The male reproductive tract is responsible for the production, maturation, and transport of sperm. This tract is a complex and highly integrated entity. Sperm produced in the testicles are transported through the genital duct system and deposited in the urethra during ejaculation followed by emission.
Abnormalities within the male reproductive tract may present as a scrotal mass. Masses may have little or no health significance or may represent life-threatening illnesses. Therefore, it is necessary to follow a set course of action to determine the nature of the masse and the most appropriate treatment. For example, testicular cancer which can present as a scrotal mass, is a source of great concern and uniformly requires prompt intervention. Other masses, such as varicoceles, may be benign or cause testicular growth retardation in adolescent boys or impair fertility in adults. Thus, it is important for a patient to seek prompt medical attention when he identifies a scrotal mass or any lump or bump while performing a testicular self examination. The following information will assist you when talking to Dr. Shaw about varicoceles.
What is a varicocele?
What causes a varicocele?
How common are varicoceles?
What symptoms or problems are associated with varicoceles?
- Scrotal swelling (typically on the left)
- Mass like structure in the scrotum, near testicle; feels like a “bag of worms”
- Testicular pain or heaviness, that worsens later in the day
- Decrease in testicular size on the side of the varicocele
Some men diagnosed with a varicocele have no symptoms, but varicoceles are important for several reasons. Varicoceles are thought to cause infertility and testicular atrophy (shrinkage). Approximately 40 percent of cases of primary male infertility and 80 percent of cases of secondary male infertility are believed to be due to varicoceles. Varicoceles rarely cause pain. When pain is present, it can vary from a dull, heavy discomfort to a sharp pain. The associated symptoms may increase with sitting, standing or physical exertion – particularly if any one of these activities occurs over long periods of time. Symptoms often progress over the course of the day, and they are typically relieved when the patient lies on his back, allowing improved drainage of the veins of the pampiniform plexus.
How are varicoceles diagnosed?
How are varicoceles treated?
Laparoscopic varicocele repair utilizes small (1cm) incisions in the abdominal wall, through which the instruments are inserted. The laparoscopic instruments are a camera, heated scissors, graspers, etcs. They are about the width of a pen. The camera inside the abdomen is used to visualize the surgery, and the surgeon uses these small instruments to operate. The gonadal vein is visualized in the abdomen; this is the vein that leads to the branching, dilated veins in the scrotum. Small clips are placed on the gonadal vein and it is cut.
Laparoscopic varicocelectomy is an outpatient procedure (you get to go home same day) performed under general anesthesia (you will be asleep). It allows for faster recovery and typically patients only have abdominal pain for 1-2 days. It is appropriate for smaller varicoceles (grade 1-2).
The open surgery is performed through a single 1 inch incision above the scrotum. This technique is appropriate for larger varicoceles (grades 3-4), because they have a lower chance of recurrence. In open varicocelectomy, the indentified. These large, varicosed veins are individually tied off and cut.
Open varicocelectomy is also an outpatient procedure, performed under general anesthesia. Because it is done above the scrotum, the recovery is somewhat longer than the laparoscopic approach. Typical side effects/risks can include scrotal brusing, swelling, pain, or hematoma formation. A hematoma is clotted blood in the scrotum and can feel like a painful hard mass. If uncomplicated, it will resolve on its own within a few weeks.