All the causes of varicocele in men: from what arises and how to prevent?
Varicocele is a fairly common urological disease and is observed in approximately 17% of men.
The disease has no age limits, however, it is most often diagnosed in men of reproductive age and in adolescents. Due to the peculiarities of the circulatory system, a varicocele is most often manifested on the left side (up to 90% of cases) and is often accompanied by specific pathologies - varicose veins, heart valve diseases, flat feet and phimosis.
What causes varicocele in men?
Factors that provoke the occurrence of varicocele in men are:
- genetics. The most common cause of varicocele is a hereditary tendency to varicose veins. With a predisposition to impaired formation of connective tissue in a patient, pathologies such as limb varicose veins, flat feet, heart valve insufficiency can be detected.
Due to a defect in the valves of the seminal vessels and the weakness of their walls, there is a return flow of blood (reflux) along the left spermatic vein, this also occurs with pressure surges in the left renal vein. In this case, the blood does not enter the main vessels, and accumulates in the cluster-like plexus, expanding its veins,
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Causes of the onset of the disease in adolescents
Usually, varicocele in adolescents is asymptomatic and is diagnosed only at routine examinations. The causes of the development of the disease in adolescents include congenital pinching in the left renal vein, accompanied by increased pressure in the region of the plexiform plexus, and rapid growth of the body, accompanied by increased stress on the vessels.
Can a disease cause infertility?
Among men suffering from varicocele, infertility is detected only in 40%, so dilation of the papillary plexus cannot be called a direct prerequisite for infertility, although this is one of its main factors.
Some men do not have problems with reproductive function, even with developed varicocele.
Normally, the temperature of the testicles should not exceed 34.5 degrees, but with developed expansion of the veins, the testicle is literally entangled with vessels, which interferes with its normal cooling.
The higher the temperature rises, the more reproductive function is inhibited.
Autoimmune inflammation also has a negative effect on sperm production, which often develops with varicocele due to the nature of the testicular tissue.
Even if the patient’s spermatogenesis is normal, reproductive problems with varicocele can also be caused by other factors, for example, by mechanical action - dilated veins literally squeeze the vas deferens.
Also hormone production declines, there is an increase in the level of FSH (follicle-stimulating hormone) - this indicator indicates a serious violation of the epithelium responsible for spermatogenesis.
Having an idea of the reasons for the development of varicocele in the testicle, necessary preventive measures can be analyzed. Due to the fact that the disease develops mainly due to a genetic predisposition and specific anatomical features of the body, certain preventive measures do not exist.
If the patient knows about his own burdened heredity, it will be useful to reconsider his lifestyle in order to prevent the development of varicocele:
- exclusion of prolonged physical overvoltage,
- refusal to drink alcohol,
- transition to a balanced diet, including vitamins,
- leveling stool problems,
- regular sex
- timely examinations by a doctor.
These simple measures will help prevent the formation of pathologically dilated veins., especially if in the past the patient has already been diagnosed with varicocele.
Is it contagious?
In order to answer this question, it is necessary to consider the pathogenesis of varicocele. The veins in the human body are responsible for the transfer of blood containing carbon dioxide. The movement along them is directed from the bottom up. The walls of the veins are elastic in comparison with the arteries, equipped with special valves that should prevent the return of blood.
If the valves of the veins surrounding the testicle with the spermatic cord are disturbed, the blood stagnates, stretching the walls of the vessels, forming a seal resembling a bunch of grapes.
However, infection with bacteria, viruses and fungi can lead to male genital inflammation, which indirectly contributes to the development of varicocele.
Can a disease develop for psychosomatic reasons? What is the case with varicocele psychosomatics?
Any severe stress is accompanied by the release of adrenaline or norepinephrine hormones into the blood. The selectivity of hormonal release depends on the individual characteristics of the man’s body:
- Adrenalin helps to reduce blood vessels in the abdominal cavity of the pelvis. In chronic stress, this phenomenon can lead to wear of the valves of the veins surrounding the testicle, as well as to narrowing the lumen.
- Norepinephrine increases blood flow by the heart muscle, which can cause excessive stretching of the walls of the veins, as well as local blood stasis.
What else are the causes of varicocele in men, why it develops, we will consider further.
Causes of varicocele
Scientists have not yet found a clear answer to the question why varicocele occurs in men. It is believed that in most cases this is due to genetic factors, and more precisely - with the features of connective tissue. As a result, the venous valve does not develop 100%, and the blood flow in the vein is disturbed.
Also, a varicocele can occur if a man is engaged in heavy physical exertion for a long time (for example, sports with weight lifting, long trips by bicycle or horse, or if his profession is associated with heavy physical labor). Other causes are inflammatory diseases and infections of the genitourinary system, injuries, tumors, kidney pathologies, and chronic constipation. The wrong lifestyle plays its role - overweight, malnutrition, alcohol abuse, etc.
Varicocele: causes in men
What causes varicocele in men? All the causes of the development of the disease in question can be divided into the following groups:
- Genetic predisposition. A disease of this kind may be associated with a defect in intrauterine development, in which an insufficient amount of connective tissue is formed.
The result of such heredity are congenital malformations of the venous valves or their complete absence, as well as thin or insufficiently elastic walls of the veins in the scrotum. Reducing the lumen of the veins. This phenomenon may be the result of inflammatory diseases, injuries, and surgical operations after which the process of scarring of the scrotum tissue began, which led to the squeezing of the egg vein.
The decrease in clearance is also determined by the presence of a tumor, the location of the vein between other vessels and chronic stress with the release of the hormone adrenaline into the blood. Kidney pathology. In this case, as a rule, secondary right-sided varicocele develops.
It differs from the left-side one in that the veins in the horizontal position remain inflated. Secondary is called varicocele, which is a consequence of another disease. Increase in abdominal pressure - Another cause of testicular varicocele. The result of increased pressure inside the abdominal cavity can be blood overflow of veins surrounding the testicle with spermatic cord, stretching of the elastic walls, their subsequent deformation.
Pressure in the lower abdomen increases with regular constipation, intense physical exertion associated with weight lifting, chronic stress and neurosis, accompanied by the release of norepinephrine into the blood. Wrong way of life. This is the most common reason why varicocele occurs, both in childhood, adolescence, and in adulthood.
The use of alcohol leads to deformation, premature wear of all vessels of the body.
Eating fast food, canned goods, cheap confectionery products with a high content of margarine and sugar is the reason for the insufficient formation of connective tissue in the body. In combination with a sedentary lifestyle, obesity can develop.
Overweight men are predisposed to the occurrence of varicocele due to the formation of cholesterol plaques on the walls of blood vessels and the possibility of squeezing fatty layer of veins in the scrotum.
We should also mention beer, which with regular use can change the hormonal balance of the male body due to the suppression of testosterone synthesis and an increase in the concentration of estrogen-like substances in the blood, which causes varicocele, and also testicular tumors develop.
Use anabolics and steroid drugs changes the hormonal balance, because of which there is a varicocele in men, as this adversely affects the state of the vessels. In combination with intense power loads aimed at the result, the likelihood of varicose veins of the testicles increases.
Doctors have not yet come to a consensus about the influence of the factor of intense sex life, and whether masturbation can cause varicocele. Common sense suggests that you should always listen to your body and stick to the middle ground. Violence over your body cannot be helpful.
Recently, the occurrence of varicocele in boys has been associated with the use of diapers, which overheat the scrotum and cause defects in the veins in the testicles. This hypothesis has not yet received official confirmation.
What are the symptoms of varicocele in men
Varicocele is different in that it can occur with noticeable symptoms, as well as without it. In the absence of symptoms, the doctor can detect the disease during a routine examination.
