lipids) – to check all the types of cholesterol
  • Carotid scan – to identify block artery to the brain hence stroke
  • Echocardiogram – to identify heart muscle function
  • $1098 + GST

Cardiovascular screening (comprehensive)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – full cardiovascular examination including the heart and limb arteries
  • Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
  • Blood tests (lipids) – to check all the types of cholesterol
  • Carotid scan – to identify block artery to the brain hence stroke
  • CT coronary Angiogram plus calcium score – gold standard to identify block heart arteries
  • $2098 + GST

Our Doctors

Senior Vascular & General Surgeon
Senior Vascular & General Surgeon