Varicocele

Introduction to varicocele Varicocele refers to the venous return of the spermatic cord is blocked, the valve fails, the blood reverses and causes blood stasis, resulting in the expansion, elongation and bending of the venous plexus. It occurs 95% on the left side and less on both sides. Most people think that varicocele can affect spermatogenesis and semen quality and cause infertility. Some people can restore fertility after surgery. The incidence of the disease is about 20% in normal men and about 40% in infertile men. The disease is more common in young adults, relatively few among adolescents. The total incidence of varicocele in 6-19 year olds is 10.76%, but the degree is heavier, mostly III. basic knowledge The proportion of sickness: 0.2% Susceptible people: male Mode of infection: non-infectious Complications: hydrocele, inguinal hernia

Causes of varicocele

Physiological factors (25%):

The young and middle-aged functions are more vigorous, and the blood supply to the contents of the scrotum is strong. Therefore, some varicocele can gradually disappear with age. In addition, standing for a long time, increasing abdominal pressure is also a disease.

Anatomical factors (20%):

The blood of the testis and epididymis is reflowed through the spermatic vein. The spermatic veins can be divided into three groups. They have side branches circulating at the outer ring. The latter group: external spermatic vein inferior epigastric vein femoral vein external iliac vein. Middle group: vas deferens vein upper bladder vein internal iliac vein. The former group: the veins of the spermatic vein, testis, and epididymis are mainly recirculated through the variegated venous plexus. The venous plexus is combined into 2 to 4 veins in the inguinal canal, and a vein is synthesized through the inner ring to the retroperitoneum. Soman vein. The right internal spermatic vein slanted upward into the inferior vena cava; the left side entered the left renal vein at a right angle.

Other factors (30%):

Compressive spermatic veins such as retroperitoneal tumors, renal tumors, hydronephrosis, etc. can cause symptomatic or secondary varicocele. The original person disappears quickly when lying down, and the secondary person often does not disappear or disappear very slowly.

(1) Causes of the disease

1. The cause of primary varicocele varicocele is mainly caused by stagnant blood flow in the spermatic vein, due to the erect posture of the person affecting the resection of the spermatic vein; the connective tissue of the vein wall and its surrounding area is weak or the cremaster muscle Insufficiency; venous valve defect or insufficiency, it is prone to varicose veins. Recently, it has been reported that varicocele is closely related to masturbation. Wang Anxi reported that the pathological changes of internal spermatic vein and blood flow disorder are causal, mutual influence, malignant Circulation, left and right spermatic veins can occur separately or simultaneously, but the incidence of left varicose veins is high. The reason is that the left spermatic vein is about 8 to 10 cm longer than the right side and enters the kidney at a right angle. Venous, venous pressure; left varicocele may be compressed by the colon; left renal vein may be compressed between the aorta and mesenteric artery, affecting spermatic vein reflux, forming the so-called proximal "clamping" phenomenon; right common iliac artery may Compression of the left common iliac vein, the left spermatic vein return is blocked, forming a so-called distal "clamping" phenomenon.

2, symptomatic varicocele kidney tumor has renal vein, inferior vena cava to form a tumor thrombus or posterior peritoneal tumor compression, hydronephrosis or ectopic blood vessels can cause symptomatic varicocele.

(two) pathogenesis

Varicocele is more common in male infertility, varicocele causes pathological changes in testis, affecting spermatogenesis, resulting in decreased sperm motility, immature sperm cell morphology and increased number of pointed sperm. The evidence clarifies the mechanism of infertility, but is believed to be related to the following factors:

1. Blood retention in varicose veins causes the local temperature of the testicle to increase and affect spermatogenesis.

2, blood retention affects the blood circulation of the testicles, so that the testicles lack the necessary nutrient supply and oxygen supply to affect spermatogenesis.

3, the left side of the spermatic vein in the countercurrent, metabolites secreted by the adrenal gland and kidneys such as steroids, catecholamines, serotonin, etc. to the testis, sterols can inhibit spermatogenesis, catecholamines can chronically testicular poisoning, 5- Serotonin can cause vasoconstriction, causing premature detachment of immature sperm, causing male infertility.

4, the above factors can also affect the endocrine function of the testicular stroma, interfere with spermatogenesis.

5, left varicocele will also affect the right testicular function, both sides of the testicular venous blood vessels have a rich anastomosis, the left side of the blood toxins can go to the right side and affect the right testicular sperm.

Varicocele prevention

1, pay attention to keep the mood comfortable, avoid anger and liver injury, pay attention to diet adjustment, eat spicy food.

2, pay attention to work and rest, to prevent strenuous exercise, heavy physical labor and long standing.

3, control the house, often wear tight underwear or use a scrotum to prevent the scrotum from falling.

Timely treatment of genitourinary infections such as prostatitis, urethritis, etc., to reduce the chance of inflammation, is also an important means to prevent the occurrence of this disease. The varicocele generally has a good prognosis. Mild patients do not need surgery. However, patients with moderate or severe symptoms or other accompanying symptoms such as decreased sperm motility and premature ejaculation need timely surgical treatment. The surgical treatment is effective, such as due to this disease. The ability of the educator to give birth after surgery is significantly improved.

Varicocele complications Complications, hydrocele, inguinal hernia

Complicated with infertility, etc., varicocele may be associated with testicular atrophy, inguinal hernia, varicose veins of the lower extremities and hydrocele.