Symptoms with varicocele are as follows: one testicle can decrease in size, sometimes there is a pulling pain in the scrotum, inguinal region or testicles (both by itself and after exercise or during intercourse), enlarged veins are felt under the skin. There is a decrease in sexual function, heaviness is felt in the groin and / or scrotum, urinary incontinence or frequent urination may even appear.
Most importantly, the man becomes infertile and the reason for this is an increased temperature in the testicles, at which spermatozoa that can fertilize the female egg can not form.
So, let's do a little home self-examination:
- Do you have pain in the groin, testicles, or scrotum? If so, do they increase after exercise?
- Can you feel the veins in one of the testicles under the skin? Do they resemble a lump?
- Have you seen a regular decrease in sexual function over the last time?
- Can you mark the appearance of heaviness in the groin or scrotum?
- Have you recently had incontinence or increased urination?
- Have you noticed that one of the testicles has become smaller than the other?
If you answered yes to even one of the questions below, we advise you not to delay and make an appointment with the doctor.
What will happen if the disease is not treated?
Varicocele is a rather insidious disease. Its most serious consequence is infertility (spermatogenesis gradually stops). Other consequences: erectile dysfunction, testicular atrophy, the development of prostatitis in some cases, chronic pain.
The first degree of varicocele can be detected by palpation. In the second degree, dilated veins are determined visually, the size and consistency of the testis is not changed. The third degree of the disease is characterized by severe bloating of the veins of the plexiform plexus, a decrease in the testicle and a change in its consistency.
Everything from which there is a varicocele, we have already considered. In the absence of congenital anomalies, the occurrence of varicocele can be prevented by taking care of the health of blood vessels and capillaries. For the prevention of varicocele, it is necessary:
- go swimming, walking or yoga. You can choose any type of physical activity that increases blood circulation in the body,
- take a contrast shower every day. If there are contraindications, you can replace it with cold wiping, followed by rubbing with a towel,
- do yourself massage twice a week with a stiff brush or just with your hands. You should start from the feet, rising gradually to the top of the head. Particular attention should be paid to the inguinal region,
- master kegel exercises and perform them regularly. They are especially useful for men in the absence of sexual activity,
- start to eat fully, including lean meat, cottage cheese, nuts, vegetables and fruits in your diet. This will help improve intestinal motility and avoid constipation,
- pay a visit to a urologist for examination. Ask him to prescribe a complex of vitamins that is right for you.
We examined the causes of varicocele, the treatment of this disease is described in our next article.
Symptoms and signs characteristic of testicular varicocele
The disease begins with puberty. This process can be developed until it stops at a certain stage, without further progressing. Cases when one stage of the disease flows into another are not frequent.
The first signs of a problem are pain covering the scrotum and testicle.
The disease manifests itself with more pronounced pain as the situation worsens, which arise in one of the testicles, or both at once. The scrotum increases or falls.
It can also give pain to the groin area. The pain syndrome intensifies if a man is subjected to physical labor, while walking, or during intercourse.
Varicocele has the feature of transition to a chronic form. The patient may not know that he has this ailment, and sometimes he gets this diagnosis when contacting a specialist for another reason.
- Depending on how difficult the situation is, each group of characteristic signs of the disease is assigned four degrees:
- First Degree (1) - patients have practically no symptoms of the disease, they are not worried about pain.
- Detect the presence of dilated veins is possible only with the help of special tools.
- Varicocele is a companion of other diseases, therefore at this stage he is diagnosed along with other diseases.
- The first degree of the disease is detected when a man is subjected to:
- dopplerography of blood vessels.
In addition to the above methods, a man can be diagnosed with a problem using a spermogram.
For the early stage of the disease, a violation of the processes in the testis is characteristic. Carrying out the analysis of sperm, examine its consistency and weight. They also analyze the percentage of motile and motionless spermatozoa. This is a very important fact in determining whether a patient is infertile or not.
The solution to this problem, even in the absence of symptoms and pain, is surgery, since only it can save the patient from infertility.
strong> 2 degree (2) - the presence of dilated veins can be detected by palpation. This degree of the disease is diagnosed when the patient is standing. In other provisions, the problem is not detected.
The egg has unchanged dimensions.. When you change the standing position to lying, the expansion of the veins becomes less noticeable. Pain and pulling pains are more pronounced. At this stage of the disease, increased pain are the consequences of hard physical labor.
3 degree (3) - The main symptom of advanced varicocell is the presence of dilated veins, which can be detected by palpation, regardless of the patient's position.
With the standing position at this stage of the disease, the veins drop down and the scrotum deforms. Edema or testicular atrophy is also seen. Very rarely, the condition of the testicle is unchanged.
Pain sensations disturb patients not only during physical activity, but also in its absence. The feeling of heaviness and pain prevents a man from living a full life and limits his ability to work - with the third degree of varicocell, these are already tangible symptoms.
This phase of the disease is diagnosed when the scrotum is examined using ultrasound. You can make a diagnosis by analyzing the spermogram for the quality and quantity of spermatozoa, and using a Dopplerographic examination, checking the vessels of the scrotum.
4 degree (4) - detect pathology allows a visual examination of the patient.
The disease is characterized by a soft testicle, reduced in size. At this stage, the seminiferous tubules wriggle, the process of functioning of the vessels and appendages of the testicle is disturbed simultaneously with the defeat of its tissues.
Blood stagnates, veins become nodular. The function that is responsible for sperm production is inhibited.
In this situation, phlebitis is a possible complication, varicose vessels can be torn, spermatogenesis, as well as the structure of the testicles, are disturbed. All this is fraught with infertility..
The cause of relapse is the internal spermatic vein, as well as the presence of smaller veins, and the joints that pass between these veins. Due to its small diameter, these veins may remain invisible to the specialist during surgery. It is possible to detect them only with special optical devices.
After a certain period of time, these veins and joints expand, expand, and then provoke the occurrence of varicocele again. The recurrence of the disease manifests itself in pains in one testicle (or both), enlarged veins passing in the scrotum.
Symptoms become more pronounced due to heavy physical activity, venous outflow of blood from the testicles is disturbed, spermatozoa cannot form and mature according to the correct pattern.
Causes of Varicocele
The causes of varicocella are situations when blood stagnation occurs in organs related to the pelvis. Blood can stagnate due to excessive physical exertionirregular stools, intermittent sexual relations.
The disease can be provoked by increased pressure, which drives blood through the veins passing through the small pelvis and scrotum.
It is possible that the vein passing through the testicle is pinched and bent by other vessels. As a result, it has a clearance insufficient for normal blood flow. For this reason, the pressure in it rises.
The presence of varicocele in adult men on the right side, or simultaneously on both sides, may indicate that the kidneys, retroperitoneal space, or small pelvis have neoplasms.
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Previous and associated diseases
The problem of the appearance of varicocele becomes real for patients after they have suffered a disease. Diseases preceding varicocele can be:
- gonorrhea. With it, pain occurs when the urethra is examined by palpation. The sponges on which the urethral opening is red and swollen. Purulent discharge of a yellowish-greenish hue, dirty underwear, the head of the penis is covered with sores,
- the process of acute inflammation in the testicle (orchitis). The disease is characterized by pain in the testicle, extending to the perineum, sacrum and groin. For the scrotum, a twofold increase in size and smoothing of skin folds are characteristic. For the testicle - an increase in size and the presence of acute pain,
- inguinal hernia. There is pain radiating to the lower back or lower abdomen, as other organs are compressed by the hernia. Presence of constipation, rumbling, and other digestive problems. Sometimes, in the case of a severe degree of illness, there is a violation of the urination process,
- cryptorchidism. This problem is characterized by a situation where the testicle does not have the possibility of dropping and being in the scrotum. It’s either not completely lowered into it, or, having descended, is in the wrong place,
- epididymitis. In this disease, the sperm has an admixture of blood, the substance is separated from the penis, the lymph nodes in the groin are enlarged, pain can be felt during urination, the scrotum becomes swollen, and pain is present in the testicles.
