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A scrotum is the important part of the male reproductive glands that looks like a sac that holds testicles and also contains the arteries and veins through which blood is supplied to these glands. The enlargement of veins within the scrotum is called varicocele. These veins are known as the pampiniform plexus. It is similar to a varicose vein that occurs in the leg. Most varicoceles develop over the time and most of them are easy to diagnose and may not need any treatment. A varicocele can result in decreased sperm production and quality that can also lead to fertility issues. It can also cause testicles to fail to develop normally or to shrink. varicocele can form when the valves inside the veins in the cord prevent blood from flowing properly, resulting in the backup that causes the veins to dilate. This may affect the testicle and fertility of the man.

Varicoceles generally occur during puberty and are commonly found on the left side of the scrotum. It’s a very rare case that varicoceles can exist on both sides and not all varicoceles affect sperm production. Some of the symptoms associated with a varicocele may include:

• a lump in one of the testicles

• swelling or scarring in the scrotum

• Enlarged or twisted veins in the scrotum

• a dull aching, heavy, recurring pain in your scrotum

• pain vary from sharp to dull discomfort

• One testicle that’s bigger or heavier than the other

• Pain that worsens when you’re standing but is relieved when you lie down

• Low sperm count

• Pain that’s worse after strenuous exercise

• Pain that is worse in hot weather

A varicocele can be diagnosed by performing physical exam while a patient is standing up and lying down or doctor may need to perform a scrotal ultrasound that helps in measuring the spermatic veins and allow doctor to get a more accurate picture of the condition. After diagnosing the varicocele, doctor will categorizes it in one of three grades. These labeled grades are 1 to 3 depending on the size of the lump in the testicle. Grade 1 is the smallest and grade 3 the largest.

• Grade 1 - The smallest type, this is not visible, but a physician can feel it if they use a Valsalva maneuver.

• Grade 2- This is not visible, but it can be felt without a Valsalva maneuver.

• Grade 3- The varicocele is visible.

These grades don’t affect the overall treatment methods. Treatment options are based on the degree of discomfort or infertility a person may have.

If the varicocele causes pain, testicular atrophy or infertility problem then person may undergo varicocele repair. The main aim of varicocele surgery is to seal off the affected vein to redirect the blood flow into normal veins that may also improve or cure the infertility or improve the quality of sperm. Treatment of a varicocele generally improves sperm quality but it is not clear if an untreated varicocele can worsen the sperm quality over time.

There are various treatment options to correct the varicocele that include:

• Open Surgery Method - it is generally performed as an outpatient surgery under the influence of general or local anesthesia. Surgeon will access the varicocele veins through the groin or through incision in abdomen or below the groin.

Patient may be able to return to normal, nonstrenuous activities after two days. Pain from this surgery generally is mild but may continue for several days or weeks. Doctor may prescribe some medications for relieving pain and discomfort after the surgery. Patient will be advised not to have sex for some period of time. Most often, it will take several months after surgery before improvements in sperm quality can be seen with a semen analysis as it takes approximately 2-3 months for new sperm to develop.

• Laparoscopic surgery – procedure is done under general anesthesia. In this, surgeon will pass a tiny instrument through a small incision made in the abdomen to see and to repair the varicocele.

• Percutaneous embolization - This procedure is done under local anesthesia and as an outpatient. A surgeon will insert a tube into a vein in the groin or neck to pass the instruments. Doctor will then releases coils or a solution that causes scarring to create a blockage in the testicular veins that interrupts the blood flow and repairs the varicocele while viewing it on the monitor. This procedure isn't as widely used as surgery.

These procedures are relatively safe but, as with any surgery, there are some risks associated that may include:

• Damage to the artery

• Infection

• Further testicular atrophy

• Scarring, bruising, swelling or buildup of fluids

• Pain in the abdomen

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