Varicocele symptoms Common symptoms Spermatozoa thickening swelling semen yellow urine urine sperm quality poor swelling abdominal pain lower abdominal dull pain and soreness male infertility varicocele

The patient can be completely asymptomatic. If there are symptoms, it usually falls after the scrotum, and it can involve the ipsilateral lower abdomen or the inner thigh. This symptom disappears after lying down. In recent years, it has been reported that the number of sperm in patients with varicocele is reduced, affecting fertility. After surgery, restore fertility. In addition, some patients have symptoms such as mental anxiety, anxiety, insomnia, general malaise, and impotence. Severe varicocele can cause atrophy of the testicle on the side, and the patient seeks medical treatment because of a small testicular testicle.

Symptomatic varicocele may have a history of primary disease such as kidney tumor and hydronephrosis; primary varicocele may have a history of male infertility. When the patient stands, the scrotum is swollen, with a heavy and swell, and can be lowered to the lower abdomen. , groin or waist radiation, walking and labor aggravation, relieved after supine rest, varicose veins and symptoms can be inconsistent, sometimes with symptoms of neurasthenia or sexual dysfunction, causing symptoms of symptomatic varicocele Such as abdominal pain, anemia, hematuria, pelvic mass and so on.

According to the degree of varicose veins, it can be divided into light, medium and heavy three degrees. When the varicose veins are not seen locally, the palpation is not obvious. The varicose veins are aggravated in the Valsalva test, and the varicose veins disappear when lying down. In the middle, the varicose veins are not visible in the standing position, but the veins in the scrotum can be touched. The varicose veins gradually disappear when lying down. When the scrotum is severe, the scrotum can touch the veins of the warts or lumps, and the varicose veins The veins disappeared slowly. In recent years, the research on subclinical varicocele has been paid more and more attention at home and abroad. The patients can not find varicocele during the physical examination. The Valsalva test is also negative, but the ultrasound, radionuclide scan or color The Pu'er examination can find very mild varicocele. These patients are often found in infertility examinations. The diagnostic criteria for subclinical varicocele are not uniform. It is generally considered that the diameter of the venous blood vessels exceeds 2 mm for subclinical sperm. Varicose veins, more than 5mm for clinical varicocele.

If the varicose veins in the scrotum cannot be alleviated or resolved after supine, the patient is bilateral varicocele, and secondary varicocele may be considered. Further examination should be performed to confirm the diagnosis.

Examination of varicocele

1, semen analysis: visible sperm number decreased, sperm activity decreased, the shape is immature and the number of pointed sperm increased, such as testicular biopsy, can be seen spermatogenic cell dysplasia.

2. Doppler ultrasonography can determine the blood flow of the testicle and determine the volume of the testicle.

3, spermatic vein angiography with Seldinger method through the femoral vein cannula to the spermatic vein, injection of contrast agent, observe the degree of contrast agent countercurrent, contrast agent in the spermatic vein in the countercurrent length of 5cm is mild; countercurrent to The level of L1 ~ 5 is moderate; the person who flows backward to the scrotum is severe.

4, for the secondary varicocele should pay attention to the examination of the abdomen, should be used for intravenous pyelography to exclude kidney tumors.

Diagnosis and diagnosis of varicocele

The varicocele can be diagnosed by physical examination and ultrasound, but its relationship with scrotal discomfort, pain, fertility, and androgen is uncertain. Therefore, attention should be paid to varicocele combined with other diseases causing the above symptoms. In particular, mental illness manifested by physical symptoms.

diagnosis

1. Consultation: medical history, marriage and childbirth history, and history of surgery.

2, physical examination

1) Body type, elongated patients are prone to occur.

2) Inspection methods and evaluation of varicose veins: 1 visual inspection: observe whether the scrotal skin has a tortuous vein; 2 check when standing; 3 check after lying down; check after breath holding (Valsalva).

3) Size and texture of the testicles (optional).

3, laboratory inspection

1) Semen examination: Semen examination twice in 3 months. The test items should include: semen volume, liquefaction time, pH value, sperm density, activity rate, etc.

2) Sex hormone testing (testosterone, follicle stimulating hormone, luteinizing hormone, etc.)

4, color Doppler ultrasonography (color Doppler ultrasonography)

Color Doppler ultrasonography is of great value in the diagnosis of varicocele. Using scrotal ultrasound can find more patients with subclinical spermatic varices in infertile patients.

a) The inner diameter of the spermatic vein during a calm breath test and the inner diameter of the spermatic vein during Valsalva's action.

b) Backflow, rest and Valsalva action, backflow duration.

c) Check the testes and epididymis at the same time.

Differential diagnosis

1. Filariatic spermatic cord lymphatic varicose veins are thick, tortuous, dilated, similar to varicocele, but have a history of recurrent filarial spermaticositis, palpated in the lower part of the spermatic cord. The lumps of masses are obvious, the position is reduced, the light position is not purple blue, and the microfilaria can be found in the peripheral blood after falling asleep.

2, the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum of the scrotum Induration.

3, vas deferens epididymal tuberculosis scrotum area bulging discomfort, but the vas deferens thickening beaded hard section changes, the epididymis tail has irregular swelling, hardening and induration, can form a sinus with the scrotum adhesion.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.