Also, the disease can occur as a result of trauma, overheating or hypothermia.
Varicocele subsequently brings with it for a man certain difficulties. The main one is the inability to have children.
This is due to an increase in body temperature in the area where the scrotum is located. Elevated temperature keeps at this level constantly, and is unable to fall. The result of these phenomena is an impaired spermatogenesis process.
In addition to infertility, there are constant painarising in the scrotum. They can be caused by prolonged inaction in the fight against the disease.
To prevent the disease, you must actively live a sporting life, allow yourself to relax, eat healthy food. It is recommended to strengthen the immune system by taking vitamin complexes.
All the causes of varicocele in men: from what arises and how to prevent?
Varicocele is the formation of a cluster-like seal in the scrotum of a man. A similar phenomenon is associated with varicose veins of the testicles and spermatic cord.
As a rule, the disease develops during puberty, that is, in adolescents. Most often, the left-sided form of varicocele occurs due to the characteristics of male anatomy.
Right-sided and bilateral forms of the disease are rare in practice. Let's look at varicocele in men: the causes, symptoms and other important nuances are described in our article.
Testicular blood supply
Testicles are powered by the testicular artery, the branch of the abdominal aorta, and the cremaster artery, which is a branch of the lower epigastric artery. In the scrotum, large vascular bundles branch into smaller ones, up to the capillaries.
Blood outflow occurs through the testicular vein. An interesting fact is that after passing through the spermatic cord, this vein from different sides flows into the inferior vena cava to the right, is a branch of the left renal vein - from the opposite side. This is of fundamental importance in the development of the disease.
Outflow on the left side is worse than on the right. Blood travels a longer way to get into a larger vein and relieve pressure. It is for this reason that most often a varicocele occurs on the left.
In men, dilated veins on the right side of the scrotum may indicate thrombosis. In this case, varicocele can be an alarming symptom, indicating a more severe pathology, even tumor decay.
Causes of development and treatment of varicocele in men
Varicocele is a very dangerous and common disease. Many do not know anything about it, do not suspect its presence, do not know that varicocele in men can lead to infertility.
At the initial stage, the disease does not manifest itself in any way: asymptomatic course is observed.
But even with the appearance of discomfort, men are in no hurry to consult a doctor. In this case, the disease takes on a more acute form of development.
In order to prevent undesirable consequences, it is important to know how this problem occurs, how to determine the varicocele and how to properly treat the disease.
Causes of pathology
The reasons for the appearance of varicocele are not completely clear. There are predisposing factors that are most often identified during examination and questioning of patients. These include:
- hormonal imbalance: most cases of the disease occur in adolescents when the hormonal background changes,
- heavy physical exertion
- lean physique,
- high growth.
More real is the theory of hormonal disorders. Under the influence of certain substances in the body, weakening of the vascular wall, expansion of the veins of the spermatic cord occurs.As a result - blood stasis, a change in the valve apparatus. It is imbalance that is the most common cause of varicocele in men.
Signs of pathology
Often patients complain of pain with varicocele, which are localized in the scrotum from the dilated veins of the testicle. Unpleasant sensations are pulling periodic in nature. The intensification of pain can be associated with a long stay in an upright position, physical activity.
Also, patients note the appearance of symptoms in the late afternoon. Sometimes the symptoms of the disease disappear when the patient takes a horizontal position. Very rarely, patients are treated with acute pain requiring immediate action.
Other symptoms include swelling of the scrotum. This process is associated with congestion and impaired blood circulation of the spermatic cord veins in men. On self-examination, patients show edema.
Instead of pain, severity in the scrotum may disturb. Sensations worsen as the disease develops. Sometimes patients note a decrease in the size of the testicle from the side of the lesion - a sign of dystrophic changes.
Another symptom of varicocele is a protrusion of varicose veins. With independent palpation, a man can note the arising areas of swelling or seals that appear in the area of the affected vessels.
Unfortunately, in some cases, patients will find out what varicocele is in men when a symptom such as infertility appears. This does not mean that everyone who suffers from an illness will necessarily face childlessness. But in the case when the couple cannot have a baby, the pathology of the vascular branches is always excluded from the man and, if necessary, eliminated.
Normally, the temperature inside the scrotum is about 33 degrees Celsius. With varicose veins of the scrotum due to blood stasis, the temperature rises to 36-37 degrees Celsius. Under such conditions, the normal functioning of the testicles, and hence spermatogenesis, is impossible.
Degrees of disease
According to the international classification of the World Health Society, there are three degrees of varicocele:
- The degree of initial manifestations: characterized by the absence of any subjective sensations and changes during palpation. This degree can only be established after dopplerography of the vessels of the scrotum, which is most often performed in the medical examination or during examination for other diseases. The criteria for diagnosis is a slight expansion of the veins according to ultrasound.
- Medium Degree: varicose vessels are determined only with diagnostic palpation. External manifestations are absent.
- Third degree: characterized by the appearance of external signs. Veins bulge and shine through the skin of the scrotum. Individual cyanotic areas are determined. The vessels are convoluted, large, often intertwined.
The classification by R. Amelar and L. Dubin (1978) is practically no different from the WHO gradation. The only difference is that scientists determine the first degree by the Valsalva test.
Urologist B.L. Coolsaet in 1980 determined the degree of varicose veins of the scrotum, based on the data of ultrasound. His classification is as follows:
- The disease of the first type is characterized by the reflux of blood from the renal vein into the testicular.
- The second type is observed in patients with blood reflux from the ileum to the testicular.
- The scrotum is said to be the third type of varicose veins when a combination of previous refluxes takes place.
This classification is extremely important. It is she who determines the course of the surgical intervention and its volume. According to Isakov, Yu.F. and Lopatkin N.A. the disease is divided into the following degrees:
- There are no subjective sensations; externally, pathology does not manifest itself in any way.Varicose veins appear only when straining, tension of the muscles of the anterior abdominal wall and intra-abdominal pressure.
- Veins become visible, they are visible through the skin in the form of convoluted, dilated, bluish cords. However, the doctor does not note any changes in the size or structure of the testicles.
- In addition to external venous manifestations, there are signs of testicular degeneration from varicose veins. It is smaller in size, has a test consistency.
Currently use the international classification of WHO. When deciding on surgical treatment, venous discharge is always determined.
Varicocele in men - what is it, danger and treatment methods
One of the most unpleasant and dangerous diseases for men’s health associated with expansion of the veins is varicocele.
With this disease, the veins located in the testicles expand, often on the left side.
In the absence of timely medical care, the disease almost always leads to infertility, so it is important to know everything about varicocele in men - what it is, what is dangerous, how it manifests itself and is treated.
So that doctors around the world could understand what diagnosis was made, they came up with the encryption of diseases. The code consists of latin letters and numbers. In this case, the first figure summarizes the group of diseases, and the second, after the point, specifies its localization, stage, etc.
For varicocele according to ICD 10, the code is: I86.I. If decrypted, it turns out that I86 is a varicose vein, and the Latin letter “I” indicates the place where the scrotum pathology arose.
Thus, the clinical diagnosis may sound as follows:
- Left-sided varicocele 3 degrees of severity, decompensated stage. Hypotrophy of the left testicle. Dropsy on the left.
- Right varicocele 2 severity. Stage of compensation. Infertility. Oligozoospermia 2 degrees.
Identified complications are always indicated in the formulation of the clinical diagnosis.
