[Vamonos Pest]

I've used the search function and apart from two brief passing mentions, there have not been any discussions here regarding varicoceles.

The below is just a brief description about varicoceles for those of you who don't know what they are. Chances are that if you already know what a varicocele is, you probably have one and have already spent ages researching it. I am in my early twenties and have had a varicocele since I was a teenager. I have spent many years researching this area. Varicoceles and their negative effects are an extremely controversial topic among the medical experts in this field. The general view among the various forums is that doctors do not properly understand (or are unwilling to acknowledge) the true effects of a varicocele.

I am due to have a microsurgical sub-inguinal varicocelectomy soon to fix my grade 3 varicocele. I have already done my due diligence regarding the surgery however I would like to get the views, opinions, experiences and advice of members of this forum who also have a varicocele or have had surgery to fix it. There is a unique and powerful collective pool of knowledge here that is unmatched by other forums. It would be good to have a discussion prior to my surgery and also for the benefit of other members here who suffer from a varicocele, whether they are aware of it or not.

Quote:

Varicoceles are abnormally dilated testicular veins (pampiniform plexus) of in the scrotum, which is normally secondary to internal spermatic vein reflux. Varicocele is found in approximately 15% of the general population, 35% of men with primary infertility and in 75-81% of men with secondary infertility. It is more common on the left side. In adolescents, the incidence of varicocele is approximately 15%; the abnormality is extremely rare in prepubertal boys

Although most men with varicoceles are able to father children, there is abundant evidence that varicoceles are detrimental to male fertility. A study by the World Health Organization (WHO) on over 9,000 men showed that varicoceles are commonly accompanied by decreased testicular volume, impaired sperm quality, and a decline in Leydig cell function.2 Another report by Johnson and colleagues showed that 70% of healthy, asymptomatic military recruits with palpable varicoceles had an abnormality on semen analysis.3 Furthermore, studies in animals4,5 and humans6-8 suggest that varicoceles cause progressive testicular damage over time. It appears that surgical repair of varicoceles not only halts this declines in testicular function but often reverses it. Whether the improvements in semen parameters, seen in 80% of men after varicocele ligation, translate into improved pregnancy and delivery rates has been a matter of ongoing controversy. Recent studies employing non-operated control groups clearly indicate that varicocelectomy does improve pregnancy rates.

ETIOLOGY
Presumably due to anatomic differences, varicoceles are much more common on the left side. The incidence of bilaterality is anywhere from 15 to 50% but isolated right varicoceles are fairly rare. The left internal spermatic vein empties into the left renal vein. It is 8 to 10cm longer than the right internal spermatic vein, which drains into the inferior vena cava. This is believed to result in increased hydrostatic pressure that is transmitted down the vein to the scrotal pampiniform plexus, causing dilation and tortuosity of these vessels.9 Elevated pressure in the left internal spermatic vein may also result from compression of the left renal vein between the aorta and the superior mesenteric artery, a phenomenon known as the "nutcracker effect." Radiologic studies have documented relative distention of the proximal left renal vein suggesting partial distal obstruction.10

Varicoceles may also arise secondary to reflux of venous blood into the pampiniform plexus as a result of absent or incompetent valves within the internal spermatic vein. A report by Braedel et al. on over 650 consecutive men with varicoceles revealed that 73% had absent internal spermatic venous valves on venography.11

Varicoceles generally become clinically manifest at the time of puberty. Although there is no data to suggest a genetic basis for these lesions and hereditary patterns have not been identified, these issues have been poorly studied. Retroperitoneal masses such as sarcomas, lymphomas, and renal tumors have been known to cause varicoceles by obstructing venous outflow from the testicles but varicoceles are not known to be a component of any clinically recognized syndrome.

https://www.cornellurology.com/clinical-...aricocele/

[MidniteSpecial]

I have it on my left nut. I remember first time I found out was in high school. Ten years ago. Was taking a physical for my football team. They had me follow up with a specialist before they cleared me to play. I was allowed to play and never thought twice about it since then. It's fun to feel it sometimes. It's weird. If anything makes balls look bigger.

I wonder if it affects me or hinders me in anyway though. I have kids and blow big loads so all good there.

[Bad Hussar]

I'm also really surprised it isn't mentioned more. It is very common. I'm not a doctor, but I have been told by one that in most cases it isn't anything to worry about and that surgery isn't recommended. Unless it is the cause of infertility, and this is apparently quite rare. Most men with Varicocele have normal sperm counts.

