Varicoceles, present in 15% of men since puberty, are dilated veins that drain blood from the testicles. Like external varicose veins, varicoceles dilate due to defective valves that are unable to efficiently shunt blood away from the testes. The resulting blood stasis brings heat to the testicles, normally 1–2°C below core body temperature for optimal function. Prolonged raised testicular temperature kills germ cells that produce sperm, reduces testicular size, damages sperm DNA, and decreases Testosterone production. Varicoceles, most common in the left testicle, are present in up to 45% of men with primary infertility. 2%–10% of men with varicoceles report dull, throbbing testicular pain that worsens with strain. Diagnosis is only made by a specialized physical exam that is confirmed by ultrasound, as done routinely by our dedicated Y-Factor team.
Fortunately, surgical correction of a varicocele, or varicocelectomy, done under IV sedation or anesthetic are available, but not all have the same outcomes. The Laparoscopic Varicocelectomy involves three 5mm openings near the umbilicus and pubic bone, and a doppler probe is used to find the veins. This procedure has a higher post-op rate of 6% varicocele recurrence and 17.6% rate of hydroceles, or fluid around the testicles.
Percutaneous Varicocele Embolization involves venous catheter access thru the femoral or internal jugular vein and blocking the varicoceles with solid or liquid agents. Although a minimally invasive approach associated with decreased postoperative pain and hydrocele risk, embolization has a failure rate of 13%.
Microscopic Inguinal Varicocelectomy uses a 3–4 cm incision over the lower inguinal canal and thru the external oblique muscle fascia. Although better than the laparoscopic method, the inguinal technique has a slight varicocele recurrence risk and greater post-op pain.
A newer, state-of-the-art technique is Microsurgical Subinguinal Varicocelectomy (MSV) that uses a 3-cm incision over the pubic bone and just below the external ring. A surgical microscope is used to magnify and find the varicoceles that are clamped with surgical clips. MSV has significantly lower post-op hydrocele (0.44%) and varicocele recurrence (1.05%) rates.
If you’ve been diagnosed with Varicoceles and want to learn more about how we can help with surgical options, book your appointment today by clicking below. We’re ready to help men in Houston, The Woodlands, Tomball, Richmond, Sugar Land, Katy, Webster, Galveston, and surrounding areas. Women have OB-GYNs | Men Have The Y Factor!
Clavijo, R. I., Carrasquillo, R., & Ramasamy, R. (2017). Varicoceles: prevalence and pathogenesis in adult men. Fertility & Sterility, 108(3), 364–369. https://doi-org.ezp.twu.edu/10.1016/j.fertnstert.2017.06.036
Johnson, Dane. (2017). Treatment of varicoceles: Techniques and outcomes. Fertility and Sterility., 108(3), 378-384. https://doi.org/10.1016/j.fertnstert.2017.07.020
Machen, G. L., Johnson, D., Nissen, M. A., Naber, E., & Sandlow, J. I. (2020). Time to improvement of semen parameters after microscopic varicocelectomy: When it occurs and its effects on fertility. Andrologia, 52(2), 1–5. https://doi-org.ezp.twu.edu /10.11 11/ and.13500
Andre Piliszek, DC, MSN, APRN, FNP-C
Andre Piliszek is a certified Family Nurse Practitioner (FNP-C) and brings to The Y Factor over 25 years of outpatient clinical experience as a certified DOT medical examiner, Nurse, Medical Assistant, and Radiographer. Guided by the training and philosophy of Dr. Russel Williams, M.D. and Dr. Tristan Grimaldo, DNP, his goal is to provide the highest level of care possible for all his Y-Factor clients by addressing their concerns in the most attentive and empathetic manner. He is firmly committed to using his clinical experience and insight to help men attain optimal clinical outcomes. Recreationally Andre enjoys hiking and target shooting outdoors, live music performances, and is also currently improving his verbal Spanish language. He is excited and honored to be invited to join the Y Factor team.