Varicocele characterized by malnutrition of the testicle, resulting in a gradual process of atrophy. Enlarged venous vessels located around the testes interfere with normal heat regulation of this part of the male body. Overheating occurs.
Since sperm production requires a strictly defined temperature - from 32 ° C to 34.5 ° C, spermatozoa are produced in smaller quantities, and sometimes they are completely stopped.
Most often, varicose veins develop on the left. According to experts, this is due to the difference in venous on the right and left sides. The vein emanating from the left testicle is much longer than from the right. The pressure in it is higher, which means that the likelihood of developing varicose veins is higher.
Varicocele in itself does not pose a particular danger to the life of a man, but it often leads to male infertility. Almost half of the patients have abnormal sperm production, and the percentage of infertility sufferers is higher, the longer they get sick.
According to WHO statistics, varicocele occurs in 15-17% of men. These numbers may vary depending on the place of residence and age. This disease occurs in 19.3% of adolescents aged 14-15 years. For those serving in the army, varicose veins occur in 5-7% of young people.
Signs of the disease are observed in 35% of mature men undergoing ultrasound. In almost all, this disease affects the left testicle. On the right side, varicose veins occur only in 3-8% of men, on both testicles - 2-12%.
Causes and Risk Factors
Experts still have not exactly determined the causes of testicular varicose veins. Judging by the fact that it often occurs in adolescents, there is an assumption in the hereditary nature of the diseasein which a deficiency of connective tissue occurs in the body. With their shortage, the venous valve develops poorly, as a result of which the reverse blood flow through the vein is disturbed.
In a healthy person, venous blood moves upward to the heart, and with varicocele, it begins to move in the opposite direction, which leads to vein deformation.
Another cause of varicocele is considered increased pressure in the abdominal cavity. Most often, this is associated with impaired intestinal activity (constipation) and excessive physical exertion. Blood circulation can be impaired with the development of malignant tumors in the genitourinary system.
Learn more about the causes of varicocele from a separate article.
The disease develops over four stages:
- In the first stage Varicose veins are not outwardly visible and can only be detected with Doppler ultrasound or ultrasound.
- Second stage characterized by an increased size of the veins, which can be determined by touch, while standing.
- In the third stage the veins are already dilated to such an extent that they are easy to feel in any position.
- In the fourth stage enlarged veins are visible to the naked eye.
Unlike adult men, in adolescents, the disease most often stops in development, reaching a certain stage.
Inspection and palpation
As mentioned above, during inspection, the following changes can be identified:
- dilated veins of the plexus, visible through the skin,
- a change in the normal direction of the vascular branches,
- cyanosis of blood vessels,
- the presence of areas overflowing with blood,
- swelling of the scrotum from the side of the lesion,
- reduction in testicle size,
- change in testicular consistency: it is softer than the neighboring one.
If the doctor doubts the diagnosis, he asks the man to perform a Valsalva test. To do this, you need to cough or just tighten your stomach. A test is considered positive if the veins have increased in diameter after an increase in intra-abdominal pressure. This is determined visually and by palpation.
Despite the fact that the symptoms of varicose vessels may be disturbing only on one side, the doctor always evaluates the condition of the second testicle. It is extremely rare, but still cases of a bilateral process are identified.
Danger and complications
The main complication of varicose veins is male infertility, resulting from a violation of the thermoregulation of the testicles and the cessation of sperm production.
Other dangers may include: malfunctioning of the heart valves, phimosis and flat feet - all these problems indicate a lack of connective tissue in the body.
Varicose veins sometimes indicate the presence of malignant tumors. therefore at the first signs of the disease, you must always consult a doctor and undergo all the necessary examinations.
Symptoms of testicular disease
At the beginning of its development, varicocele proceeds almost without symptoms. You can identify varicocele by pain in the testicle and scrotumwhich will intensify as the disease progresses.
The pains are pulling in nature, and they can occur not only in the scrotum and testicles, but also in the entire groin area. Sometimes you may notice enlargement of the scrotum in size, as well as its omission from the affected testicle.
The pains usually become stronger during walking, when lifting weights and during intercourse. If the disease is in the early stages of development, pain disappears after the person has lain and rested. At 3 or 4 stages of pain are almost incessant in nature and do not depend on the physical activity of the patient.
There are no specific tests to establish a diagnosis. If the diagnosis is already made, the doctor may recommend taking a spermogram to make sure that the function of the testicles is not impaired. Those who complain of infertility may receive the following sperm results:
- oligospermia - a small volume of ejaculate,
- teratozoospermia - a large number of abnormal forms of sperm,
- oligozoospermia - few sperm,
- azoospermia - there are no sperm in the ejaculate,
- asthenozoospermia - reduced sperm motility,
- necrosoospermia - dead sperm cells were found in the ejaculate.
Typically, sperm changes occur in advanced cases, when a man lives with the disease for a long time and there are dystrophic changes in the testicles. However, the presence of pathology does not always lead to a change in the spermogram, it is important to remember this. In the case when infertility is associated only with varicocele, the doctor recommends surgical intervention.
To exclude the accompanying inflammatory process, the doctor prescribes a general analysis of urine, blood, and microscopy of the secretion of the prostate. Examination data are performed according to indications or before surgical treatment.
A coagulation examination may be recommended. This is necessary to select a treatment method.
In age-related patients, a hormonal profile study can be performed. As you know, many hormones affect vascular tone. If there is a deficiency, it probably caused varicose veins.
When to see a doctor and to which
It is necessary to go to the hospital at the slightest sign of varicocele - if there are pains in the area of the scrotum or testicle, especially after physical exertion, or when probing the enlarged veins on the testicles. Varicose veins are detected by a urologist or phlebologist.
If you suspect a varicocele, it is the urologist who directs the patient for additional examinations, with which you can accurately diagnose testicular varicose veins.
Diagnosing this disease is easy enough.. An examination by a phlebologist reveals the medical history, duration of symptoms, as well as the likelihood of injuries of the lumbar region.
In some cases, the doctor determines the expanded veins already at a visual examination of the patient, or upon palpation of the affected area. Sometimes a testicle affected by varicose veins becomes smaller in size, its elasticity is reduced.
Palpation is carried out in several positions of the patient. - standing, lying, as well as straining.
If in a standing position or straining the veins are not determined, then varicose veins are most likely at the 1st stage of development.
If the veins are visible to the naked eye, we can talk about the more severe stages of the disease.
To exclude the presence of tumors, it is mandatory ultrasound examination of the retroperitoneal space and kidneys. If vascular thrombosis is suspected, CT or MRI is prescribed.
Reduced activity and a decrease in sperm volume is a common occurrence with varicocele, so adult patients are prescribed an ejaculate analysis (spermogram).
As additional diagnostic methods can be assigned Ultrasound of the scrotum, thermography, thermometry or dopplerography.
To determine the correct course of treatment, sometimes prescribed renal testicular venography or testiculophlebography. If a surgical decision has been made, antegrade venography is usually indicated.
It is carried out not only before the operation, but also during it, as well as after surgical treatment.
The value of dopplerography
The gold standard for examination is Doppler ultrasound. This method has several advantages, which include:
- high accuracy of research,
- the ability to evaluate blood flow,
- determination of concomitant pathologies in the scrotum (orchitis, epididymitis),
- the ability to determine the type of venous discharge,
- the ability to assess the structure of the testis.
Thus, even if the doctor did not reveal any problems during the examination, the ultrasound scan determines the varicocele in the early stages. This makes it possible to monitor the patient and take the necessary measures in a timely manner.
The criteria for the diagnosis are excessive tortuosity of the vessels, their expansion of more than 3 mm at the level of the inguinal ring or more than 2 mm in the region of the lower pole of the testis.
