Varicocele

Introduction Varicocele refers to the expansion of the veins in the spermatic cord due to obstruction of reflux. It is a common disease in young and middle-aged people. It refers to the vasodilatation, distortion and lengthening of the spermatic plexus (venous vascular plexus) caused by the accumulation of spermatic vein blood flow. The incidence rate is 10-15% for males and 15-20% for male infertility. This disease occurs mostly on the left side, but it is not uncommon for both sides to develop, which can be as high as 20%. Varicocele may be associated with testicular atrophy and spermatogenesis disorders, resulting in male infertility. Varicocele can also be caused by a kidney tumor or other retroperitoneal tumor. The varicocele caused by compression is called symptomatic or secondary varicocele.

Cause

(1) Anatomical factors:

1. The left internal spermatic vein is long and enters the renal vein at a right angle, and the blood flow is subject to certain resistance. The left internal spermatic vein near the left renal vein has no valve, so the blood is easy to reverse.

2. The left internal spermatic vein is located behind the sigmoid colon and is susceptible to intestinal fecal compression, which affects blood return.

(2) Physiological factors: The young and middle-aged functions are more vigorous, and the blood supply of the contents of the scrotum is strong. In addition, standing for a long time, increasing abdominal pressure is also a disease.

(C) other factors: retroperitoneal tumors, renal tumors, hydronephrosis and other pressures of the internal spermatic vein 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.

an examination

95% of the disease occurs on the left side. Let the patient stand while checking. It can be seen that the scrotum of the affected side is obviously drooping, and sometimes there are curved veins on the surface of the skin. The scrotal veins are lumped into a mass, and the male examination reveals that the spermatic veins are distorted and expanded like a wart. At the time of percussion, a soft mass that can be compressed and touched in the spermatic cord above the testicle. Even small nodules that can reach the thrombus. A mass of the same nature can also be found in the lower back of the testicle. After the patient was lying down, the mass quickly disappeared. If it cannot disappear after lying down, it should be considered as secondary. A corresponding check is required.

The varicocele is the most reliable method for the diagnosis of primary varicocele. This method can not only understand the existence, extent and anatomical variation of varicocele, but also determine whether it is suitable for surgery or embolization. The reasons for the continued existence of posterior varicocele and the timing of the surgery. However, the law is an invasive method of inspection and its high cost, which limits its application.

Differential diagnosis

1. Filaria-spermatozoa lymphatic varices are thick and thick, with distorted dilatation similar to varicocele, but with a history of recurrent filarial sperm sinus, palpated in the lower part of the spermatic cord with a smaller group of cords The lumps are obvious, the position is reduced, the lying position is reduced, the light transmission test does not show the purple blue color of the vein, and the microfilaria can be found in the peripheral blood after falling asleep.

2. Filaria scrotum scrotum bulge discomfort, thick cord, but recurrent local severe pain or dull pain and radiation to the lower abdomen, thickening of the spermatic cord, tenderness, small induration at the lower end of the spermatic cord .

3. The vas deferens epididymal tuberculosis scrotum area bulge discomfort. However, the thickening of the vas deferens is a beaded hard knot change. The epididymis has irregular swelling and hardening and induration. Can adhere to the scrotum to form a sinus.

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