Varicocele

Overview of Varicocele

• Generally, Testicular veins which drain the testis and epididymis, form multiple veins in the scrotum which are called as pampiniform plexus of veins. Additionally, As they travel the inguinal canal, they are reduced to 6-8 in number. In detail, At the level of deep ring, they are 2 in number and in retroperitoneum, it forms the single testicular vein.
• On the right side, the testicular vein drains into inferior vena cava (in other words, IVC) directly.
• On the left side, it drains into the left renal vein at right angles where there is a valve. [3]
• Besides this, Varicocele is common in tall, thin young men.
• More common on the left side, but often can be bilateral. [5]

Indian epidemiology then other

Causes of Varicocele

Congenital absence of valves. [3]

Primary or Idiopathic i.e.:

• Incompetence of valves of the testicular vein
• Common on left side

Secondary i.e.:

• Left sided renal cell carcinoma with a thrombus in left renal vein. [5]

Classification of Varicocele

1. Firstly, Primary or Idiopathic
2. Secondly, Secondary [5]

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

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Sign & Symptoms of Varicocele

• Swelling in the root of the scrotum
• Dragging pain in the groin also scrotum
• “Bag of worms” feeling
• Impulse specifically, on coughing
• Especially, On lying down it gets reduced (except in renal cell carcinoma) [4]

Clinical / Physical Examination For Varicocele

• Bow sign: After holding the varicocele between thumb and fingers, patient is asked to bow. In detail, Varicocele gets reduced in size. Bowing reduces the blood flow of testicular vein also pampiniform plexus causing reduction in size. [4]
• On palpation it feels like a ‘bag of worms’. [1]

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Differential Diagnosis of Varicocele

• Hydrocele
• Inguinal hernia
• Lymph varix
• Lipoma of the cord. [4]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Varicocele

• Venous Doppler of the scrotum also groin.
• USG abdomen to look for kidney tumours.
• Semen analysis. [4]

Treatment of Varicocele

• Palomo’s operation i.e.: Suprainguinal extraperitoneal ligation of the testicular vein.
• Inguinal approach i.e.: Easier also safer.
• Scrotal approach i.e.: In case of grade IV, veins have to be excised through this approach
• Laparoscopic approach i.e.: Presently accepted, good approach. [4]

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Homeopathic Treatment of Varicocele

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Varicocele:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Acidum Flour:

• Moist palms, pain especially in left side.
• Tendency to whitlows fistulae.
• Alopecia, history of syphilis.

Acidum Phos:

• Phosphaturia; additionally pain in testicle.
• Swelling of testes also swelling and tension of spermatic cords.
• Testes tender to touch, either gnawing pain or excoriated feeling in testes.

Aesculus Hip:

• Varicocele from disturbances of portal system with constipation also haemorrhoids.

Aurum:

• Testicles small and weak; in detail indurated.
• Pressive pain when touching or rubbing it.

Hamamelis:

• Drawing pains in testicles night and day.
• Aggravation after midnight till morning, extending from groins.
• Enlargement of spermatic veins, testicle painful, swollen and hard.
• Profuse cold sweat on scrotum; capillary stasis.

Osmium:

• Varicocele produced or aggravated by a deep, hollow, low cough, seemingly coming from low down in the body.

Pulsatilla:

• Especially suitable to fat persons, or those of lax fibre and tearful mood.
• Burning of testicles, without swelling; drawing tensive pains from abdomen through of testicles, without swelling.
• Drawing tensive pains from abdomen through cords into testicles.

Silicea:

• Basically Squeezing pains in testicles.
• Furthermore, Itching humid spots on genitals, mostly on scrotum.
• Sweat-on scrotum.
• Sweaty feet; additionally chilblains.
• Suppression especially of habitual foot-sweat. [6]

Diet & Regimen of Varicocele

• Eat fresh vegetables and fruits such as beat, cauliflower, broccoli, cucumber, banana, apples, pomegranates, kiwi.
• Other food are wholegrains, olive oil, flaxseed oil, flavonoids.
• Take Plenty of fluid.
• Food to avoid varicocele treatment: caffeine, hydrogenated oil, margarine, sugar, refined white flour, animal fat, alcohol.
• Do Yoga and asanas such as Vajrasan, Dhanurasan, Padmasan and so on. [7]

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References use for Article Varicocele

[1] Clinical Surgery S. Das

[2] Bailey_and_Love_s_Short_Practice_of_Surgery

[3] Manipal Manual of Surgery (PDF Drive)

[4] SRB_s Manual of Surgery, 3rd Edition

[5] SRB’s Clinical Methods in Surgery

[6] Homeopathic Therapeutics by Lilienthal

[7] https://nirogamonline.com/blogs/articles/how-to-cure-varicocele-with-yoga-and-diet

Frequently Asked Questions

What is Varicocele?

A varicocele is a varicose dilatation of the veins draining the testis.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Varicocele?

• Acidum Flour
• Acidum Phos
• Aesculus Hip
• Aurum
• Hamamelis
• Osmium
• Pulsatilla
• Silicea

What causes Varicocele?

• Incompetence of valves of the testicular vein
• Common on left side
• Left sided renal cell carcinoma

What are the symptoms of Varicocele?

• Swelling in the root of the scrotum
• Dragging pain in the groin and scrotum
• “Bag of worms” feeling
• Impulse on coughing
• On lying down it gets reduced

Give the types of Varicocele?

• Primary or Idiopathic
• Secondary