Varicocele and male infertility

 WHAT IS VARICOCELE?

Varicocele is produced by dilatation of the pampiniform plexus on veins. It is usually left sided; possibly because the left testicular vein is longer than the right, enters the left renal vein at a right angle and is crossed by the colon(part of large intestine) which may compress it when loaded.

In varicocele, there is an elongation and dilation of the veins of the pampiniform plexus(the venous network of approximately 10 veins draining the testis and epididymis). It is a common disorder found in adolescents and young adults. The great majority occur on the left side of scrotum because the right testicular vein drains into the low-pressure inferior vena cava , whereas the left vein drains into the left renal vein, in which the Venus pressure is higher. Very rarely, a malignant tumor of the left kidney with invasion of the left renal vein may block the exit of the testicular vein.

What Are Possible Varicocele Complications OR SYMPTOMS?

Pain. A dull, aching pain or discomfort is more likely when standing or late in the day. Lying down often relieves pain.

A mass in the scrotum. If a varicocele is large enough, a mass like a "bag of worms" may be visible above the testicle. A smaller varicocele may be too small to see but noticeable by touch.

Differently sized testicles. The affected testicle may be noticeably smaller than the other testicle.

Infertility. A varicocele may lead to difficulty fathering a child, but not all varicoceles cause infertility.
This infertility is due to low sperm count.

How Is a Varicocele Diagnosed?

A varicocele may be detected during a routine physical exam, scrotal ultrasound or fertility evaluation. A varicocele may lead to difficulty fathering a child, but not all varicoceles cause infertility. Your doctor may feel a twisted growth on your testicle or notice that one testicle is larger than the other. The varicocele if it’s become swollen or enlarged. If the varicocele cannot be visibly detected, your doctor may ask you to stand up, take a deep breath, and hold it while you bear down. This is also known as a Valsalva maneuver(The Valsalva maneuver is a breathing method that may slow your heart when it's beating too fast. To do it, you breathe out strongly through your mouth while holding your nose tightly closed). and may help your vascular specialist to detect abnormally large veins in the testicles.
A scrotal ultrasound uses high-frequency sound waves to give your vascular specialist a clear view of the inside of your groin and testicles. 

WHAT IS THE TREATMENT OF VARICOCELE?

Surgery

Embolization

Pain Medicine and Athletic support

There are several treatment options that can help you find varicocele pain relief. Most of these treatments are available at an outpatient vascular center.
This disease is related to scrotum and it content so lets explain about these structure

WHAT IS SCROTUM?

The scrotum is an outpouching of the lower part of the anterior abdominal wall. It contains the testes, the epididymites, and the lower ends of the spermatic cords.

The wall of the scrotum has the following layers:

• Skin.

• Superficial fascia, contain dartos muscle 

• External spermatic fascia from the external oblique

muscle which is the muscle of abdominal wall.

• Cremasteric fascia from the internal oblique muscle which is also muscle of abdominal wall; the

cremasteric muscle is supplied by the genital branch of

the genitofemoral nerve. The origin of genitofemoral branch is lumbar plexus.

• Internal spermatic fascia from the fascia transversalis the innermost muscle of abdominal wall.

Scrotum contain testes so lets explain about the testes:

What is testes?

The testes are male gonad-paired, ovoid organs responsible for the production of spermatozoa and testosterone.
Blood supply of testes is testicular artery arise from anterolateral abdominal aorta just inferior to renal arteries
Layers of testes
There are two layers of testes
1.Tunica vaginalis
2.Tunica albuginea
WHY TESTES ARE KEPT OUTSIDE THE BODY?

Normal spermatogenesis(DEVELOPMENT OF SPERM CELL) occurs only at a temperature lower than that of the abdominal cavity

(IT REQUIRE TEMPERATURE LOWER THAN THE BODY TEMPERATUE)

, hence the descent of the testes into the scrotum. The tunica albuginea is the outer, fibrous capsule of the testis.

WHAT IS EPIDIDYMIS?

The epididymis is an organ present in male reproductive system made up of highly coiled tube that act as reservoir of spermatozoa. The epididymis on each side lies posterior to the testis and has a head, a body, and a tail. It is a coiled tube approximately 20 ft. (6 m) in length. The vas deferens emerges from the tail.
BLOOD SUPPLY OF EPIDIDYMIS

The epididymis is supplied by the testicular artery through a branch which anastomoses with and reinforces the tiny artery to the ductus deferens.

The epididymis consist of the following 
1.Head of epididymis
2.Body of epididymis
3.Tail of epididymis

WHAT IS SPERMATIC CORD?

The spermatic cord is a collection of structures that pass

through the inguinal canal to and from the testis.

 These structures include the following:

• The vas deferens.

• The testicular artery.

• Testicular veins (pampiniform plexus).

• Testicular lymph vessels.

• Autonomic nerves.