Why does a varicocele keep recurring?

Varicocele

Varicocele (Varicose vein hernia): Varicose vein formation in the area of ​​the venous plexus of the testicle. The varicocele mostly occurs in young men between the ages of 15-25 and predominantly on the left side. The reason for this is the unfavorable inflow path of the left testicular vein into the left renal vein. This type of varicocele does not require treatment, unless the fertility is limited or persistent symptoms exist. A varicocele is rarely the result of an entrapment of the outflow path of the testicular vein, e.g. B. by a kidney tumor.

There are several methods available to treat the varicocele. There is still a controversial debate as to whether this improves a restricted fertility.

Leading complaints

  • Mostly none; Accidental discovery, for example in the context of diagnostics in the event of an unfulfilled desire to have children, sterility diagnostics or during a medical examination
  • Possibly discomfort after standing for a long time (pulling pain or feeling of heaviness in the scrotum).

When to the doctor

In the next few days to

  • to rule out other testicular diseases.

The illness

Causes and Risk Factors

The cause of the varicocele is usually missing or defective venous valves, which normally prevent the blood from "sinking". In addition, there is an almost right-angled entry of the left testicular vein into the left renal vein, which hinders the outflow of blood. The result is a backlog of blood down to the venous plexus of the testicle.

The so-called symptomatic varicoceles are less common: They arise when a tumor (mostly kidney tumor, but also lymphoma) presses on the renal vein on the affected side or the vena cava, causing "blood backlog" to the testes. The occurrence of the varicocele in later life or when the right testicle is affected is suspect.

Consequences and complications

In about 50% of men with varicoceles, fertility is limited, presumably due to the excessively high testicular temperature as a result of the congestion of the blood.

Diagnostic assurance

First, the doctor examines the testicle while lying down and standing. He can often feel soft strands or blood vessels in the scrotum. Using ultrasound and a display of the testicular blood flow (Doppler sonography), he classifies the severity of the varicocele more precisely and checks the testicle for other changes. He also uses ultrasound to assess the kidneys to rule out a tumor.

Usually at least two spermiograms (examination of the sperm for number and quality) are carried out to determine whether fertility is already restricted by the varicocele. The doctor also determines the hormones FSH, LH, testosterone and prolactin in the blood.

Differential diagnoses: Similar tactile findings occur with hydrocele, testicular cancer and spermatocele.

treatment

If the patient has no complaints and either a normal sperm analysis or no sperm in the ejaculate (azoospermia), there is no need for action. Even with a child's varicocele with normal testicular volume, one can initially wait under regular control - these varicose veins recede in up to 70% of the time.

If fertility is restricted or if there are permanent symptoms, the doctor usually recommends operating on the varicocele. This includes extensive advice about the potential complications of the various procedures and how often a varicocele recurs. The study results regarding improved fertility after treatment of a varicocele are still contradicting itself.

The following procedures come among others. for the treatment of varicocele in question:

  • Microsurgical varicoceles operation under general anesthesia. This method is considered the method of choice (2019), it has the lowest complication rate and the fewest recurrences (renewed varicoceles formation). It can be carried out on an outpatient basis
  • Open surgical procedures, e.g. B. with access via the bar
  • Sclerotherapy from the scrotum, here the rate of recurrence of a varicocele is up to 10%, there is also the risk of developing thrombosis and inflammation of the veins (thrombophlebitis). If the sclerosant is accidentally injected into the testicular artery, there is a risk of testicular infarction
  • Laparoscopic surgery, i.e. a laparoscopy. The laparoscopic procedure has the highest complication rate and is only recommended for bilateral varicoceles.

In the case of a symptomatic varicocele, the focus is on treating the triggering cause, e. B. the removal of a tumor or the treatment of a lymphoma.

Complications

A typical complication in the surgical treatment of a varicocele is the formation of a hydrocele. Thrombophlebitis threatens with sclerotherapy; very rarely testicular atrophy occurs, e.g. B. by damage to the supplying testicular artery and subsequent insufficient blood flow.

forecast

If the varicocele is not treated, fertility may be impaired. Whether an operation increases fertility is controversial.

Authors

Dr. med. Martina Sticker, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:06


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.