Varicocele
Varicocele is a varicose dilation of the blood vessels of the spermatic cord: the cluster plexus and the internal testicular vein. On average, varicocele is diagnosed in 10-20 percent of the male population of the planet. Among adolescent boys, about 2-10 percent suffered varicocele. In men over the age of 18, it occurs in 2.5-10 percent of cases. The disease has a very negative effect on the fertility of the male body. Thus, according to analyses taken from sick men, signs of spermatogenesis are observed in 20-70 percent of patients. Also at the time of clinical studies, it was revealed that in men suffering from infertility, varicocele is observed in 50 percent of cases. Doctors have established a direct relationship of the violation of spermatogenesis to the duration of varicocele.
CAUSES OF VARICOCELE
The occurrence of varicocele, as a rule, is associated with venous hypertension in the area of the renal vein, and this has a connection with the anatomical features of the body structure. High pressure in this area provokes the inability to perform their functions by the valves of the testicular blood vessel and the development of a blood path with the reverse direction of the flow of venous blood from the renal vein along the testicular to the area of the cluster plexus. The causes of high blood pressure are called:
prolonged muscular tension of the anterior abdominal wall leading to an increase in intra-abdominal pressure with a slowdown in blood flow to the inferior vena cava;
being in an upright position for a long time;
pinching of the left renal vein between the superior mesenteric artery and the aorta, this area is also referred to as the aortomesetrial “tweezers”.
SYMPTOMS OF VARICOCELE
Most men with varicocele do not go to medical institutions, especially at the stages when the disease has not yet begun to seriously bother them. Next, patients begin to observe that the left part of the scrotum begins to descend and increases in size. To this, mild, pulling pains begin to be added in the testicle area, in the scrotum or in the groin. Pain is characterized by the fact that it increases with physical exertion. Often, the tortuosity of the veins in the area of the worm-like lump also increases. If the disease is permanent, then the testicle can greatly decrease in size. The main complaint when visiting the hospital is the inability to conceive a child.
DIAGNOSTIC PROGRAM FOR SUSPECTED VARICOCELE
During the examination, the emphasis is placed on the side of the alleged lesion. An increase in the veins of the cluster plexus is revealed, with the help of palpation there is a glomerulus of worm-like, soft, greatly enlarged veins of the cluster plexus. The absence of such a lump in the right half of the scrotum indicates a left-sided varicocele. If the veins remain dilated in the supine position with right-sided and left-sided varicocele, then the possibility of symptomatic varicocele should not be excluded.
Laboratory methods of research are limited to a spermogram, which will help to identify reduced movements and the number of spermatozoa. Recently, color echopodplerography has been used to diagnose varicocele, it helps to identify the disease in the early stages. Ultrasound, CT and MRI can also be performed.
TREATMENT OF VARICOCELE
Most often, varicocele is treated with surgical intervention. The tactics of limiting all kinds of physical exertion almost does not give results, and the risks of infertility development do not allow us to expect.
Ligation and excision of the veins of the spermatic cord is performed at the entrance to the inguinal canal, in itself or at the exit from the inguinal canal. Due to the reduction in the number of surgical and postoperative complications and relapses of the disease, various microsurgical operations on dilated veins are widely used.