As you know, varicose veins are not a disease of one vessel. She finds weaknesses in the body and attacks them, especially the lower limbs. If a man has a varicocele, he needs to exclude the expansion of vascular formations on his legs, phlebitis, thrombosis. Using a Doppler ultrasound probe, this can be done immediately after examining the scrotum.
Fully cure varicocele is possible only with surgical intervention. If the disease in the initial stages of development, surgery can be avoided with the help of special diets, reducing physical activity and normalizing bowel activity. If the disease has already reached severe stages, only surgical intervention will help.
Operations with varicose testicles are most often of two typesc: in the first case, a dilated vein is ligated or removed, and in the second case, a sclerotizing substance is injected into the vein through a puncture in the thigh, which stops the blood flow in the affected vessel.
Learn more about male varicocele disease and the need for treatment from this video:
Other diagnostic methods
Magnetic resonance imaging is an expensive, highly accurate diagnostic method. It is used for varicocele, if there is a suspicion of a malignant process, thrombosis. MRI determines well soft tissue formations, including vessels, blood clots.
Previously, selective angiography was used to determine the type of venous reflux. To do this, choose a vessel, contrast it, take a series of pictures. By how and in what direction the blood moved, venous discharge was determined. Currently, the method is not relevant, it has been replaced by a simpler and safer - dopplerography.
Therapeutic methods are practically not used. Doctors often choose observational tactics in the first and second stages of the disease, if the pathology does not bother. As a supportive treatment, vitamins, minerals, angioprotective agents, venotonics can be prescribed. External forms of drugs are not used.
If a hormonal imbalance has been identified, consultation with the endocrinologist will be required with further correction of the indicators.
When concomitant pathologies in the form of thrombosis or phlebitis are found, NSAIDs, steroids, and also blood clot-dissolving agents can be recommended. But usually the disease is not accompanied by such complications.
Varicocele: the main signs of the disease and treatment
Varicocele is a disease of the male genital area. It is characterized by varicose veins of the spermatic cord. It is mainly diagnosed in reproductive age, less commonly in childhood and adolescence. The disease has several types and forms, differing in the degree of defeat and associated symptoms.
Types of operations
The presence of pain, infertility, dystrophy - direct indications for surgical treatment of varicocele in men. The following types of interventions are possible:
- The operation according to the method of Ivanisevich: in the iliac region from the side of the lesion, the surgeon makes an incision 3-5 cm long, secures the testicular vein, bandages it from two sides, crosses. After this, the intervention ends with suturing the wound tightly without additional drainage. Analgesics and antibiotics are always prescribed after surgery as a prophylaxis of the inflammatory process. The Ivanisevich method is performed under general anesthesia, has a number of significant drawbacks: a sufficiently large postoperative suture, a high number of relapses.
- Operation Marmara refers to microsurgical interventions. Access is through a 2-3 cm incision in the area of the root of the penis, the projection site of the spermatic cord (the area of the external inguinal ring). Microinstruments with optical magnification of all anatomical structures are used for the intervention.After the incision, the doctor finds the affected veins and collaterals, bandages them. At the same time, there are practically no risks of damage to nerve bundles, important vascular branches. When all varicose formations are found and ligated, the doctor sutures the wound. Advantages of the method: low relapse rate, cosmetic suture, safety.
- Embolization. The intervention consists in the introduction of a special catheter into the femoral vein, which, under the control of x-rays, moves into the testicular vein. When the tool has reached its goal, the doctor introduces an embolus - an embolus - into the vessel. To make sure that he is in the right place, the surgeon contrasts the venous trunk and completes the operation. The advantages of this method of treatment are low invasiveness, safety, high selectivity and low risk of disease recurrence.
- Laparoscopy used in exceptional cases according to indications: concomitant hernia, overweight patient, bilateral process. The operation is performed only under general anesthesia. After the introduction of laparoscopic instruments, the surgeon examines nearby organs, finds the testicular vein and bandages it. At the same time, you can get rid of inguinal hernia. Of the disadvantages of this type of intervention, frequent relapses and complications in the form of dropsy are noted.
- Sclerotherapy and laser therapy - high-tech minimally invasive methods. With sclerotherapy, a gluing agent is selectively injected into the vein, which stops the blood flow through this vessel. It differs from the laser only in the method of exposure.
Some time after the operation, the varicocele may return, since the bloodstream finds collaterals and begins to actively use them. This again indicates a systemic disease. Repeated surgical intervention is often required.
Spermatic cord - paired organs that form even in infancy when the testicles are lowered into the scrotum. They are necessary to maintain the latter and conduct sperm. The spermatic veins regulate the outflow of blood from the genitals to the inferior vena cava and renal. With their varicose veins, blood circulation is disturbed.
Due to the peculiarities of the anatomical structure, the left-sided varicocele is most often diagnosed, the pathology of the right testicle is determined only in 10-20% of cases. Bilateral vein expansion is very rare.
Fact: the right-sided type of disease is most often the result of a tumor or other formation that compresses the veins and disrupts local blood supply.
The main reason for the development of varicocele is a violation of the valves that regulate blood flow. With the appearance of this pathology, stagnant processes occur, pressure in the veins changes. Often this is accompanied by varicose veins of the lower extremities and hemorrhoids.
The varicocele code according to ICD 10 is I86.1. It belongs to the group of diseases arising from the course of varicose veins of the lower extremities.
Complications after interventions are divided into intra- and postoperative. Among the first is the risk of bleeding, trauma to adjacent anatomical structures. Early and late postoperative complications include:
- scrotal hematoma
- infection attachment
- divergence of the edges of the wound, etc.
To prevent unpleasant consequences, the doctor prescribes a course of antibiotic therapy, painkillers, dressings. With a favorable course, the sutures are removed after 10 days. If the edges of the wound heal poorly, extend the rehabilitation period.
Causes of Varicocele
The main causes contributing to the occurrence of varicocele in men:
- high intra-abdominal pressure - a consequence of constipation, strong physical exertion, chronic stress, entails overflow of veins, stretching of their walls, in the future - deformation,
- genetic predisposition - in the presence of this factor, the likelihood of a congenital disease characterized by pathologies of the venous valves or low elasticity of the veins in the scrotum is high,
- kidney disease - contributes to the development of the right-sided type of disease,
- reduction of venous lumen as a result of inflammatory processes, injuries, surgical interventions, hormonal imbalance and growth of formations,
- improper lifestyle management - abuse of alcohol and smoking, a large number of fast food, preservatives and heavy food in the diet, a sedentary lifestyle - all this entails an increase in the number of cholesterol plaques, thinning of the walls of blood vessels, squeezing veins with a fat layer,
- irregular sexual life or its absence - causes blood stasis in the pelvic and scrotum, increases the risk of other diseases of the genital area,
- taking hormonal drugs - without a doctor’s prescription, this can disrupt the work of endocrine organs.
In childhood, pathology most often develops due to intrauterine disorders, vascular diseases, increased intra-abdominal pressure. In adolescents, varicocele is often the result of weight lifting or weightlifting.
How to prevent relapse?
The recovery period after the intervention is 2 weeks. At this time, physical activity is excluded. According to the doctor’s recommendations, special suspensions can be prescribed - wearing bandages.
The patient is recommended to visit the attending doctor at least 2 times a year. In this case, after surgical treatment, the patient needs to get rid of bad habits. Healthy food. During the first two weeks, a man is not recommended to have a sexual life.
Alternative methods of treatment and prevention are often ineffective in this case. Therefore, it is not worth hoping that herbs can get rid of varicose veins.
Symptoms of varicocele
The intensity of the symptoms depends on the degree of varicose veins. The first stages of the disease are most often asymptomatic - this condition is also possible with a prolonged absence of varicocele progression.
