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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 > varicocele
Expert: Arthur Goldstein, M.D.
Date: 10/3/2008
Subject: varicocele
Question
hi,
2 months ago i had epididymitis from trauma not from infection. I went to see a urologist for a check up, he said my testicle where i had it, felt thick, why would it feel thick? what does this mean?
I have notice that the vas defren and the epididymis do look bigger, he kinda felt around and i had no pain really.
Can a varicocele form from traumatic epdidymits ?- which was caused by constant grabbing and flipping of the testicle
Answer
Phil, it is common after an episode of epididymitis to have residual scarring in the epididymitis and associated vas deferens as part of the healing process. I suspect the "thickening" you feel is merely scar tissue. This gradually resolves over many months but some remnant of the scar may persist indefinitely. There is no way that epididymitis (either traumatic or infectious) can cause a varicocele. The latter is due to a deficient valve in the venous system that drains the scrotal contents. For your information, to follow is a "macro" I have written on varicoceles.
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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