What is varicocele? Varicocele is a disease defined as the enlargement of the veins of the testicle in men. It typically disappears when patients lie down but appears when standing. It is palpable i.e. can be felt when touched by hand. Sometimes patients may notice worm-like enlarged veins in their scrotums. This is quite common and usually occurs in young men. It occurs in an average of 10% of men.

However, it occurs in an average of 30% of men with infertility problems and can also be defined as varicose veins in the testicles. Disturbance of normal testicular temperature and accumulation of toxic substances affect blood flow and testicular function. It also negatively affects sperm and testosterone production. Some people with this condition need treatment. If it is found to cause different conditions, treatment is administered. Surgical treatment methods are usually applied.

Erkeklerin ergenlik döneminde daha sık ortaya çıktığı bilinmektedir. Büyük çoğunlukta sol testis toplar damarı üzerinde oluştuğu gözlemlenmektedir. Küçük bir kısımda ise her iki testis üzerinde oluşum görülmektedir. Aynı zamanda varikosel, testislerde hasara ve erkek doğurganlığında azalmaya neden olabilmektedir.

Symptoms of Varicocele

Symptoms of varicocele are among the curious topics. Many patients show no symptom, however, it causes pain in some patients. Some men experience minimal pain while some experiences severe pain. This condition that varies from person to person occurs particularly in standing position. Prolonged standing and heavy activities can lead to increased pain. The pain experienced during the day can vary.

Apart from pain, varicocele mostly changes sperm count and movement. As the temperature of the testicle increases, sperm production slows down. This can delay couples from having children. In some patients, it may cause shrinkage of the left testicle.

Why Varicocele Occurs?

Why varicocele occurs? It is not known exactly why varicocele occurs. In individuals who have children, it is seen that the male problem is mostly varicocele. This rate is twice as high in men presenting with infertility. Varicocele usually occurs in the left testicle and sometimes in both testicles. It occurs only in the right testicle very rarely. The reason of occurrence in the left testicle is secondary to anatomical factors.

Examples include the left testicle being slightly lower than the right testicle and the left vein being longer than the right vein. The relationship of the left testicular vein to other organs in the abdomen can also cause this condition. The drainage pattern of the left testicular vein can also cause this to occur in the left testicle. Because of all this, varicocele occurs 90% in the left testicle.

Degrees of Varicocele

Varicocele is considered in three degrees. These are:

• Degree 1: No symptoms are observed in the examination in standing position. However, varicocele can be palpated.

• Degree 2: Minimal symptoms are observed in the examination in standing position. The veins become visible and prominent when the patient pushes and during palpation.

• Degree 3: It is visible during examination in standing position without any intervention.

Varicocele is sometimes not detected by physical examination and an ultrasound is therefore ordered. In this way, it can be better seen and diagnosed.

What is Left Varicocele?

What is left varicocele? Varicocele is a swelling of the veins in the scrotum. It can occur at almost any age but is more common in young men. It is usually asymptomatic, but in some cases it can cause pain and swelling. The testicle with varicocele may appear larger than the other. The larger one is usually the left testicle. Because the left testicle shows some anatomical differences compared to the right testicle.

If the left varicocele shows any symptoms, an examination is absolutely necessary. This is because it causes infertility in some patients. In addition to physical examination, it can be observed in ultrasound scanning. Painkillers are recommended in cases where it causes pain and swelling.

It is more common in the left testicle because the left testicle is lower than the right testicle. The vein in the left testicle also has a longer course than in the right testicle. This left testicular vein is more often associated with other organs than the right one. Another reason is that the blood discharge structure of the left testicular vein is more susceptible to varicocele formation. As soon as varicocele is detected, it should be examined and the necessary treatment should be administered.

What is Right Varicocele?

What is right varicocele? Varicocele is 90% seen in the left testicle. However, it can sometimes occur in both testicles. It rarely occurs in the right testicle. Some patients with right testicular varicocele have a kidney tumor and this is the reason why it occurs in the right testicle. Although it is a rare condition, it should not be overlooked and should be examined.

The reason for the very low rate of right testicular varicocele is anatomical morphology. There are some differences in the morphology and appearance of both testicles. These differences increase the likelihood of varicocele in the left testicle.

How is Varicocele Diagnosed?

How is varicocele diagnosed? Varicocele is easy to diagnose. First, a physical examination is performed and the patient's complaints are listened to. During the physical examination, it is checked whether there is any swelling in the veins in the scrotum. There is also a risk of knotting of the vessels in the testicle and this should be taken into account during the examination. This can be better seen especially in the standing position and the examination is performed in this way.

The patient may be asked to push or cough during examination. Pushing and coughing allows a better detection of the varicocele condition. Testicular size is also assessed and an ultrasound scan may be ordered afterwards. If the varicocele is rarely right-sided, a kidney ultrasound is also ordered. Occurring in the right testicle can sometimes be caused by a tumor in the kidney.

How is Varicocele Treated?

How is varicocele treated? Some patients do not need treatment, while others may require surgical intervention. Surgery is especially recommended for young men. After varicocele surgery, sperm values of some patients increase. However, it is observed that surgery has an effect on the elimination of infertility.

Surgical methods can be used especially in painful varicocele. It is checked whether varicocele affects the size of the testicles in young men and sperm analysis is performed.

When a varicocele is detected or suspected, it should be examined. When appropriate, surgical treatment is performed. However, treatment modalities may vary from patient to patient.