MEDICAL ANIMATION TRANSCRIPT: A varicocele is a group of swollen blood vessels, called veins in a man's scrotum. The male reproductive system includes the testicles, also known as testes, which are two glands inside a pouch of skin called the scrotum. The testicles normally produce and store reproductive cells called sperm. They also produce a hormone called testosterone. Testosterone is important for sperm production, muscle strength, and sex drive. The scrotum is outside the body, which keeps the testicles cool enough to make sperm. Each testicle is suspended inside the scrotum by a structure called the spermatic cord. Inside each cord are blood vessels and a tube that sperm travel through called the vas deferens. The testicular artery is the blood vessel that brings most of the blood to the testicle. Most blood leaves the testicle through a group of veins called the pampiniform plexus. Blood also leaves the testicle through smaller veins next to the vas deferens that bypassed the pampiniform plexus. From the pampiniform plexus blood flows into the testicular veins. A series of one-way valves inside the testicular veins prevent blood from flowing backward into the testicles. A varicocele may begin to form when the valves inside the testicular vein are damaged or don't work properly. The valves may not close completely, allowing blood to flow backward inside the vein to the testicle. In addition, since the left testicular vein is straighter and longer than the right testicular vein, there is a greater downward pressure of the blood inside the left vein. Another problem may occur, where your left testicular vein connects to a larger vein coming from your kidney called the left renal vein. An artery to the intestines may squeeze the left renal vein, causing blood to back up in the left testicular vein. This is called nutcrackers syndrome. As a result of any of these problems, a varicocele seal can form in the left pampiniform plexus when blood begins to back up in it. The blood pooling in these veins causes them to become swollen. Depending on the severity of the varicocele seal, the pooled blood may raise the temperature around the testicle. This higher temperature can make it harder for the testicle to produce sperm. This condition may decrease male fertility, which has the ability to get a woman pregnant. Over time a varicocele seal may also decrease the level of testosterone made in the testicles. Low testosterone can lead to decreased energy and muscle strength, as well as sexual problems. A varicocele seal doesn't usually cause symptoms or require treatment. However, if a varicocele seal causes pain, discomfort, or problems with fertility, the most common treatment is either an inguinal or subinguinal microsurgical varicocelectomy. To begin, the surgeon will make a small incision low on the groin for a subinguinal varicocelectomy slightly higher for an inguinal varicocelectomy. Then spermatic cord will be pulled out through the incision. The surgeon will open the outer tissue of the spermatic cord and separate the varicocele seal from the rest of the tissue. Small metal clips will be placed on these veins. Then the veins will be cut. After these veins are cut, blood will still be able to leave the testicle through the smaller veins on the vas deferens. These veins are less likely to become swollen. The surgeon will finish the procedure by placing the spermatic cord back through the skin incision and closing the incision with sutures and skin closure tape. Other procedures that may be done to repair a varicocele include a laparoscopic varicocele seal repair or percutaneous varicocele seal embolization.