Men diagnosed with varicocele may notice some changes in their condition over time, or they may find conflicting descriptions of symptoms when they search for information online. Varicocele patients may not realize that there are two types of varicocele, and 3 grades within each type. Below is a description of the various types of the condition.
Primary and Secondary Varicocele
Primary varicocele happens when the configuration of the left internal spermatic vein and the renal vein forms a high-pressure blood column. This often happens in combination with malfunctioning valves in the veins of these patients. The configuration prevents blood from escaping from the scrotal veins back into the systemic circulation. As a result, the blood pools and causes the veins to swell, or dilate, resulting in varicocele formation.[i]
A secondary varicocele occurs when a mass in the scrotum impedes blood flow in the internal spermatic vein.
Either a primary or a secondary varicocele can be classified in any of the three varicocele grades of the condition:
Grade I Classification of Varicocele
In this category, the dysfunctional veins are not visible. A doctor detects them during a physical exam while the patient performs a [medical term alert] Valsalva maneuver. A Valsalva maneuver is a breathing exercise used as a diagnostic tool.
Grade II Classification of Varicocele
Varicoceles in this grade are still not visible, but can be felt during a doctor’s exam even without the aid of a Valsalva maneuver.
Grade III Classification of Varicocele
In this category, the varicoceles can be easily identified through the scrotum; there is no need to perform a physical exam to detect them.[ii]
Beyond the diagnosis classifications, there are two types of varicocele based on how the dysfunctional veins affect the body. The key difference between the classifications is how the varicocele affects the internal and external [medical term alert] iliac vein (one of three veins that drain the pelvic area of blood).
Pressure Varicoceles lead to retrograde blood pooling of the [medical term alert] internal spermatic vein (which carries deoxygenated blood from the testis), resulting in the varicocele. However, there is no varicocele to the internal or external iliac vein. This type of varicocele usually falls under the Grade I category.
Shunt Varicoceles have a severe pooling of blood that results in a large varicocele forming where damaged veins expand to the internal or external iliac vein. This type of varicocele is typically under the Grades II and III categories.[iii]
How Do the Different Grades Affect Me?
There are ongoing studies reviewing the link between the size of the varicocele as determine by varicocele grading and infertility. Prior studies have shown links related to the various varicocele types and grades and infertility in men, including the effects on sperm count, movement, and quality. According to those studies:
- The raised temperature in the scrotum caused by varicocele leads to lower sperm counts.
- Varicocele can cause damaged sperm and also creates an environment in the body where sperm do not thrive, therefore they do not move or function as well as healthy sperm.
- Sperm quality decrease is correlated with the higher grades of varicocele.
- The primary difference in semen quality among the three groups is that those with Grade III varicocele more often had a low sperm count (oligospermia) and decreased sperm motility than those in the other groups.[iv]
What Should You Do Now?
If you’re wondering how to treat varicocele, The American Urological Association recommends medical intervention, even for men who aren’t trying to impregnate their partner. This group also says men with a varicocele that can be felt in an exam, or those with semen that is outside typical parameters, should get the varicocele treated.[v]
It is not uncommon for a urologist to recommend surgery, even though there are non-surgical options, such as varicocele embolization available. Varicocele embolization is done as an outpatient procedure by interventional radiologists. This procedure is minimally invasive and offers a quicker recovery time than traditional surgery. Varicocele treatment statistics indicate embolization works for 90 percent of patients.[vi]
Varicocele embolization can be used to treat reoccurring varicocele after surgical correction. A recent study revealed embolization was successful in 93 percent of cases when used for reoccurring varicocele. According to the study, 80 percent of the group’s problems were completely resolved, while others saw at least partial improvement. Embolization resulted in half of the group remaining pain free and another third of the group reported having less pain.[vii]
Those who suffer from varicocele do not have to live with the diagnosis. There are simple exams and tests that can be done to determine the grade and type of varicocele, and it’s important to keep in mind that regardless of the grade or type, embolization offers a non-surgical treatment option for varicocele.
[vii] Kim, J., et al., Persistent or recurrent varicocoele after failed varicocoelectomy: Outcome in patients treated using percutaneous transcatheter embolization. Clinical Radiology, 2012. 67: p. 350