- pain in the scrotum - vary from aching to acute, are most pronounced when walking, after physical exertion and in hot weather, weaken when lying on your back,
- decreased potency - varicocele negatively affects sexual function,
- testicular atrophy - manifested by a change in their size and location,
- prolonged lack of conception with low sperm motility - leads to infertility,
- visual definition of vein expansion,
- swelling and swelling of the scrotum.
The course of the second stage is accompanied by periodic pain. In the third stage, the symptoms of varicocele are most pronounced. Men during this period complain of constant pain, aggravated by physical exertion. It is during this period that the expansion of veins is most noticeable to the naked eye, the shape of the scrotum and the location of the testicles change.
The danger of varicocele if untreated
In the absence of proper treatment, the disease progresses. Stagnant processes in the scrotum lead to a lack of oxygen in the tissues and an increase in local temperature, which provokes the death of sperm.
Subsequently, the enlarged affected testicle begins to decrease and dies, and it is impossible to restore the organ’s functionality.
Possible consequences of varicocele in the absence of medical intervention:
- hydrocele, or dropsy of the testicle - accumulation of fluid in the scrotum, which is manifested by its increase and smoothness,
- teratozoospermia - a decrease in the number of capable sperm, leads to infertility,
- prostatitis - can occur with a prolonged course of bilateral varicocele,
- orchitis - an autoimmune inflammatory process in the testicles, characterized by damage to male germ cells,
- testicular cancer - the effect of varicocele on its occurrence is not proven, but the presence of the disease increases the risk of oncological processes.
With high resistance of sperm to environmental influences, the risk of complications is reduced. At the same time, the ability to fertilize is preserved, but the probability of conception is reduced.
This method of treating varicocele consists in taking medications and changing the rhythm of life. The following types of drugs are prescribed to patients:
- antioxidants (Antiox, Triovit, Vitamax plus C) - are necessary to replenish nutrients in the body, contain vitamins,
- means for improving blood circulation (Orbiflex, Trental, Agapurin) - eliminate stagnant processes in the scrotum, normalize blood flow,
- venoprotectors (Esuzan, Detralex, Flebodia) - restore the functioning of veins, increase their elasticity.
In parallel with taking medications, it is necessary to observe some rules that impede the further progression of the disease:
- the exclusion of such physical activity as long walking, weight lifting, horse riding and cycling, dancing,
- elimination of constipation and bloating,
- regular sex life
- weekly swimming lessons
- hardening of the scrotum by dousing it with cold water,
- wearing a special supportive bandage is most relevant in the last stages of the disease,
- giving up bad habits - smoking, alcohol.
The conservative treatment method is effective only in the first stage of varicocele. In the future, it is used as maintenance therapy.
Indications for surgical intervention to remove varicocele:
- lack of effectiveness of conservative treatment,
- constant pain
- change in the size and structure of the testicle,
- violation of sexual function,
- detection of pathologies in the spermogram,
- prolonged lack of conception,
- contraindication for military service,
- psychological discomfort of the patient.
Types of surgical treatment:
- Traditional. The obsolete method, performed using local anesthesia, the incision length does not exceed 5 cm. The damaged vein is bandaged or intersected.
- Operation Marmara. It is considered one of the most effective; local anesthesia is used for its implementation. The length of the incision is about 1 cm; instruments are not inserted into the abdominal cavity to perform manipulations. The rehabilitation period after the intervention lasts no more than two days, after which the patient is discharged from the hospital.
- Laparoscopy. To carry it out, three small cuts are made through which an instrument with a video camera at the end is inserted. Requires the use of general anesthesia. Laparoscopy is an effective and safe type of surgical treatment for varicocele.
- Sclerosis of the veins. A catheter is inserted through a puncture in the femoral vein, then it moves into the inferior vena cava, into the left renal vein and into the necessary vessel. The latter is filled with sclerosing substance, which stops the flow of blood. This method is most often used for bilateral varicocele.
- Microsurgical operation. Passes under general anesthesia. Its principle is the transplantation of the testicular vein into the epigastric, which restores blood supply. The method is characterized by a low risk of complications.
In the first days after surgery, the patient feels pain in the scrotum, its swelling. This is considered normal and disappears within a few days. Full recovery occurs one month after the operation.
Rules that must be observed after surgery from varicocele:
- exclusion of sexual intercourse,
- restriction of salt, spices, sauces,
- a complete rejection of physical activity.
A doctor may wear a special supportive bandage.
Complications after surgery
Complications can occur for a short period of time. In some cases, they develop due to improper treatment or as a result of the manifestation of the individual characteristics of the patient.
- lymphostasis - occurs with damage to the lymphatic vessels,
- the presence of pain - in rare cases, it does not disappear even after a successful operation,
- dropsy of the testicle
- relapse of the disease
- testicular atrophy - a consequence of a medical error during surgery.
The success of treatment is determined by the state of sperm - normally, the number of viable sperm should increase within six months.
Prevention of varicocele is to prevent stagnant processes in the pelvic area and scrotum. To do this, exclude prolonged stay in one position, regularly engage in gymnastics or other sports.
A man should normalize his lifestyle. To do this, you need to have regular sexual intercourse, include in your diet as much healthy, vitamin-rich foods as possible. In the presence of any diseases, it is necessary to immediately begin their treatment, otherwise they can provoke other pathologies of the body.
Effective diagnostic methods for varicocele in men: how to detect the disease on time?
Home> Male genitals> Effective diagnostic methods for varicocele in men: how to detect the disease on time?
Varicocele is a fairly common disease in men. It comes down to a change and deformation of the veins in the scrotum as a result of a violation of blood flow.
Patients experience aching pain in the inguinal region and discomfort. If the disease is not treated, then the testicle may decrease in size, and its consistency will change.
In this case, there is a violation of reproductive function in men.
The initial diagnosis takes place in the doctor’s office. It is quite difficult to independently determine your varicocele in the initial stages. Often patients learn about the disease during a planned visit to a doctor or in connection with a consultation about another disease.
The specialist conducts a survey to learn about the history of varicocele in the patient, as well as conducts a visual examination of the scrotum and its palpation. Inspection is carried out in a standing and lying position..
The purpose of the survey is to identify the following complaints and features for the purpose of making the correct diagnosis:
- The presence or absence of aching pain or discomfort in the scrotum.
- Does pain intensify with long walking or during physical exertion, and also whether it appears when the scrotum is raised and during an erection in a man.
- If the patient lives a constant sex life, then it turns out how long the partner can not get pregnant when having sex without contraception.
- Prescription of the appearance of varicocele.
- Did the patient have diseases such as urethritis, prostatitis, mumps or injuries of various kinds.
- Whether there is a chronic intoxication.
- The time of the onset of sexual activity in the patient (voice changes, first emissions, sexual excesses, the beginning of pubic hair growth, the onset of sexual activity).
- The presence of factors provoking varicocele (smoking, excessive alcohol consumption, prolonged physical activity, contact with carbon disulfide, genetic predisposition, exposure to microwave etc).
During the initial medical examination, it is possible to distinguish the following symptoms:
- Dilation of the veins in the scrotum in the standing position and with straining the abdomen. Today, a modified Valsalva test for varicocele is also used for this. The patient needs to take a deep breath and strain. It is required not to breathe for 15-20 seconds.In this case, the veins can expand and become clearly visible to the naked eye. In the end, you need to make the same deep exhalation in order to study the dynamics of vein changes during exertion.
- Palpation felt small densified areas of obliterated veins. It is possible to detect a change in testicle size in the late stage of the disease.
- Positive Segond Test. In this case, the patient must lie on the couch. The outer ring is squeezed into his groin and asked to rise. With varicocele, the veins replenish. This method is called a Tokihara orchidometer.
