Varicocele is one of the most common reproductive health problems in men that can affect fertility. It is a pathological expansion of the veins of the testicles most often manifested on the left side of the body. Since in most cases varicocele does not cause any symptoms, it is often detected by chance during a medical examination for prophylactic purposes.
More about this pathology, its symptoms, diagnostics and an innovative method of treatment – embolization of varicocele – is told by urologist Martynas Stanionis, doctor of Vilnius City Clinical Hospital and Diagnostic Center, and Rokas Girčius, a doctor of VUL Santaros Clinic.
According to M. Stanionis, varicocele develops due to stagnation of blood in the veins of the testicles, which is caused by improper functioning of the venous valves or their insufficiency. The most common cause of this condition is the anatomical structure of the left vein of the kidney. “On the left side, the blood flows from the testicular vein to the left vein of the kidney, then crosses the aorta and only then enters the lower empty vein. There are many differences in pressure on this path, so the blood can hold on and expand the veins,” the doctor explains. In more rare cases, varicocele can be caused by tumors or venous obstructions.
According to the urologist, the likelihood of varicocele can be increased by:
• Genetics. If there have been cases of varicocele in the family, its risk increases by 2 – 4 times.
• Circulatory disorders (in particular, obstruction of the renal veins), which may be congenital or have arisen as a result of other diseases.
• Age. Varicocele is most often diagnosed in men aged 15-25 years.
• Physical factors such as irregular posture, prolonged sitting or excessive physical exertion.
According to M. Stanionis, varicocele is often asymptomatic and detected by chance, but some patients may feel:
• Pain or discomfort in the testicles, usually when standing or playing sports. The pain is usually mild, but can intensify during normal activities.
• Feeling of heaviness in the groin.
• Differences in testicular size (one testicle is larger than the other).
Symptoms of varicocele or their exacerbation can be provoked by factors such as prolonged standing or sitting, which can lead to stagnation of blood and varicose veins, intense physical exertion, sports training. Blood flow disorders can also be promoted by prolonged stay in hot environments or drinking alcohol. Chronic inflammations and other pathological processes often contribute to the exacerbation of the symptoms of varicocele.
M. Stanionis emphasizes that if left untreated, varicocele can have a significant impact on male fertility. Blood stasis can raise the temperature in the testicles, disrupt sperm production, impair sperm quality and motility. In addition, oxidative stress and tissue damage can occur, which further aggravates the situation. “If a patient has varicocele and faces infertility problems, treatment in many cases can significantly improve sperm quality and increase the likelihood that the couple will successfully have children,” he says.
The urologist notes that varicocele may not be noticed until, having decided to have children, a woman cannot become pregnant.
According to M. Stanionis, the diagnosis of varicocele begins with the collection and clinical examination of anamnesis. “The patient is usually asked to stand or cough, for example, in order to better assess the dilation of the veins,” explains the urologist doctor. For the confirmation of varicocele, ultrasound diagnostics is most often used. Doppler ultrasound detects a violation of blood flow and varicose veins. In more rare cases, contrast computed tomography (CT) or magnetic resonance imaging (MRI) examinations may be used.
The urologist says that the choice of treatment for varicocele depends on the severity and symptoms of varicocele. Currently, the following methods are used in Lithuania:
• Conservative treatment, which involves monitoring the patient’s condition and lifestyle changes, if the symptoms are mild and do not affect the fertility of the man.
• Surgical treatment used to treat infertility or reduce severe symptoms. It involves microsurgical excision of varicocele derivatives or laparoscopic operations.
• Embolization is an innovative, less invasive procedure with a low risk of complications and faster recovery of patients than after surgery. Doctor M. Stanionis describes the procedure as “an effective, minimally invasive method that allows you to stop blood flow with dilated veins.”
Interventional radiologist Rokas Girčius explains that varicocele embolization is a procedure during which, under X-ray control, special substances are introduced into the veins through a catheter, which close blood circulation in the dilated veins and eliminate the symptoms of varicocele.
“The embolization of varicocele usually takes from 30 minutes to 1 hour. To ensure maximum accuracy, the procedure is carried out under X-ray control. Most often, local anesthesia is applied, access is chosen through a large vein in the neck or groin. The vein is punctured under ultrasound control and a catheter/tube system is introduced, navigating through it with special wires and radiocontrastic agents to reach the dilated veins of one or both testicles. They are closed through the same catheters by introducing spirals and / or special glue into the veins. To enhance the effect of the procedure, the veins are simultaneously sclerosed with a special sclerotherapeutic agent,” R. Girčius shares the details of the procedure.
According to the interventional radiologist, approximately three hours after the procedure, the patient can be discharged home. After the procedure, a special regime of rest or care is not necessary, so the usual rhythm of life is almost not disturbed. Possible minor discomfort or discomfort can be easily managed with small doses of non-steroidal anti-inflammatory drugs. “The poembolising period, during which mild bathing or stinging may be felt, sometimes mild nausea, usually lasts 1-2 days, and positive changes in the spermogram are observed after 1-2 months,” says the specialist
According to R. Girčius, the embolization of varicocele has many advantages:
• The procedure is minimally invasive, so there is no need for large incisions.
• Low risk of complications. In comparison with surgical methods of treatment, embolization significantly reduces the risk of damage to the nerve plexuses and seminal duct.
• Fast recovery. The patient is discharged home on the same day and can return to daily activities.
• High efficiency. When using a combination of embolization and sclerotherapy techniques, the success rate of the procedure reaches about 95 percent. If necessary, the procedure can be easily repeated.
“Thus, embolization is a quick, safe and reliable method of treating varicocele, providing the patient with minimal discomfort. This method is a great choice for those who want to avoid surgical operations and seek a faster recovery,” concludes the interventional radiologist.
Concluding the conversation, doctors say that medicine is advancing rapidly – thanks to advanced methods of diagnosis and treatment, varicocele can be effectively managed and its effect on men’s health can be reduced. “It is important, if you feel the symptoms of this disease, not to delay and consult a doctor, as well as not to forget to regularly undergo preventive health examinations,” recalls Martynas Stanionis and Rokas Girčius.
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