Mar 06, 2018
Varicocele ( varicocele) is an expansion of the veins of the spermatic cord, representing enlarged, knotty, swollen( varicose) veins in the scrotum. Veins are vessels that return blood to the heart after body tissues have received oxygen. Along all the walls of the veins are valves, which allow blood to flow only in one direction. Varicose veins mean that these valves are missing or become weak or defective and allow blood to flow back or stagnate in the vein. Varicocele develops when varicose veins form in the scrotum;they are not a serious risk to health and in many cases do not require treatment. However, in some people varicocele can lead to infertility. It is believed that stagnant blood can increase the temperature of the testicles and interfere with the flow of blood;all this can stop the production of sperm cells. Infertility can be cured when the varicocele is removed surgically. Varicocele occurs quite often, about 10 percent of all men.
• Weak or defective valves in the veins leading from the testicles can cause varicocele. Due to increased retrograde blood flow down the testicular vein, there is an expansion, abundant development of the veins of the clustate plexus. The development of varicocele is also explained by the right angle incidence of the left internal spermatic vein into the left renal vein, in contrast to the right inflowing at an acute angle into the inferior vena cava, which allegedly hampers the circulation on the left side, which explains the high frequency of the veins of the spermatic cord:80-86%, on the right - 7-19%, on both sides - 1-6% of cases.
• Occasionally, blockage of the vein by a tumor or blood clot can lead to varicocele.
Predisposing to varicocele factors are stagnant phenomena in the pelvic organs - constipation, irregular sexual life, hard physical work.
There is a varicocele variety, called "secondary varicocele".Due to the development of the tumor in the abdominal cavity or retroperitoneal space, the outflow of blood from the veins of the spermatic cord is impaired. As a result, the venous wall also widens. This type of disease makes it necessary to carefully examine the suffering varicocele, in order to exclude such a serious pathology as the kidney tumor, as well as other tumorous diseases.
• Painless swelling on one side of the scrotum( almost always on the left side), which can disappear in the lying position. The swollen area may seem like a mass of soft tubules or worms when it is gently palpated.
• Pain or a feeling of heaviness in the scrotum in the heat or after intense physical activity.
I stage - varicose veins reveal only palpation when straining the patient in the vertical position of the body;
II stage - enlarged veins are visually determined, the dimensions and consistency of the testicle are not changed;
III stage - pronounced dilation of the veins of the clustate plexus,
decrease in size and change in the consistency of the testicle.
• Examination of the testes, including mild feeling of the testicles and scrotum by the doctor, to determine the size and consistency of the seals.
• The scrotum can be enlightened by a special bright light to facilitate diagnosis;varicocele is opaque and does not transmit light, while other anomalies( such as hydrocele or spermatoceles) are transparent.
• Ultrasound examination may be required to confirm the diagnosis.
• Infertility is taken for analysis of seminal fluid.
• In many cases, treatment is not required. It is enough to eliminate the cause of stagnant phenomena in the small pelvis( chronic constipation, the exclusion of heavy physical exertion, etc.) and everything rises to its place.
• Wear supportive equipment for athletes or suitable shorts to provide additional support for the scrotum and reduce pain. In elderly people, wearing a suspensions is very useful.
• An operation to remove the affected veins through a small incision in the scrotum can be performed to combat infertility. The remaining veins compensate for the work of distant veins.
There are several methods for treating varicose veins of the spermatic cord. All these methods can be divided into three groups: excision of veins, raising of the testicle, and also blockage of veins from the inside( embolization).
Indications for surgical intervention in varicocele are the following circumstances:
Impaired sperm quality;
Termination of growth of the affected testicle during puberty.
Excision of veins involves the removal of dilated veins. The complexity of such operations is that it is necessary to preserve the venous outflow and at the same time to remove the dilated veins. Operations aimed at raising the testicle, can improve the outflow of blood from the veins and thereby solve the problem. Embolization involves occluding the veins from the inside with the help of special materials. Unlike other methods, transvenous embolization is an effective, safe method. This technique allows you to quickly recover to the patient after the intervention.
The most common is the operation on Ivanissevich. Considering the cause of varicocele not only reflux in the testicle vein, but also increased arterial blood flow to the testicle along the testicle artery, A. Palomo( 1949) proposed to tie up the vein and the artery together. In the Palomo operation, the testicle vein is bandaged together with the accompanying it in the form of a thin crimped trunk with the testicle artery.
To improve the results of vascular surgery, it is suggested to use a microsurgical method.
Endovascular obliteration of the testicular vein is considered an alternative to surgery in children and adults.
With the extensive introduction of endoscopic methods into clinical practice, ligation of the internal testicular vein has been performed in recent years by introducing an endoscope into the retroperitoneal space with transperitoneoscopy.
• The X-ray method( angiography) can be used to stop the blood flow to an enlarged Vienna and thus block the varicocele.
• There is no known way to prevent varicocele.
• Regular examinations of the testes help in the early diagnosis and treatment of anomalies.
• Consult a doctor if you feel an unusual lump in the scrotum. Although varicocele is not a health threat, all neoplasms should be examined by a doctor to rule out cancer.
• Consult a doctor if you are concerned that varicocele can lead to infertility.