[Vamonos Pest]

Yeah my one is on the left side too. Due to the anatomy of the human body, varicoceles occur on the left side the majority of the time; isolated cases on the right side are rare and can indicate a different underlying problem.

My one causes me discomfort, especially on a hot day when my testicles hang low and also whenever I lift weights. It hasn't affected me in any way, I blow big loads and bang bitches with no issues. I haven't tried to have a kid yet so I don't know if it is affecting my fertility. That's another reason why I am getting the surgery. One thing about varicoceles is that the effects of it are extremely individualistic. One guy might have a huge grade III varicocele and have no issues and be able to have kids with no problem. Then another guy might have a small grade I varicocele and run into a host of issues which stem from the varicocele. It's one of the reasons why there is so much controversy and opposing views on this topic. When somebody starts researching about varicoceles they go down a path like this:

The place where varicoceles are discussed the most are bodybuilding forums. If you visit forums like anabolic minds/t-nation etc, this is a issue that is regularly discussed. One of the most comprehensive threads out there discussing varicoceles is the one below:

http://anabolicminds.com/forum/male-anti...ffect.html

The thread used to be 80+ pages long so I don't know what has happened to it. However even if you read through the entire thread multiple times (as I have), you still don't arrive at a definite conclusion regarding the true effects of a varicocele and the benefits of surgery. Something which really annoys me in that forum and also other forums is that guys post complaining about their varicocele and decide to have surgery to fix it. Then instead of posting the most valuable piece of information regarding how surgery went and how they are faring x months down the line, they decide to stop posting. You also get a sense that there are too many variables involved with the problems that these guys are having to arrive at a conclusion. They are on steroids, aromatase inhibitors, serms, Hcg, the works. So when they start complaining about hormonal, testicular, fertility, sexual problems etc and how they are convinced it's because of their varicocele, it becomes extremely difficult to view it objectively and in a scientific manner where there is a cause and effect relationship free of all other variables. Personally I feel that unless somebody has a HUGE bilateral (on both sides) varicocele that has caused significant testicular atrophy (shrinkage) then it shouldn't affect testosterone levels. This however is virtually unheard of.

If you research varicoceles it's inevitable that you will also stumble upon the fertility forums. Here girlfriend's and wives who can't get pregnant post about how their 'DH' (yeah I didn't know what it meant either, it stands for Dear Husband) has a varicocele. After searching these forums, there are a handful of cases where the guy has gotten surgery and his sperm count drastically improved. Key note here is handful. There simply aren't enough threads and cases to make a definite conclusion and feel that the results are statistically significant.

The misc over at bb.com is also a place full of guys with varicoceles. There are a lot of threads there about this and quite a few guys there have gotten surgery to fix it. The same problem happens here too where guys stop posting x months down the line about the results. However I found that there are enough guys there who have posted positive results about their surgery.

Then you come across a multitude of general medical forums where varicoceles are discussed but these are the equivalent of yahoo answers and I don't rate them at all.

Lastly are the medical journals. There are a number of studies and research about varicoceles and they normally conclude with 'There was a statistical significance in the increase of sperm quality and size of the testicle after microsurgical approach.....however surgical approach remains a topic of controversy. However increasingly results and studies show that if the patient meets a number of specifications, then surgical approach should be looked at....'.

After years of research, I have found that the gold standard to fix a varicocele is via 'microsurgical sub-inguinal varicocelectomy'. This approach virtually eliminates risks of complications such as hydrocele formation and inadvertent severance of the testicular artery. It also has the lowest rate of recurrence. DO NOT have your varicocele fixed via the inguinal approach or laparoscopically or worst of all via embolisation. Your surgeon might want to fix it via these methods but that alone is an indication to find another surgeon. Do your due diligence as although this is a common surgery, the amount of unnecessary complications and problems that can arise is not to be taken lightly. If you cannot find a surgeon in your area who specializes in microsurgery and has performed a number of micro surgical sub-inguinal varicocelectomy's then look further. If you need surgery and this is not an option, then I would advise you to not get it fixed until you have the ability to find a surgeon who meets these requirements. Once you're cut, you're cut and there is no going back.

Edit: Somebody posted the below in another thread which I strongly advise also:

Quote:

(I'd get a male doctor for something like this, I wouldn't trust a female on something as important as this, but that's just my thought on it). I chose a highly rated doctor who wasn't too old, nor too young (More than 40, less than 60)