Varicocele - Causes, Symptoms and Treatment .MF .
varicocele is a varicose veins of the spermatic cord and testicles.
Varikotsele one of the most common diseases among men, which often leads to very unpleasant consequences.In itself, varicose veins of the spermatic cord is not a big problem, the patient's life is not threatened, and with it you can safely live life without any worries.The problem can be a major complication of this disease - male infertility and pain symptom.
According to WHO (World Health Organization) varicocele occurs among women in 15-17% of cases.This reveals a wide range of frequency of occurrence depending on the region and the age of the subjects.However, on examination using ultrasonic methods varicocele is found in 35% of men of reproductive age.During conscription varicocele detected in 5-7% of young people, and the highest incidence between the ages of 14-15 years - 19.3%.Typically, varicocele is only on one side - the left (80-98%).This is due to different vein confluence eggs left and
Symptoms of varicocele
In most cases, the disease begins at puberty, quickly reaches a certain extent and no longer progressing. Varikotsele can does not manifest itself, and the diagnosis is made by chance during any medical examination.
If we talk about the complaints of patients, as a rule, they do not happen.
In general, this condition is painless and any anxiety causes.Young people have noted an increase, ptosis of the left half of the scrotum, slight "pulling" sensation in the testicles, scrotum willows groin area on the affected side, worse when walking and physical activity, sexual arousal;with significant varicocele pendulous scrotum prevents walking;point reduction in the left testicle.The increase in the left half of the scrotum often appears in a standing position and disappears in the supine position.In severe cases, the pain is permanent.Note the significant increase in the scrotum, contouring tortuous veins, reduction of the left testicle.
As already noted, a major complication of varicocele and other symptom is infertility.The laboratory analysis of the patient's sperm is found a decrease in sperm count and motility.
by how much dilated veins of the spermatic cord and testicles, are 4 degrees of varicocele:
0 degree - testicular veins are not palpated hands, their varicose determined only instrumental (ultrasound, Doppler).
1 degree - enlargement of veins palpable in the standing position, in a prone position varicocele is not defined.
2 degree - dilated veins palpable in the standing position and a lying position.
3 degree - dilated veins testicle and spermatic cord are visible to the naked eye.
Very rarely one degree varicocele moves to another.
Causes and risk factors varicocele
development of this disease due to the fact that the valves, which exist in the veins, and which shall prevent the reverse flow of blood, do not work or work poorly, and when the pressure in the veins (e.g., uprightthe body during physical exertion), this pressure begins to be transmitted in the reverse direction, causing gradual expansion of the venous vessel.Thus, the expanded veins surrounding the spermatic cord.
Another reason varicocele is a special anatomical relationship of the renal vein and the upper mesenteric artery to form the so-called aortomezenterialnogo "tweezers".
Gradually, under the influence of high pressure, the veins start to increase in size, stretch, expand.Depending on the strength of the vein walls for different people and on the magnitude of the venous pressure, this stretching may reach different degrees.The venous network around the egg becomes more and more, and in severe cases, the egg appears as though immersed in the sponge from the veins.This blood "cushion" of the veins around the testicle causes that thermo function of the scrotum is lost, and the egg is no longer cool.Consequently, the low temperature required for sperm production, is no more, and normal spermatogenesis is suppressed.That is why the varicocele is one of the main factors of male infertility.
Thus, factors of infertility in varicocele are:
- increase in temperature in the testis to body temperature (normal testicular temperature is lower than body temperature, which is necessary for normal spermatogenesis (for the same reason testicles "taken out" beyondabdomen into the scrotum).
- Reverse throw biologically active substances from the kidneys, the adrenal glands in the testes.
- hypoxia (oxygen starvation, ischemia) eggs.
- accumulation of free radicals in the testicular tissue (which are strong cell poisons), which damage their
Complications of varicocele
If we consider the structure of the causes of male infertility, varicocele is the main factor causing infertility:.
- in 60% of patients with varicocele were impaired spermatogenic testicular function,
- 40% of men surveyed about infertility, varicocele detected.
Thus, treatment of varicocele in the first place be aimed at prevention and treatment of male infertility.
diagnosis of varicocele
To diagnose varicoceles in some cases there is a sufficient inspection and palpation "pampiniform" (grozdevidnogo) plexus (in the form of a vine, cluster) with the patient standing.More clear results are obtained by palpation of the Valsalva maneuver (test with straining: with an increase in abdominal pressure increases blood circulation in the veins testicle).
If a significant increase in the veins, and the diagnosis is in doubt, the additional testing is required.
If the degree of varicocele is small, it is necessary to conduct a special examination - Doppler ultrasound or scrotum.Doppler ultrasound or a suspected varicocele must be carried out in two positions of the patient - lying and standing.If this is not done, the survey has no meaning.
Doppler ultrasound of the scrotum or in the lying and standing must be carried to all men with infertility and pain in the testicles.
addition to all the above, with varicocele have to be made to semen.It is necessary to conduct at least two studies, at intervals of 4-12 weeks.Also required is sexual abstinence before putting semen within 2 to 7 days.
Treatment of varicocele
As for varicose veins on the legs, the only real way of treatment is surgery in one form or another.
On the other hand, as a varicocele - a disease not dangerous and usually asymptomatic, in itself, its detection in an adult male is not an indication for surgery.
Surgical treatment is required in the following cases:
- presence of pain in the testicle.
- Male infertility (by reducing the quantity, quality and mobility of sperm).
- aesthetic defect in the scrotum.
- cessation of growth of the affected testis at puberty.
However, many experts believe that children and adolescents for the prevention of potential infertility in varicocele surgery should be done in any case.
Currently, there are 4 main ways of surgical treatment:
- open (normal) operation.
- Operation of minimal access.
- Endoscopic surgery.
- Microsurgical testicular revascularization.