Varicocele in men: what is it?
Varicocele is a pathology of the veins of the spermatic cord, which is usually found among young men (12 – 25 years). Basically register the left-sided defeat. This article describes a varicocele, is indicated what it is, what causes and how to manifest.
General characteristics and etiology
The term «varicocele» understand varicose veins in the area of the spermatic cord, which forms the so-called Lozovo plexus of the scrotum. This pathology in 40% of cases diagnosed among men who suffer from infertility. In 60% of patients exhibit the defeat of the veins on the left side, though it may be right or bilateral vasodilation. Sometimes with a specified violation no complaints, but if it exists, should conduct appropriate therapy, because of possible consequences in the form of disorders of spermatogenesis or phimosis.
The main reasons for the development of varicocele:
- birth defects, which are manifested by the absence of valves in the veins of the testicles (blood in this case is not in great vessels and accumulates in lozovina plexus);
- the high pressure in the pelvic area or the vessels of the scrotum leads to anatomical changes in the veins of the testicles;
- sometimes this pathology is a consequence of chronic disorders of the chair;
- overexertion of the muscular fibres of the stomach;
- excessive physical work involving heavy lifting;
- irregular sex;
- also, a secondary lesion on the background of tumors, which are localized in the abdominal cavity and compromises the blood flow of the spermatic cord.
Important etiological factor is renal hypertension, which leads to incorrect redistribution of the blood and its accumulation in the veins of the testicle. The primary form of hypertension in the veins of the kidney provokes their contraction that often occurs after an inflammatory or traumatic lesion, and the presence of tumor.
Left-sided varicocele usually can be linked to anatomical features of the left vein of the testicle. It empties into the renal vein, therefore, when any renal venous hypertension are observed venous reflux and congestion. In addition, in the veins of the testicle on the left side most lacking venous valves. Right Vienna egg connects with the inferior Vena cava, so the blood flow it does not depend on the nature of the hemodynamics in the kidney.
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There are 4 degrees of severity of the disease:
There are cases of asymptomatic of the disease. At clear clinic, there are complaints of discomfort while walking, burning sensation in the scrotum, pain that sometimes radiates to the lower back. Sometimes recorded a sharp pain, which by their nature are reminiscent of neurological. Also characterized by increased sweating and sexual dysfunction.
Are formed with time wasting and atrophy, testicular hematoma, asymmetry of the scrotum as a result of lowering of testicle. Also, a characteristic manifestation of the disease is pathospermia. It manifests itself with a decline in semen sperm count, poor motility. In addition, there is a change in sperm morphology (manifested by disruption of their normal structure), and autoimmune inflammation, and that becomes the cause of infertility.
Among the factors that cause infertility on the background of the varicocele, one should also note the increase in temperature in the testes to body temperature (OK it is slightly below) that disrupts the normal spermatogenesis, testicular hypoxia and accumulation of free radicals, which are harmful to the sperm.
Diagnosis is quite often put up during the inspection and palpation Lutovinovo plexus when the patient is standing. Palpation examination also conducted in horizontal position of the patient and straining (called the sample of Valsalva). If they find dilated veins only on the left, it is likely that the patient has the primary form of the disease. When bilateral or right pathological process talking about the symptomatic nature of the lesion.
To exclude the possible presence of tumors that lead to secondary varicocele, it is recommended to do a renal ultrasound. To detect thrombosis or other disorders using CT or MRI. To diagnose subclinical forms of the disease used ultrasound imaging with Doppler.
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Adult patients are also prescribed spermatogramma. In the analysis of ejaculate can often reveal asthenozoospermia, which is a decreased sperm motility and oligospermia, which recorded a reduced number of sperm in the sample material. For prescribing the right treatment using contrast research methods (e.g., retrograde renal venography or testicular transscrotal testikuliarnah).
In secondary form of disease, it is necessary to treat the underlying disease. If you lose 1 – 2 the degree of complexity of the operation is not carried out. As a rule, enough to prevent stagnation of blood in the pelvic area. For this recommend standardized physical activity and control over a normal bowel movement, avoiding alcohol and regular sex. Sometimes prescribed antioxidants, drugs that improve microcirculation and vasoprotector to prevent the progression of varicose veins.
The indication for surgery is pain syndrome, oligo-, asthenozoospermia or other pathology of spermatogenesis, as well as stunted growth of the testicle on the affected side at puberty. If desired, the men carried out an operation to correct cosmetic defect. There are 4 main surgical methods of therapy:
- open surgery;
- surgery with minimal access;
- endoscopic technique;
- microsurgical revascularization.
Open operation provides for the conduct of men rather large incision in the iliac region and the ligation of the veins of the testicle. During the surgery with minimal access make a small incision in the area of the projection of the inguinal ring and tie up the veins of the spermatic cord.
Endoscopic intervention make 3 small puncture wounds. One carried out in the navel area and enter the mini-Cams, which is connected with a monitor (it renders everything that happens during the operation). Through the other puncture introduced special tools by which veins are superimposed brackets, or held their ligation with surgical thread. The duration of this operation is about 20 minutes.
In microsurgical revascularization to restore blood flow to the testicle. For that testicular Vienna transplanted in the upper abdomen venous vessel, which ensures a good outflow of blood. One of the modern methods is laser treatment. The surgery is performed under local anesthesia, with minimal risk of injury to surrounding tissues or other complications.