Varicocele Ppt

[Renau Sheard]

Avaricocele (VAR-ih-koe-seel) is an enlargement of the veins within the loose bag of skin that holds the testicles (scrotum). These veins transport oxygen-depleted blood from the testicles. A varicocele occurs when blood pools in the veins rather than circulating efficiently out of the scrotum.

A varicocele may cause poor development of a testicle, low sperm production or other problems that may lead to infertility. Surgery to treat varicocele may be recommended to address these complications.

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The male reproductive system makes, stores and moves sperm. The testicles produce sperm. Fluid from the seminal vesicles and prostate gland combines with sperm to make semen. The penis ejaculates semen during sexual intercourse.

Having a varicocele can make it difficult for your body to regulate the temperature of the testicles. Oxidative stress and the buildup of toxins can result. These factors may contribute to the following complications:

Dr. Alana Biggers is an ABMS board certified internal medicine physician. She is an assistant professor at the University of Illinois at Chicago College of Medicine, where she specializes in internal medicine.

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The scrotum is a skin-covered sac that holds your testicles. It also contains the arteries and veins that deliver blood to the reproductive glands. A vein abnormality in the scrotum may result in a varicocele.A varicocele is an enlargement of the veins within the scrotum. These veins are called the pampiniform plexus.

A varicocele only occurs in the scrotum and is very similar to varicose veins that can occur in the leg.A varicocele can result in decreased sperm production and quality, which in some cases can lead to infertility. It can also shrink the testicles.

A spermatic cord holds up each testicle. The cords also contain the veins, arteries, and nerves that support these glands. In healthy veins inside the scrotum, one-way valves move the blood from the testicles to the scrotum, which sends it back to the heart.

Wearing tight underwear or a jockstrap can sometimes provide you with support that alleviates pain or discomfort. Additional treatment, like varicocelectomy and varicocele embolization, might be necessary if your symptoms get worse.

Varicocele embolization is a less invasive, same-day procedure. A small catheter is inserted into a groin or neck vein. A coil is then placed into the catheter and into the varicocele. This blocks blood from getting to the abnormal veins.

A varicocele is when veins become enlarged inside your scrotum (the pouch of skin that holds your testicles). These veins are called the pampiniform plexus. Out of 100 males, 10 to 15 have varicocele. It is like getting a varicose vein in your leg.

Varicoceles are when the pampiniform plexus veins in the scrotum become enlarged. These veins are like varicose veins (twisted, swollen veins found in the leg.) Varicoceles form during puberty. They can grow larger, and you may notice them more over time. Varicoceles are more common on the left side of the scrotum. This is because the male anatomy is not the same on both sides. Varicoceles can exist on both sides at the same time, but this is rare. About 10 to 15 boys out of 100 have a varicocele.

The male reproductive system makes, stores and moves sperm. The scrotum is the sac of skin that holds the testicles (testes). Sperm and the hormone testosterone are made in the testicles. Sperm mature while moving through a coiled tube (the epididymis) behind each testicle.

Sperm travel to the prostate from each epididymis through a tube called the vas deferens. When you ejaculate, seminal fluid mixes with sperm in the prostate to form semen. The semen travels through the urethra and comes out the end of your penis.

The spermatic cord holds the vas deferens and the testicular artery, which brings blood to the testicle. It also houses the pampiniform plexus, a group of veins that drain the blood from the testicles. Testes need a certain body heat that is below our core body heat for optimal sperm production, maturity and function. The body heat in the scrotum is about five degrees lower than that of the belly or pelvis. The latter is due to the presence of pampiniform plexus, which act as a countercurrent heat exchanger, cooling blood in the testicular artery before it enters the testicles. This helps keep the testes at the body heat needed to make good quality sperms. When these veins become enlarged such as in varicocele, overheating of the testes can lower sperm production and function, which may affect fertility.

Most males with a varicocele have no symptoms. But varicoceles are a concern for many reasons. Some may cause infertility (problems fathering a child) and slow growth of the left testicle during puberty. Varicoceles may be the cause of fertility problems in about four out of ten men who have problems fathering their first child. They may also be the cause of fertility problems in about eight out of ten men who have problems fathering a child after their first.

There may be many causes of varicoceles. The valves in the veins may not work well (or may be missing). If blood flow is sluggish, blood may pool in the veins. Also, the larger veins moving from the testicles towards the heart are connected differently on the left and right sides. More pressure is needed on the left side to keep blood flowing through the veins towards the heart. If blood flows backwards or pools in the veins, that can cause veins to swell. Rarely, swollen lymph nodes or other masses behind the belly block blood flow. This can lead to sudden swelling of the scrotal veins. This is often painful.

About 15 out of 100 men have varicoceles. It is hard to predict which of these 15 will have fertility problems caused by their varicocele. But about 4 in 10 men tested for fertility problems have a varicocele and decreased sperm movement. There is no link with other defects, race, place of birth or ethnic group. Though varicoceles are often found in men tested for infertility, 8 out of 10 men who have a varicocele do not have fertility problems.

Since surgeons have started using smaller cuts through the muscle for open surgery, healing time and pain are about the same with microscopic and laparoscopic surgery. Problems after either surgery are rare. Some problems could include:

There is a small chance surgery won't fix the problem. In rare cases, injury to the testicular artery can lead to loss of the testicle. Persistence or recurrence of the varicocele happens in less than one of ten patients who have surgery. Microscopic surgery has the lowest persistence rate or chance of varicocele coming back.

Embolization is done by an Interventional Radiologist. Injection of contrast through a tube with x-ray guidance is used to see the source of the problem. The goal is to find all veins leading to the varicocele. Coils (plugs with or without sclerosant, a dehydrating drug) are used to block the blood flow to the varicocele. It is done either with local anesthetic or with light sedation through a very small hole in the groin or neck. The method most often takes 45 minutes to an hour. Some problems are:

Healing after surgery is fast and pain is often mild. You should not work out for 10 to 14 days. You can often return to work 5 to 7 days after surgery. You will also follow-up with your urologist. For surgery done for fertility problems, semen analysis is done three to four months later.

Healing after embolization is also relatively short with only mild pain. You should not work out for 7 to 10 days after the procedure. You can often return to work one to two days later. The recurrence rate with embolization is on par with surgery. There are cases where embolization is preferred over surgery.

Most males with varicocele will not have problems. One out of five males with varicocele will have trouble fathering children. Semen analysis is highly recommended after age 16 years to determine if varicocele repair is needed. If a semen analysis is normal, it is recommended to have a repeat analysis every 2 to 3 years as the quality of sperms may go down with time. Fertility issues may come up years later, even if not seen earlier.

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