Using these methods, the doctor can identify other possible diseases of the urogenital system of men.
Today to identify varicocele a fairly wide range of laboratory studies is used. They allow you to study the degree of change in the size of the testicle and its consistency, determine the presence of male infertility and identify other diseases of the genitourinary system in the early stages.
Ultrasound diagnosis of varicocele is mandatory if the doctor cannot determine the degree of development of the disease. Ultrasound varicocele allows you to give the most complete information about the size and consistency of the testicle.
If a Doppler prefix is also used, then the vessels of the scrotum are visualized. So, it is possible to identify reverse reflux of venous blood or reflux, an increase in the diameter of the veins during the Valsava test and determine their tortuosity.
Phlebography of the seminal veins today almost never used. However, this method allows you to separate the primary varicocele from the symptomatic.
Spermogram assigned only to persons over 18 years of age. This study allows us to determine the morphological component of spermatozoa, their number, activity and ability to fertilize. At the initial stages of varicocele development, there are no deviations from the norm or they are weakly noticeable.
However, with the development of the disease, a spermogram shows that sperm become sluggish, and their number decreases. In rare cases, sperm is completely absent. It is worth noting that before this study sexual abstinence is required 2-7 days.
Calculation of Farris fertility indicators shows the number of active sperm and allows you to detect the presence of male infertility. In this type of study, the volume of the ejaculate is multiplied by the number of motile spermatozoa. Norm, if the result exceeds the mark of 200.
Sex hormone testing determines the level of testosterone, FGS, prolactin, luteinizing hormone and estradiol. It is necessary to differentiate the cause of infertility with varicocele.
Urography allows to identify concomitant diseases of the urogenital system of a man in the diagnosis of varicocele.
Dynamic NephroscintigraphyIndirect isotopic aniography and scintography of the testicles provide complete information about the functioning of the kidneys and testicles.
In all patients, the sizes and volumes of the scrotum and testis are different. These parameters are always taken into account during laboratory and instrumental studies. So, to calculate age norms, the following formula is used: volume = 0.523 і A і B і C, length, width and depth of the testicle.
Find out what this disease can be dangerous, what consequences can be with untimely treatment and how to avoid infertility?
Where to go?
In the process of treating this disease, two specialists participate: urologist and surgeon.
Exactly the urologist should be the first to diagnose and determine the degree of damage to the scrotum and testis. Blood and urine may be needed for laboratory testing.
After examination and additional studies, the patient will be asked to undergo surgery. It is recommended to do it for all adolescents for the prevention of infertility, as well as for men who are still going to have children.
In the initial stages of the development of the disease, it is possible to do with medication, however, it is not able to completely save a man from the disease. The only treatment is surgery.
IMPORTANT: in most cases, a varicocele reaches a certain stage in men and stops developing.
Therefore, in case of developmental arrest at stage 1, surgery may not be necessary, since at this stage reproductive dysfunction is not observed.
To determine the presence of disease progress is possible only with a specialist. Since the disease develops very slowly, it will take 2-3 visits to the urologist for 1-2 years.
If the patient agrees to the operation, then it is necessary to conduct a full analysis before planned hospitalization. If no contraindications to the operation are detected, then hospitalization occurs. The operation takes place under general anesthesia.
Varicocele is the main cause of male infertility. 15% of all men suffer from this disease, and 40% of all infertile women have lost the opportunity to have children as a result of varicocele.
The older the boy, the greater the risk of the disease. So, less than 1% of children under 6 years old are susceptible to varicocele. At the age of 10 years, it is diagnosed in 1.5% of boys. Slightly less than 10% of adolescents under 14 go to the doctor with symptoms of varicocele.
Most often, this disease develops upon reaching the age of 15. About 15% of all patients have reached the age of 15, but have not yet reached adulthood.
Most often, the disease affects the left side of the scrotum.. Both are much less common. Only 2% of patients are diagnosed with right-sided varicocele.
Varicocele - A fairly common disease in men. It comes down to a change and deformation of the veins in the scrotum as a result of a violation of blood flow.
Patients experience aching pain in the inguinal region and discomfort. If the disease is not treated, then the testicle may decrease in size, and its consistency will change. Note that there is a violation of reproductive function in men.
Find out whether it is possible to recover without surgery? What are the popular methods and physical exercises to combat the disease?
Varicocele in men - what kind of disease is it and its degrees, drug and surgical therapy, complications
Varicocele of the testis appears when the venous outflow of blood is disturbed due to the fact that for various reasons valve mechanisms in the veins stop working. In this case, the flow in the arteries passes unchanged. The cluster-shaped venous plexus is overflowing with blood, stretched. Provoking factors of varicocele in men:
An important factor in the development of varicocele in men is an increase in pressure in the abdominal cavity. This situation is caused by:
The appearance of varicocele in men causes a rush of blood to the pelvic organs, an increase in pressure in the vessels of the scrotum. This is facilitated by bodybuilding, weightlifting. The causes of the development of the disease are:
The disease often occurs in adolescents. Classifying varicocele disease in men, doctors distinguish two stages, depending on the causes. Considered:
- Primary phase. Appears as a result of congenital anomalies - the absence, underdevelopment of vein valves, abnormal formation of blood vessels, anatomical features of their location among themselves.
- Secondary stage. May develop in middle-aged men. The causes of the pathology are tumors in the pelvic organs, obstruction of blood flow of various etiologies, inguinal hernia.
In medicine, it is customary to classify varicocele in four stages, which take into account the severity of the disease, the transformation of testicular trophism. As the pathology develops, the following are distinguished:
- first - external changes are absent, detected by ultrasound examination, dopplerography of blood vessels,
- the second stage - the veins are enlarged, determined by palpation, when the man is in a standing position,
- third - dilated vessels are palpated in any position of the body,
- fourth stage - enlarged vessels are visible through the skin of the scrotum with the naked eye.
Over the years, physicians studying varicocele in men and the World Health Organization (WHO) have developed their disease classification systems. They describe the pathology in their own way:
determined by palpation when straining a standing patient
not visually observed, felt when probing in a stressed state
the veins are invisible, not palpable, except for expansion when performing the Valsalva test
extensions are visible, testicle consistency and size unchanged
transformations are invisible but palpable
The development of varicocele during classification is described by the following degree. It takes into account the severity of the disease, the condition of the testicle in a man:
significant transformations of the vein-like veins, changes in the consistency of the testicle, a decrease in its size
dilated venous plexuses protruded through the skin of the scrotum, easily palpated
During the progression of varicocele in men, severe symptoms of the disease are observed. In the second degree of pathology, a variety of pains are manifested from pulling to sharp, aggravated by sexual arousal, physical activity. There are signs of the disease:
- prolapse of the scrotum in the zone of varicose veins,
- increased sweating,
- decreased performance
- inconvenience when walking.
The second degree of varicocele in men is distinguished by the expansion of the veins that can be detected by palpation. Visually observed increased scrotum size. Due to the anatomical features of the genital organs, varicocele on the left testicle is often manifested. A man complains about the occurrence of:
- neuralgic pain
- heat, burning in the scrotum,
- sexual dysfunction
- heaviness in the groin,
With the development of the disease, an increase in the size of the scrotum occurs. Bump-shaped clusters appear. Venous congestion in the third degree of pathology causes the onset of symptoms:
- development of ischemia, atrophic, sclerotic processes in the testis,
- ongoing pain regardless of stress and body position,
- decreased spermatogenesis (sperm development),
- external asymmetry of the testicles,
- dilated veins, similar to a bunch of grapes,
- change in the shape, elasticity and size of the testicle.
