What is varicocele?
Varicocele is a varicose dilation of the veins (varicose veins) of the spermatic cord (located in the bursa, above and around each testicle). This dilation is the consequence of a malfunction of valves located in the veins. The blood is no longer able to go up along the veins to reach the larger veins (left renal vein and inferior vena cava).
In 85 to 90% of cases2, the left side is affected. On this side, the spermatic veins join the left renal vein while on the right side they join the inferior vena cava. Even though both sides can be reached symmetrically or asymmetrically.
What are the causes ?
Varicocele is caused by the malfunction of a valve located in the veins (which allows blood to flow to the testes). As the cause of this dysfunction is still unknown, it is impossible to explain the exact causes of varicocele.
Symptoms of varicocele
Varicocele may either not give any symptoms (and in this case it remains undetectable), or manifest itself by the following symptoms:
A heaviness in the testicles, especially at the end of the day or in hot weather;
At an advanced stage, an increase in the size of the testicle.
Diagnosis and additional examinations
Bilateral and comparative, the diagnosis looks for varicose dilations above the testes. Palpation of the testicles is performed lying down and then standing, following what doctors call the Valsalva maneuver.
The examination eliminates another cause of heaviness (inguinal hernia, cyst of the spermatic cord, effusion of fluid in the bursa, tumor of the testis). The doctor should also perform a comparative size of the testes using a Prader orchidometer or via ultrasound. The latter highlights venous dilations, eliminates another local pathology and may, if a Doppler study is associated, show stagnation of blood in dilated veins.
There are four grades of varicocele defined by the Dubin and Amelar classification:
Grade 0 where the varicocele is not visible, not palpable and only detectable only by ultrasound;
Grade I for which the disease is palpable after Valsalva maneuver but not visible;
Grade II where it is not visible but palpable filling by gravity in a standing position without Vasalva maneuver;
Grade III where it is visible and palpable without Vasalva.
The evolution of varicocele
The course is variable: a varicocele may very well never bother the patient. Conversely, it can cause discomfort that increases over the years to become almost permanent. Sometimes varicocele is only bothersome in periods.
In addition to the other pathologies of the cord and the testicle (see above), it is necessary to think in an adult of more than 30 years of the possibility of a tumor of the kidney. In fact, the bulky masses of the kidney can cause compression of the renal vein, or even of the inferior vena cava, and reduce the venous return of the spermatic veins. A varicocele can therefore, exceptionally, lead to the discovery of kidney cancer.