Varikotsele - Causes, symptoms and treatment. MF.

Varicocele is a varicose veins of the spermatic cord and testicle.

Varicocele is one of the most common diseases among men, which often leads to very unpleasant consequences. In itself, varicose veins of the spermatic cord are not a big problem, the patient's life is not threatened and with him one can safely live his entire life without much anxiety. The problem may be the main complication of this disease - male infertility and pain symptom.

Overview of varicocele

According to the WHO( World Health Organization) varicocele is found among men in 15-17% of cases. At the same time, a wide range of frequency of occurrence is revealed depending on the region and age of the subjects. However, in a survey using ultrasound varicocele is found in 35% of men of reproductive age. During the recruitment of varicocele , 5-7% of young people are diagnosed with , and the highest incidence is at the age of 14-15 years - 19.3%.As a rule, varicocele is only on one side - on the left( 80-98%).This is due to the different admission of the testicle veins on the right and left. Two-way

Symptoms of varicocele

In most cases, this disease begins during puberty, quickly reaches a certain extent and does not progress any more. Varicocele may not manifest itself in any way, and the diagnosis is established by accident, during any medical examinations.

If we talk about the complaints of patients, then as a rule, they do not happen.

In general, this condition is painless and does not cause any concern. Young people note an increase, lowering of the left half of the scrotum, minor "pulling" sensations in the testicle, scrotum and in the groin on the side of the lesion, which increase with walking and physical exertion, sexual arousal;with a significant varicocele, the saggy neck interferes with walking;note a decrease in the left testicle. The increase in the left half of the scrotum appears more often in the standing position and disappears in the prone position. In neglected cases, the pain is permanent. There is a significant increase in the scrotum, a contouring of the convoluted veins, a decrease in the left testicle.

As already noted, infertility is the main complication and another symptom of varicocele. In laboratory tests of sperm of such a patient, a decrease in the number of spermatozoa and their mobility is detected.

By how much the veins of the testicle and the spermatic cord are enlarged, 4 degrees of varicocele are distinguished:

0 degree of - veins of the testicle are not palpable, their varicose extension is determined only by instrumental means( ultrasound, dopplerography).

1 degree - the expansion of the veins is palpated in a standing position, in the prone position varicocele is not defined.

2nd degree - enlarged veins are palpated both in a standing position and in a prone position.

3 degree - enlarged veins of testis and spermatic cord visible to the naked eye.

Very rarely one degree of varicocele passes into another.

Causes and risk factors for varicocele

The development of this disease is due to the fact that the valves that exist in the veins and which should prevent the return flow of blood do not work, or work poorly, and with increased pressure in the veins( for example, in the vertical position of the body,at physical stress) this pressure starts to be transferred in the opposite direction, gradually causing expansion of a venous vessel. Thus, the veins surrounding the spermatic cord widen.

Another cause of varicocele is a special anatomical relationship between the renal vein and the upper mesenteric artery with the formation of the so-called aortomethosensorial "tweezers."

Gradually, under the influence of increased pressure, the veins begin to increase in size, expand, expand. Depending on the strength of the veins walls in different people and the magnitude of venous pressure, this stretching can reach different degrees. The venous network around the testicle becomes larger and larger, and in severe cases the testicle appears to be immersed in a sponge from venous vessels. Such a bloody "cushion" of venous vessels around the testicle leads to the fact that the thermoregulatory function of the scrotum is lost, and the testicle ceases to cool. Consequently, there is no lower temperature required for the production of spermatozoa, and normal spermatogenesis is suppressed. That is why varicocele is one of the main factors of male infertility.

Thus, infertility factors for varicocele are:

• Increase in testicle temperature to body temperature( normal testicle temperature is lower than body temperature, which is necessary for normal spermatogenesis( for the same reason, the testicles are "taken" beyond the abdominal cavity into the scrotum)
• Rejection of biologically active substances from the kidneys, adrenals in the testes
• Hypoxia( oxygen starvation, ischemia) of the testis
• Accumulation of free radicals in testicular tissues( which are strong cellular poisons), which

Complications of varicocele

If we consider the structure of the causes of male infertility, varicocele is the main factor causing infertility:

• in 60% of varicocele patients report a violation of the spermatogenic function of the testicles,
• in 40% of men examined for infertility, find varicocele

Thus, treatment varicocele primarily should be directed to the prevention and treatment of male infertility.

Diagnosis of varicocele

For the diagnosis of varicocele , in some cases, it is sufficient to perform an examination and palpation of the "lobate"( bunchy) plexus( in the form of a grapevine, bunches) when the patient is standing. More pronounced results of palpation are obtained with a Valsalva test( test with straining: with increasing pressure in the abdominal cavity, the blood supply to the testicles increases).

If the veins increase is significant, and the diagnosis leaves no doubt, no additional examination is required.

If the degree of varicocele is small, then you need to conduct a special examination - ultrasound or dopplerography of the scrotum. Ultrasound or dopplerography in case of suspected varicocele must necessarily be performed in two patient positions - lying and standing. If this is not done, the survey loses all meaning.

Doppler ultrasound or scrotal ultrasound in lying and standing positions should necessarily be performed for all men with infertility and with pain in the testicles.

In addition to all the above, with varicocele must be done spermogram. It is necessary to conduct at least two studies with an interval of 4-12 weeks. Also mandatory is sexual abstinence before spermogram delivery within 2 to 7 days.

Treatment of varicocele

As with varicose veins on the legs, the only real treatment is an operation in one form or another.

On the other hand, since varicocele is a non-dangerous disease, and usually asymptomatic, its detection in an adult male is not an indication for surgery.

Surgical treatment is required in the following cases:

1. The presence of pain in the testicle.
2. Male infertility( by reducing the number, quality and mobility of spermatozoa).
3. Aesthetic defect in the scrotum.
4. Termination of growth of the affected testicles during puberty.

However, many experts believe that in children and adolescents for the prevention of potential infertility, an operation with varicocele should be done in any case.

Currently, there are 4 basic surgical methods of treatment:

1. Open( normal) operation.
2. Operation from a mini-access.
3. Endoscopic operation.
4. Microsurgical testicular revascularization.