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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > second degree varicocele
Expert: Arthur Goldstein, M.D.
Date: 10/7/2008
Subject: second degree varicocele
Question
Sir,
4 weeks back ,I started getting fever with slight chills, accompanied with a swelling of the scrotum predominantly on the left side.
I consulted a doctor who diagnosed me with Filaria.He prescribed an antibiotic course for 5 days and a 3 week course of DEC.Following the treatment, the hydrocele subsided and i felt fine.
However 3-4 days after completing the course, i could feel slight discomfort in my lower abdomen on the left side as well as a slight swelling on the left side of the scrotum.
I feared that the filaria wasnt cured and saw a doctor again who asked me to take a blood, urine test and an ultrasound.
After analysing the blood and urine tests, he said I no longer suffered from Filaria , but the ultrasound indicated that i have a second degree varicocele.(diameter 2-3 mm on the left side).
he suggested i meet a surgeon next.
does this condition require surgery or will it tend to recede on its own.
i still am experiencing some discomfort and i generally do wear boxer shorts.
thanks and regards.
Answer
Anoop, let me preface my remarks by stating that I live in the USA and have never seen a case of filiariasis. However, I am familiar with this parasite which travels via the lymphatic system]m and can cause the development of hydroceles (as you had). However, I do not believe there is any relationship between filiariasis & the development of a hydrocele. A varicocele is due to a deficient valve in the veins that drain the scrotal area. To follow is a "macro" I have written on varicoceles that should be of help to you in understanding what they are. The majority of men with varicoceles do NOT require surgery. In other words, the presence of a varicocele in itself is not an indication for operating!
A varicocele is a collection of varicose veins of the spermatic cord (the rope-like structure that suspends each testicle). They occur in about 15% of the population. More than 90% occur on the left, 5% on the right and the rest are bilateral. Varicoceles are due to a defective valve in the vein that drains blood from the testicle. They fill by gravity and therefore are not detectable while recumbent but apparent when upright. On examination, the lesion feels like a bag of worms. Small varicoceles may only be detected by imaging studies such as ultrasound. A varicocele that does not disappear when lying down may indicate a tumor in the abdomen (but this is quite unusual). Varicoceles are generally painless. Often men present to the doctor with pain in the testicle and the varicocele is discovered at that time. In my experience, the pain is very rarely due to the varicocele and usually due to prostatitis (an inflammation of the prostate gland). In other words, the varicocele is an incidental and unrelated condition. Varcioceles may cause an infertility problem manifest by lower sperm counts and increased numbers of immature sperm in the semen on analysis. However, the majority of men with varicoceles do NOT have infertility. Of men who have abnormal semen analyses and varicoceles, in about 70% of them, the 2 are related and fixing the varicolele often will improve their fertility. If a teenager or young man with a varicocele has a smaller than normal testicles on that side, there is an increase risk of infertility and many urologists consider this an indication to fix the varicocele surgically. Other than for infertility, thereare just a few indications for repairing a varicocele. They can be fixed for cosmetic reasons or because they become too weighty. There are several types of varicocele repair, but they all have in common ligating the vesssels supply in the varicocele rather than actually removing the veins. This prevents blood from filling the varicocele. Good luck.
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