Grade 1 Varicocele - Does It Require Treatment?

Varicocele occurs when the one-way valves in the veins do not function properly and cause blood to flow backward into the testicle due to the dilation of testicular veins and the scrotal cord. The blood entering the testicles contains respiratory waste products. Therefore, varicocele can cause increased waste products in the testicle, increased testicular temperature, and sperm disorders in men.

Varicocele grade 1, also known as mild varicocele, is the mildest form of this condition and is characterized by small, dilated veins in the testicle. It is often asymptomatic and may not require treatment unless it is causing fertility issues. 

Varicocele is present in 35 to 40% of infertile men. This condition is classified into three grades in terms of severity. This article discusses mild varicocele (grade 1) and explains how to diagnose and treat it.

How Does Mild Varicocele Occur?

A mild varicocele, classified as grade 1, occurs on the left testicle in 90% of cases, on both testicles in 8%, and on the right testicle in only 2% of cases. Therefore, left-sided varicocele is one of the most common male diseases.

What Are Grade-1 Varicocele Symptoms?

Unlike severe varicocele (Grade-3), which is mainly associated with pain, mild or grade 1 varicocele has no specific symptoms and can only be diagnosed during examinations for infertility.

How Is Mild Varicocele Diagnosed?

During physical examinations for diagnosing grade 1 varicocele, the patients should stand for 30 minutes. They should swallow their saliva and cough for the veins to become obvious. The testicles with a mild varicocele look completely healthy and usually take a long time to be diagnosed. 

It should be noted that patients suffering from mild varicoceles cannot diagnose the condition by themselves and must see a urologist. Additionally, diagnosing grade 1 varicocele requires an ultrasound.

Grade 1 varicocele can only be detectable by performing the Valsalva maneuver. The reason is that doing these maneuvers (coughing and straining) causes the blood to flow back to the venous network of the testis (pampiniform plexus) and will make it easier for the doctor to examine mild varicocele. 

In grade 3 varicocele, the enlarged veins are visible in the scrotum. If these veins are palpable without doing the Valsalva maneuver, the patient is diagnosed with grade 2 varicocele.

How Does Grade 1 Left-Sided Varicocele Affect Male Fertility?

The greater the severity or grade of varicocele, the more impaired spermatogenesis and male infertility! Mild left-testicle varicocele can also lead to low sperm count and increased sperm deformity, resulting in male infertility. The earlier the varicocele is diagnosed and treated, the more likely it is to recover and have children in adulthood.

Read more: What Are the Top Causes of Male Infertility?

How to Treat Mild Varicocele?

The mild left-testicle varicocele does not usually require treatment. Treatment is recommended only under the following conditions:

• Men with fertile wives who have not been able to conceive after 6 - 12 months of trying;
• Men with abnormal semen tests regarding quality, quantity, and deformity of sperm;
• Teenage boys going through puberty whose testicle growth has been inhibited due to varicocele.

What Are the Treatment Methods for Grade 1 Varicocele?

• Lifestyle changes
• Pharmacotherapy
• Surgical procedures

Lifestyle changes to manage mild varicocele

If varicocele treatment is necessary, it is firstly recommended that patients try conservative treatments like lifestyle changes, including:

• Avoid wearing tight underwear;
• Avoid prolonged standing;
• Avoid long hot baths;
• Keep the testicles cool and wash them with cold water;
• Consume red fruits such as cherries, strawberries, and blueberries due to their high amounts of antioxidants.

Pharmacotherapy to treat grade-1 varicocele

Pharmacotherapy can be a practical option when varicocele is not complicated. The intake of vitamin C, vitamin E, and medicines such as Pentoxifylline and Coenzyme Q10 positively improve spermatogenesis due to their high antioxidant properties.

Surgical procedures

Surgical procedures are recommended when patients do not respond to conservative treatment. Although surgery may result in complete treatment in 50% of cases, it is not recommended for patients with severe pain who have children. In a varicocele, grade-1 surgery is not really common, and they may need surgical treatment only in special cases. 

There are three surgical procedures for varicocele, including:

• Open surgery;
• Laparoscopic varicocelectomy;
• Microscopic varicocelectomy.

Read more: Varicocele Surgery Benefits: Is a Varicocelectomy Worth it?

What is the best surgical procedure to treat grade 1 varicocele?

The microscopic varicocelectomy is the best option for the treatment of mild varicocele. A small incision (sometimes more minor than the incision in open surgery) is made at the affected area during this procedure. The testicular cord is placed under a microscope so the doctor can find the enlarged veins with greater magnification and precision. Thus, the success rate of varicocelectomy is higher, with fewer side effects. 

Varicocelectomy in Iran

Thousands of urology surgeries, such as varicocelectomy, vasectomy, prostate procedures, orchiopexy, etc., are being performed in Iran with high success rates. Many patients choose Iran as their medical destination for performing varicocele surgery due to some factors such as having low surgical costs, low travel costs, modern and well-equipped hospitals and medical labs, immediate medical visas, and having skilled and experienced doctors. Contact us for consultations about Iran's best surgeons and medical centers for varicocelectomy.

Varicocele surgery in Iran