Varicocele is a varicose vein of the spermatic cord and testis. It can cause very unpleasant consequences, although it is not dangerous for the patient's life. The problem is that varicocele is fraught with male infertility and a pain symptom.
This disease is very common among men. World Health Organization data show that varicocele occurs on average in 15-17% of the male population. Moreover, most often young people aged 14-15 are exposed to it - they account for 19.3%. In most cases, varicocele is observed on the left side (80-98%), because the outflow of blood from the scrotum on the left is worse than on the right. The percentage of cases of bilateral varicocele is from 2% to 12%, and right-sided varicocele is from 3% to 8%.
Varicocele - the causes of the disease
Most often, the narrowing of the left renal vein occurs due to the fact that it is infringed in the region of the superior mesenteric artery and the aortic trunk. This disease is most characteristic of puberty, which is accompanied by an increase in blood flow to the genitals. Also, the disease can develop due to prolonged sexual arousal, weight lifting, etc.
Varicocele - Symptoms
The severity of symptoms of varicocele can have three degrees.
In the first degree, pathology can be detected by palpation when straining the patient in a standing position. In the second, you can visually detect the expanded veins of the plexiform plexus. The third degree is characterized by pronounced expansion of the veins and a decrease in the size of the testicle.
Clinically, the disease is manifested by omission, an increase in the left half of the scrotum, a feeling of heaviness and pulling pain in it during physical exertion and during sexual arousal. However, the main symptom of the disease is a decrease in the size of the testicle (usually on the left), which occurs due to the death of spermatogenic epithelium, which makes up about 80% of the testicular tissue.
In addition, with a prolonged course of the disease, testicular atrophy occurs. Narrowing of the renal vein caused by scarring in the surrounding tissue, nephroptosis, leads to hypertension in the kidney. In this case, there is almost no change in the filling of the veins of the spermatic cord, or occurs slightly, when the patient changes from a standing position to a lying position.
Varicocele - diagnosis
Diagnosis is by palpating the patient when he is in a standing position. With the disease, the scrotum sags on the affected side and the veins expand along the spermatic cord. In the supine position of the patient, the diagnosis is difficult, since in this case the outflow of blood is facilitated, and the dilated veins of the spermatic cord may subside. Diagnosis of right-sided or bilateral varicocele is even more difficult.
Today, the disease is diagnosed mainly by conducting venographic studies (renal testicular venography, antegrade venography, transcrotal testiculophlebography). To determine the motor ability of sperm, an analysis of the ejaculate is carried out. Sometimes rheography, thermography, thermometry, doppleroscopy, ultrasound scanning are used (the last two methods are mainly used to diagnose the disease in children of preschool and early school age).
Varicocele - treatment and prevention
The purpose of treatment for varicocele is preceded by a medical history, which includes information on the duration of symptoms, the presence of injuries of the lumbar region, the likelihood of transformation of orthostatic varicocele into a constant.
The most optimal treatment for varicocele is surgical. An endoscopic method is also used in which the internal testicular vein is produced by introducing an endoscope into the retroperitoneal space. It is recommended to limit physical activity and sexual life, as well as wearing a suspension.
Timely initiation of treatment is the main condition for a favorable prognosis and restoration of testicular function.
