VARICOCELE

• Varicocele is an abnormal enlargement and tortuosity of the pampiniform plexus in the scrotum due to proximal obstruction of the spermatic vein
• Usually left-sided since the left testicular vein is longer and drains into the left renal vein at a right angle without an anti-reflux valve at the junction, leading to a poor outflow of blood and an increased reflux
• Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause failure of testicles to develop normally or shrink

Idiopathic/primary 

• The cause of primary varicocele is not fully understood
• The left testicle is most commonly affected (85% of cases) 

Symptomatic/secondary

• Caused by a mass in the retroperitoneal space (Ormond disease, lymphoma, renal cell carcinoma) obstructing venous drainage into inferior vena cava (right-sided varicocele) or left renal vein (left-sided varicocele) or a thrombotic event (e.g., pampiniform plexus obstruction in renal cell carcinoma)
• Persist in the supine position due to a physical obstruction to blood flow within the spermatic vein

• Painless enlargement may be present
• Dull, aching pain (typically left-sided)
• Heaviness of the affected scrotum
• Soft bands/strands are palpable in the upper pole of the affected scrotum (“bag of worms”) 
• Symptoms worsen when standing or when performing the Valsalva maneuver
• Negative transillumination 
• Complication -Infertility

 Grading of Varicocele

• Grade I - No visible varicosity, Reflux in vessels of the inguinal channel only when provoked by Valsalva maneuver
• Grade II - Stasis and small varicosities up to superior pole of the testes, Visible reflux in supratesticular region only during Valsalva maneuver
• Grade III- Dilation of veins at inferior pole of testes in standing position, No enlargement in supine position, Reflux only when provoked by Valsalva maneuver
• Grade IV - Enlarged veins even in supine position, Upright position and valsalva maneuver intensifies dilation, Possible testicular hypotrophy
• Grade V - Venous enlargement evident in supine and prone position, Spontaneous basal reflux at rest that does not increase during Valsalva maneuver, Evidence of testicular hypotrophy

• Physical examination
• Negative transillumination 
• Ultrasound –dilated ( >2 mm) hypoechoic pampniform vesels
• Doppler Ultrasonography – To determine the grade of varicocele

• Patients with a grade 1-3 varicocele (visible or palpable) associated with infertility should consider having the varicocele repaired
• Surgery – Laparoscopic varicocelectomy

 Ayurvedic Treatment

 Internal Medicines 

• Chiruvilwadi kashaya
• Dusparshakadi kashaya
• Sukumara kashaya
• Gandharvahastadi kashaya
• Punarnavadi kashaya
• Suranavaleha
• Bahushalaguda
• Arshoghna vati
• Kankayana gudika
• Kanchanara guggulu
• Arshakutara rasa
• Abhayarishta 
• Sahacharadi sevya
• Panchagavya gritha

Procedures 

• Virechana - Kalyanakaguda, Hingutriguna taila
• Vasti – Mustadi rajayapana 

 After these treatments, sukrajanaka, pravartaka drugs should be given