Varicocele Grading

Do you often feel a heavy sensation or painful discomfort in your scrotum? It could be a sign of varicocele. Varicocele, a condition that is similar to varicose veins in the legs, occurs within the veins of the scrotum. They do not cause any life-threatening condition, but might impact male fertility. In fact, the Asian Journal of Andrology reports that varicocele affects 15% of healthy men between the ages of 15 and 25 years.

While most individuals have the condition, many don't understand how the varicocele classification system determines the severity of the condition and when to seek help. So, read on to get the full details. 

What Factors Contribute to Varicocele Formation?

Varicocele usually occurs when the valves inside the testicular veins malfunction, resulting in poor blood circulation. These veins, known as the pampiniform plexus, are responsible for draining blood from the testicles back to the heart. When the valves fail, blood will accumulate in the veins, causing them to enlarge. As a result, the veins will become dilated, leading to testicular discomfort, shrinkage, and deterioration of the sperm quality. Here we have compiled some factors that influence the formation of a varicocele, 

Genetics and Age

If your family has a hereditary history of varicoceles or varicose veins, then you are more likely to develop the condition. Moreover, you are at higher risk in your adolescence, which might progress over time without proper treatment.

Lifestyle and Occupation

If you have undergone straining physical activity like prolonged standing, heavy lifting due to your occupation, then you might develop a varicocele. In fact, a recent study found that occupation and physical activity cause excess abdominal pressure in men, resulting in enlarged veins. 

Anatomical Factors

Research found that 80-90% of varicoceles are commonly found in the left testicle due to anatomical differences in venous drainage patterns. The left testicular vein is longer than the right vein, entering the left side renal veins at a right angle. It makes the left testicle more prone to develop varicoceles. 

Can Varicocele Affect Fertility?

Yes, varicoceles can affect fertility in men. In fact, it contributes to about 40% of cases of male infertility. Nonetheless, most individuals with the condition also have no problems in achieving pregnancy. But it is also possible that blood accumulation in the veins will raise the temperature inside the scrotum, which in turn affects the testicles and sperm count or production.

What is the Varicocele Grading?

The varicocele classification system helps doctors assess how advanced the condition is. The grading also helps them to recommend the appropriate treatment to manage the condition. Typically, your healthcare professional uses three grades to classify the varicoceles, such as:

Grade I

Grade I is the smallest and often difficult to detect. They can only be felt when you perform the Valsalva maneuver (the act of bearing down as if you are trying to have a bowel movement). It is usually asymptomatic and has no visible signs. 

Grade II

Grade II varicoceles are not visible, but are more pronounced than Grade I. The swollen veins can usually be detected during a physical examination, without the need to perform the Valsalva maneuver.

Grade III

Grade III varicocele is easily noticeable and is the most severe form. The enlarged veins are palpable, which causes the scrotum to swell and appear large on one side. 

Let us take a brief look at each Varicocele grade's symptoms, diagnosis, and treatment options.

How is a Varicocele Diagnosed Based on Ultrasound?

Apart from the clinical grading of varicocele, Doppler ultrasound imaging is used to precisely diagnose the severity of the condition. This Sarteschi classification system includes five grades of varicocele, graded based on the venous reflux and blood flow abnormalities detected in the Doppler ultrasound. Let’s take a brief look at them:

Can A Varicocele Go Away on its Own?

No, a varicocele cannot cure or resolve on its own. Once the veins get enlarged in the condition, they will not shrink or return to their normal size if you fail to seek proper treatment. However, the varicocele severity levels as well as their symptoms might remain stable or get worse over time. For instance, if you have a mild varicocele, that is Grade I or II, then you may not need treatment unless it causes pain, infertility issues, or testicular shrinkage.

When to Seek Medical Attention

Now that you know the grading of varicocele, you should also be aware of when to consult your healthcare professional for timely treatment. Speak to your doctor if you experience any of the following:

• notice any visible lumps 
• have a feeling of heaviness in your scrotum.
• Experience Warning Signs and Symptoms such as scrotal swelling, testicular pain.
• Get disrupted to handle your daily routines due to the discomfort.
• Have been facing fertility issues and want to start a family 

How to Treat Varicocele?

Varicocele, a condition often mentioned as a bag of worms in the scrotum, is usually harmless. If your symptoms are mild and harmless, then you can follow the conservative treatment approach for relief. Some of the remedies are,

• Over-the-Counter Painkillers: Medicines like paracetamol or ibuprofen can manage pain and inflammation. However, always make sure to follow the prescription of your healthcare professional to get the right dosage.
• Supportive Underwear: Wearing briefs or athletic supporters can give extra support and alleviate the discomfort.
• Rest: Refrain from prolonged standing or heavy lifting. Such physical activities could worsen the symptoms further.
• Cold Compression: Use cold packs to reduce swelling, discomfort, and pain in the scrotum.
• Lifestyle changes: Maintain a healthy weight, engage in regular exercise, and consume a balanced diet to reduce the symptoms as well as to improve your overall well-being. 

When Do You Need Surgery for a Varicocele?

You don’t need surgery to treat a varicocele if you are diagnosed with the condition in its initial grade. In such cases, you are less likely to experience pain or fertility issues. However, if you tend to struggle with pain and discomfort even after following conservative treatment, then your healthcare professional may advise one of the following surgical options:

• Varicocelectomy: An open surgery involves ligation of the affected veins to divert blood flow. It is done under general anesthesia and has an excellent rate of success in improving fertility.
• Laparoscopic Varicocelectomy: A less invasive procedure to correct the affected veins through tiny incisions and a camera. It is highly advised because it has a shorter recovery time compared to open surgery.
• Percutaneous Embolisation: A non-surgical treatment where a coil or sclerosing agent is inserted in the veins to stop abnormal blood flow. It is performed under local anesthetic and has fewer chances of complications.

Understand Your Varicocele Grade to Get the Right Treatment!

A varicocele is a common condition that affects men at different ages and stages of life. While most people experience no symptoms, some might experience mild discomfort or severe pain during certain activities. Depending on the varicocele grading assessment and your fertility health, make sure to choose the right treatment plan for you. 

If you have a varicocele that’s affecting either your daily life or your plan to start your family, then you need expert advice. Book your consultation with Apollo Spectra to get an accurate diagnosis and personalised treatment plans for long-lasting results.