Varicocele

What is Varicocele?

A varicocele is a condition characterised by the abnormal enlargement of the veins within the scrotum, specifically those in the pampiniform plexus, a network of veins responsible for cooling the blood flowing to the testicles. This condition can be likened to varicose veins that occur in the legs It commonly develops during puberty and is most frequently observed on the left side of the scrotum due to differences in vein anatomy and blood flow.

Varicoceles are relatively common, affecting approximately 10% to 15% of males While many individuals with a varicocele may not experience noticeable symptoms, the condition can have significant implications for testicular health, fertility, and hormone production. It is considered one of the leading causes of male infertility and testicular discomfort.

Varicoceles are classified based on their severity, which is determined through physical examination and imaging studies:

Grade 1 — the varicocele is not visible but can be felt during a Valsalva manoeuvre (when you bear down and hold your breath).
Grade 2 — the varicocele is not visible but can be felt without requiring a Valsalva manoeuvre.
Grade 3 — the varicocele is large enough to be visible through the skin.

What causes Varicoceles?

Varicoceles develop due to the malfunction of the valves within the veins of the spermatic cord, which are responsible for ensuring the one-way flow of blood from the testicles to the heart. When these valves fail to function properly, blood begins to pool within the veins, causing them to dilate and form a varicocele. This results in increased venous pressure within the scrotum, particularly affecting the pampiniform plexus, a network of interconnected veins that play a critical role in regulating testicular temperature.

The left side of the scrotum is more commonly affected due to anatomical factors. The left testicular vein drains into the left renal vein, which is a longer and higher-pressure pathway compared to the right testicular vein, which drains directly into the inferior vena cava. This difference in venous drainage creates a predisposition for blood pooling and the subsequent formation of varicoceles on the left side. Additionally, the perpendicular angle at which the left testicular vein meets the renal vein further contributes to the likelihood of increased venous pressure, making varicoceles more prevalent on this side.

This disruption in blood flow and pooling within the veins can elevate the temperature within the scrotum, impairing the environment necessary for healthy sperm production and function.

In older patients, detailed diagnostic tests are needed to rule out the possibility of a kidney tumour causing the compression of the vein.

What are the symptoms of Varicoceles?

Varicoceles may not always present noticeable symptoms, but when they do, they often impact scrotal comfort and testicular function. Here are some common signs to watch for:

Pain or discomfort

The affected area may feel achy or uncomfortable, particularly after prolonged standing, physical activity, or at the end of the day. This pain often improves when lying down.

Heaviness in the scrotum

A persistent sensation of weight or dragging in the scrotum is common, adding to discomfort.

Visible or palpable veins

The dilated veins may appear enlarged or feel like a “bag of worms” under the skin, especially when standing.

Testicular atrophy

The testicle on the affected side may shrink in size due to impaired blood flow and decreased function.

Fertility problems

Varicoceles can impact sperm production and quality, potentially contributing to difficulties in conceiving.

If you notice any of these symptoms, it is important to seek medical advice to prevent complications and ensure appropriate management.

Who is at risk of developing Varicoceles in Singapore?

While varicoceles can affect men worldwide, certain factors may increase the likelihood of developing this condition. Risk factors include:

If you fall into one or more of these categories, regular check-ups with a urologist can help with early detection and management.

Age

Varicoceles are most commonly diagnosed during adolescence or early adulthood, typically between the ages of 15 and 25.

Anatomical differences

Variations in vein structure, particularly on the left side of the scrotum, can predispose individuals to varicocele formation.

Occupational strain

Jobs that involve prolonged standing, heavy lifting, or physical exertion may increase venous pressure in the scrotum, raising the risk.

Family history

A genetic predisposition to weak vein walls or faulty valves may run in families, making some men more susceptible.

Obesity

Being overweight can contribute to increased abdominal pressure, which may exacerbate vein dilation and blood pooling in the scrotum.

How are Varicoceles diagnosed?

At Allen Sim Urology, we prioritise accurate and personalised diagnosis to ensure the most effective treatment plan for varicoceles. Our comprehensive approach includes the following methods:

01. Physical examination

During the consultation, we assess the scrotum for any enlarged veins. The diagnosis often involves the Valsalva manoeuvre, where you are asked to bear down or hold your breath to help detect smaller varicoceles.

02. Scrotal ultrasound

We utilise high-resolution ultrasound imaging to confirm the presence of a varicocele, assess its severity, and rule out other potential conditions.

03. Semen analysis

For patients experiencing fertility concerns, we may recommend a semen analysis to evaluate the impact of the varicocele on sperm count, motility, and quality.

04. Testicular volume measurement

By measuring the size of the testicles, we can determine if the varicocele has caused any testicular atrophy, which is an important factor in treatment decisions.

At Allen Sim Urology, our team is dedicated to providing precise and thorough diagnostic services, ensuring you receive the care you need.

What are the treatment options for Varicoceles in Singapore?

At Allen Sim Urology, we provide comprehensive and highly personalised treatment options for varicoceles to address your specific needs. Whether your symptoms involve discomfort, fertility concerns, or testicular health, our team ensures you receive the most appropriate care. Our treatment options include:

Monitoring and management

For mild cases or asymptomatic varicoceles, we may recommend regular monitoring, lifestyle modifications, and over-the-counter pain relief to manage symptoms without the need for surgical intervention.

Microsurgical varicocelectomy

This minimally invasive surgical procedure involves ligating the affected veins to redirect blood flow to healthy veins. At Allen Sim Urology, we perform this procedure with precision to ensure minimal discomfort and a quick recovery.

Percutaneous embolisation

In collaboration with interventional radiology specialists, we offer embolisation, a non-surgical procedure that uses a catheter to block the affected veins, which helps improve blood flow and alleviate symptoms.

Assisted reproductive techniques

For patients with fertility challenges, we may recommend varicocele treatment with fertility interventions such as intrauterine insemination (IUI) or in-vitro fertilisation (IVF) to optimise outcomes.

At Allen Sim Urology, your care is our priority. We develop treatment plans according to your specific health condition, which helps us ensure the optimal outcomes and improved quality of life.

If you are experiencing discomfort or fertility concerns due to varicoceles, schedule a consultation with us for a detailed diagnosis and personalised treatment options.

Frequently Asked Questions (FAQs)

01. Can a varicocele cause infertility?

Yes, varicoceles can impact sperm production and quality, potentially leading to infertility. They are found in approximately 40% of men evaluated for fertility issues.

02. Is a varicocele dangerous?

Varicoceles are usually harmless and often don’t cause any symptoms. However, some men may feel a dull ache or a heavy feeling in the scrotum. In more serious cases, varicoceles can affect sperm production and quality, which might result in fertility challenges.

03. Can a varicocele be prevented?

Unfortunately, there’s no known way to prevent a varicocele because the exact cause isn’t fully understood.

04. Does a varicocele always require treatment?

Not everyone requires treatment. If it doesn’t cause pain, discomfort, or fertility issues, treatment may not be necessary.

05. Can a varicocele recur after treatment?

While treatments like varicocelectomy and embolisation are generally effective, there is a possibility of recurrence. Discussing potential outcomes with your healthcare provider is important.

06. Is a varicocele the same as a hydrocele?

No, a varicocele is an enlargement of veins within the scrotum, while a hydrocele involves fluid accumulation around the testicle. Both can cause scrotal swelling but have different causes and treatments.