Varicocele: Common Concerns and Expert Insights

Q: Varicocele: Common Concerns and Expert Insights

Hello： <br>Q1. <br>Regarding varicocele, I found information indicating that it occurs more commonly on the left side (90%) due to vascular anatomical issues. <br>If varicocele occurs on the right side, it may be due to compression from tumors in the liver, kidney, or lower abdom

Follow-up Inquiry #200952

Dear Dr.
Du,
Thank you for your response and explanation regarding my inquiry in “#200952.” Today, I followed your advice and visited the urology department, where I underwent a scrotal ultrasound and a scrotal examination.
The results indicated that there were no obvious tumors in my scrotum, and both the testicles and epididymis were of normal size without signs of atrophy or other abnormalities.
However, there is a "mild" varicocele on both sides.
The physician advised me to continue monitoring the condition and did not prescribe any medication before I left.
I have the following questions for you, Dr.
Du:
Q1: Regarding the varicocele, I found information indicating that it is more common on the left side (90%) due to vascular structure issues.
If a varicocele occurs on the right side, it may be due to compression from tumors in the liver, kidney, or lower abdomen.
Could my mild right-sided varicocele simply be a vascular issue unrelated to tumors?
Q2: Following up on the previous question, if my mild right-sided varicocele is indeed just a vascular issue unrelated to tumors, what could be the causes of the right-sided varicocele? (For example: prolonged standing, prolonged sitting, or increased abdominal pressure, etc.)
Q3: In your clinical experience, how common or rare is a right-sided varicocele that is unrelated to tumors?
Q4: During the scrotal examination today, when pressure was applied to my epididymis, I felt a slight dull pain.
However, I do not experience spontaneous pain unless pressure is applied to that area.
The physician concluded that there was no significant issue and suggested that I avoid applying pressure to the epididymis.
Is it normal to feel slight discomfort when pressure is applied to the epididymis, or should there be no sensation or pain at all when pressure is applied?
Thank you, Dr.
Du.

Kris, 40~49 year old female. Ask Date: 2023/09/25

Dr. Du Shixi reply Urology

Hello:
Q1.
Regarding varicocele, I found information indicating that it occurs more commonly on the left side (90%) due to vascular anatomical issues.
If varicocele occurs on the right side, it may be due to compression from tumors in the liver, kidney, or lower abdomen.
Dr.
Du, I have a mild varicocele on the right side; is it possible that it is simply a vascular issue unrelated to tumors?
--> It cannot be said with 100% certainty that there is no problem, but regular monitoring can be considered.
Q2.
Following up on the previous question, if my mild right-sided varicocele is merely a vascular issue unrelated to tumors, what could be the cause of the right-sided varicocele? (e.g., prolonged standing, prolonged sitting, or increased abdominal pressure, etc.)
--> It is mostly due to poor venous return; there are many reasons, and you can change some lifestyle habits.
Q3.
Dr.
Du, in your clinical experience, is right-sided varicocele unrelated to tumors common or rare?
--> It is common.
Q4.
Today, during the scrotal examination, when the doctor pressed on my epididymis, I felt mild discomfort, but I do not experience spontaneous pain when not pressing on that area.
The doctor believes there is no significant issue and suggested that I might be overly sensitive, advising me to avoid pressing on the epididymis.
Dr.
Du, is it normal to feel mild discomfort when pressing on the epididymis, or should there be no sensation or pain at all when pressing there?
--> It depends on whether you have experienced tenderness in the past.
If you did not have tenderness before but do now, it should be monitored.
Wishing you good health.

Reply Date: 2023/09/25

More Info

Dear Patient,
Thank you for your detailed questions regarding your recent diagnosis of mild varicocele. I appreciate your proactive approach in seeking further clarification about your condition. Let’s address your concerns one by one.

Q1: Is it possible that my mild right-sided varicocele is simply a vascular issue and not related to tumors?
Yes, it is indeed possible for a mild right-sided varicocele to be a benign vascular issue. While it is true that left-sided varicocele is more common due to anatomical differences in venous drainage, right-sided varicocele can occur without being associated with tumors. However, it is essential to monitor any changes and keep in touch with your healthcare provider. If there are any significant changes in symptoms or if the varicocele becomes more pronounced, further evaluation may be warranted.

Q2: If my right-sided varicocele is just a vascular issue, what could be the causes?
Several factors can contribute to the development of a right-sided varicocele. These may include prolonged standing or sitting, which can increase pressure in the veins of the scrotum. Additionally, increased abdominal pressure due to heavy lifting, obesity, or chronic cough can also contribute to the development of varicoceles. In some cases, anatomical variations in the venous drainage system can predispose individuals to varicocele formation.

Q3: In your experience, how common is a right-sided varicocele that is not associated with tumors?
In clinical practice, right-sided varicoceles that are not associated with underlying tumors are less common than left-sided ones. However, they do occur, and many cases are benign. It is crucial to maintain regular follow-ups to ensure that there are no changes in the condition. Your urologist will likely monitor your situation and perform follow-up examinations as needed.

Q4: Is it normal to feel mild discomfort when pressure is applied to the epididymis during examination?
Experiencing mild discomfort when pressure is applied to the epididymis can be normal, especially if you are sensitive in that area. The epididymis is a sensitive structure, and some individuals may experience discomfort during palpation. However, if the discomfort is significant or if you experience spontaneous pain outside of examination, it would be advisable to discuss this further with your doctor. It is essential to communicate any concerns you have regarding pain or discomfort to ensure that your healthcare provider can address them appropriately.

In summary, while your mild right-sided varicocele may not be a cause for concern, it is essential to continue monitoring your condition and maintain open communication with your healthcare provider. Regular follow-ups will help ensure that any changes are detected early, and appropriate management can be initiated if necessary.
Thank you for your thoughtful questions, and I hope this information provides you with clarity and reassurance. Please feel free to reach out if you have any more questions or concerns.

Best regards,
Doctor Q&A Teams

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