Corrected transposition of the great arteries

Disease Description (Causes and Symptoms)

• Definition: Varicocele is a condition in which the veins that drain the testicles (testicular veins) become enlarged and tortuous, causing venous blood stasis in the scrotum due to venous reflux or impaired drainage.
• Causes and pathophysiology:
  • Anatomical factors (especially common on the left): The left vein is long and has a structural feature in which it joins the renal vein at a right angle; defects in the valves and other factors make increased venous pressure and reflux more likely (approximately 90% occur on the left).
  • Blood stasis can cause increased scrotal and testicular temperature, hypoxia, exposure to toxic substances, and abnormalities in hormonal regulation, which may adversely affect sperm production.
  • It commonly begins after adolescence (puberty), and family history or mechanical factors may contribute.
• Main symptoms:
  • Usually asymptomatic (often discovered incidentally)
  • A feeling of heaviness or discomfort in the scrotum, pain (especially when standing for a long time or after activity), and scrotal swelling (a tortuous mass, shaped like ‘ramen noodles’)
  • Male infertility (varicocele is one of the causes of male infertility)
• Clinical classification (based on physical examination):
  • Grade 1: Palpable during the Valsalva maneuver (increased intra-abdominal pressure)
  • Grade 2: Palpable even without the Valsalva maneuver
  • Grade 3: Clearly visible to the naked eye
• Epidemiology:
  • Occurs in approximately 10–15% of adult men
  • Found in 21–41% of infertile men
  • Varicocele accounts for more than 30% of cases of male infertility
• Course:
  • If untreated, it may progress, and testicular atrophy and impaired sperm production may occur
  • If it develops suddenly or progresses acutely on the right side or on both sides, evaluation for other underlying diseases (e.g., an abdominal mass or kidney cancer) is necessary

Treatment Methods and Precautions

• General indications for treatment:
  • When pain is significant
  • When abnormal findings are present on semen analysis and recovery of fertility is desired
  • In adolescents, a decrease in the volume of one testicle due to varicocele (a difference between the left and right sides of ≥2 mL or 2 cc)
  • When testicular atrophy is progressing
• Treatment methods:
  • Conservative management
    • Observation when symptoms are mild or there is no risk of infertility
    • Temporary symptomatic treatment: bilateral support garments, rest, NSAIDs (for pain control), etc.
  • Surgical treatment
    • Microsurgical varicocelectomy (usually via a subinguinal or supratesticular approach): Has the lowest recurrence rate and complication rates (testicular artery injury and hydrocele formation). The rate of improvement in sperm parameters is high.
    • Open (inguinal/subinguinal) surgery: A widely performed method
    • Laparoscopic ligation: Performed through small incisions; a success rate of 85–95% has been reported
  • Non-surgical procedures
    • Embolization (percutaneous venous embolization): May be used for recurrence after surgery or when surgical indications are not met
• Course and follow-up after treatment:
  • Improvement in semen parameters is observed in most cases, but some cases may not improve
  • Semen analysis is evaluated at 3–6-month intervals after surgery (usually the first test is performed 3–6 months later, with additional testing if necessary)
• Complications and precautions:
  • Surgical complications: Recurrence, testicular hydrocele (hydrocele formation), testicular artery injury (rare, but testicular atrophy may occur), infection, and bleeding
  • Precautions during recovery: Limit lifting heavy objects; follow the doctor’s instructions regarding excessive exercise and sexual activity during the early period
  • In cases of acute or atypical findings (sudden pain, rapidly increasing scrotal swelling, isolated occurrence on the right side, or rapid worsening), additional testing (abdominal and pelvic imaging) is needed to rule out underlying causes
• Lifestyle management:
  • Avoid standing for long periods or hot environments; using support garments may help relieve symptoms
  • Overall health management, including avoiding smoking and excessive alcohol consumption, may help improve reproductive health

Checkpoints Before an Outpatient Visit (Including Example Questions)

• Items and materials to bring:
  • List of medications currently being taken (including nutritional supplements and other supplements)
  • Previous test results (semen analysis, ultrasound results, blood tests, etc.)
  • When symptoms began and how they have changed (frequency and intensity of pain, changes according to posture or activity)
  • Past medical history (surgery, trauma, chronic diseases) and family history (varicocele and infertility)
  • Reproductive plans (whether pregnancy is desired and the desired timing)
• Key information to provide the doctor during the visit (examples):
  • "When did the pain begin, and in what situations does it worsen?"
  • "Do your symptoms improve when you lie on your side?"
  • "Have you ever had a semen analysis or scrotal ultrasound? Did you bring the results?"

General Example Questions to Ask the Doctor

• "What are the criteria for determining whether surgery is necessary in my case?"
• "If I undergo surgery (or embolization), how much improvement in sperm count or motility is likely?"
• "What are the risks of complications and recurrence after surgery?"
• "Is it okay to monitor the condition with conservative treatment instead of surgery, and how long would you recommend observation?"

Examples of Condition-Specific Questions

• "Which semen analysis values (total sperm count, motility, morphology, etc.) need to improve for the chances of pregnancy to improve?"
• "One of my testicles is smaller than the other (or there are signs of delayed growth). In children and adolescents, when do you recommend surgery?"