Treatment of varicocele in men
The disease, which is at an early stage of development, does not require special treatment. During this period, doctors recommend limiting to conservative methods. The treatment regimen includes the use of:
- venotonics that improve the condition of blood vessels - Detralex tablets, Trosevasin gel,
- antioxidants that increase tissue oxygen saturation - Antiox, Triovit,
- drugs that activate blood circulation, reduce blood viscosity, - Agapurin, Trental,
Treatment of varicocele at the onset of the development of the disease involves preventive measures. They help stop the progression of pathology. The treatment technique includes:
- the use of a special dressing - a bandage for the scrotum,
- normalization of nutrition to eliminate constipation,
- medical gymnastics
- massage of the testicles with essential oils,
- wearing tight swimming trunks,
- limitation of physical activity,
- intake of vitamin complexes,
- the use of folk remedies.
Completely eliminate the disease in men is possible only surgically. Indications are the appearance of pain. There are several ways to conduct operations. These include:
- Ivanissevich method. It is performed with general anesthesia. A 5 cm incision is made along the inguinal canal of the iliac region of the skin, fiber, and muscles. The vein is bandaged to prevent backflow of blood. Relapses are not excluded.
- Palomo's way. The incision is made over the inguinal canal. Bandage the vein of the testicle together with the artery. Due to convenient access, the risk of relapse is reduced.
Modern methods of surgical intervention for varicocele include several options for implementation. Surgeons perform:
- Treatment with endoscopic surgery. 3 punctures are made in the abdomen, an endoscope is inserted. Perform dressing of the affected vein.
- Operation by the Marmara method. With local anesthesia, a 2 cm long incision is made. The spermatic cord is removed into the wound, testicular veins are isolated, and each is ligated under a microscope.
Another method of surgical treatment is the introduction of a sclerosing agent into the affected vessels. When performing X-ray endovascular occlusion of the testicular veins:
- do local anesthesia
- vein puncture
- a catheter is inserted to the affected area,
- under X-ray control using contrast, occlusion (artificial narrowing) of the spermatic vein is performed - it is filled with a special sclerosing substance that blocks the blood flow.
Doctors identify complications caused by the lack of treatment for varicocele. Varicose veins cause unpleasant effects on the health of men. Violation of thermoregulation of the testicles causes:
- hypoxia (oxygen starvation) of tissues,
- ischemia (circulatory disorder that provokes organ dysfunction),
- reflux from the adrenal glands of active components,
- accumulation in the testes of cellular poisons that stimulate their damage,
- the development of infertility due to the malfunction of the cells responsible for the synthesis of testosterone, a decrease in production, sperm quality.
The lack of treatment for varicocele leads to the formation of inflammatory processes, the risk of rupture of blood vessels, hemorrhage in the scrotum. Development is not excluded:
- heart valve dysfunctions,
- phimosis - narrowing of the opening of the foreskin,
- malignant neoplasms,
- hydrocele (dropsy of the testicle) - accumulation of serous fluid,
- orchitis - a disease in which the body's immune system rejects, destroys germ cells, leading to infertility.
Although modern methods of surgical treatment of varicocele are highly effective, the occurrence of postoperative complications is not ruled out. Doctors say:
- wound infection with poor-quality antiseptic treatment,
- development of thrombophlebitis of the spermatic cord veins,
- damage to tissues, arteries of the scrotum,
- the appearance of dropsy as a result of impaired lymph flow,
- relapse after surgery,
- allergic to drugs during embolization,
- the occurrence of testicular atrophy,
- overflow of appendages with blood during laparoscopy.
The disease can be completely cured using surgical methods. Varicocele in men after surgery has a favorable prognosis, even with advanced cases. Positive results are influenced by the age of the patient - up to 35 years, normal hormonal levels. After operation:
- fast recovery occurs
- In the photo of varicocele before and after surgery, positive changes are visible, there are no noticeable scars.
If a man consulted a doctor for symptoms of testicular atrophy, irreversible processes and the development of infertility are not ruled out. Timely treatment, modern surgical techniques:
- relieve varicose veins of the spermatic cord,
- do not give serious complications
- exclude the appearance of infertility,
- restore the reproductive function of the male genital organs.
Symptoms of the disease
Varicocele is a varicose vein of the spermatic cord of the scrotum.
Signs of varicocele in men may include testicular damage on both sides. But medical practice says that most often there is varicocele of the left testicle. This is due to the features of the angle of inclination of the vein leading to the kidney. Signs of varicocele are not always present.
This disease is inherent in boys aged 10-12 years. The first symptoms of varicocele can occur at the age of 14 years. It may be a feeling of heaviness in the scrotum. Frequent cases of varicocele are recorded during the growth period of the body of young men up to 30 years.
A man should pay attention to pain in the scrotum after intercourse. Pain can be caused by the presence of a disease. As a rule, an ailment is detected at preventive medical examinations. In children, varicocele may develop after an injury.
There are 3 stages of the disease:
- In the first stage signs of varicocele are difficult to determine. Cannot diagnose the disease while lying down. The ailment can be detected with the help of special equipment.
- In the second stage the presence of venous nodes under the skin of the scrotum can be palpated. Upon examination, the man should be in an upright position. An additional criterion is straining: veins are more pronounced. The structure of the testis at this stage is preserved.
- In the third stage there is swelling of the scrotum tissue, redness of the skin, the testicle sags. Pain is present. The nodes of the veins are painful and visible immediately.
Causes of the disease
With varicocele, the causes are due to structural features of the veins. The main mechanism of varicose veins deformation is stagnation of blood in the venous channel due to weakness of the valve apparatus and venous walls.
This can happen during physical exertion, long standing on legs, with frequent constipation. The lumen of the vein is expanding. The valve is not able to hold the blood that flows back from the kidney down (reflux).
Another reason is vein thrombosis.. With hemorrhoids, varicose veins of the legs, this disease may occur.
Some diseases can provoke varicocele. In particular, we are talking about diseases that lead to an increase in intra-abdominal pressure, which may result in narrowing of the veins.
These diseases include: a tumor in the abdominal cavity, renal failure, inflammation of the lymph nodes.
Characteristic features of the disease
Varicose veins in the testicles are classified at the site of the lesion. Left-sided varicocele is observed more often than the expansion of the veins of the testicle on the right. Bilateral varicose veins can also be observed.
Many men believe that with a unilateral lesion, the functions of the second testicle are not impaired, but this is a common misconception. The spermatogenesis of the other testis also decreases, but not to the same extent as in the affected organ.
An isolated testicular varicocele on the right indicates tumor processes in the kidneys, possible retroperitoneal fibrosis. Varicocele on the left can spread to the right side of the scrotum. The vein on the left is longer.
When stretched, part of the vein begins to shift to the right. This provokes mechanical pressure on the right vein, which can lead to impaired blood flow and the development of varicocele in the testicle on the right side, inclusive. Then a bilateral testicular lesion is diagnosed. Fortunately, such cases are rare.
Varicocele may be primary (idiopathic), in which the hereditary structure of the veins is the cause of the disease. As a rule, the varicocele on the right is secondary (symptomatic). In this case, an external cause (mechanical pressure due to various diseases) will serve as a provoking factor.
Varicocele in men: causes, symptoms and best methods of treatment
Varicocele is a pathological expansion of the venous plexus of the scrotum, accompanied by stagnation of blood. It is manifested by visible vasodilation, tenderness or heaviness in the groin.
Varicocele in men leads to an accumulation of blood in the genitals, which is fraught with overheating of the testicles, impaired spermatogenesis and infertility. To determine the state of the vessels, an ultrasound of the scrotum is performed with dopplerography.
Conservative treatment is ineffective, therefore, surgery is often recommended.
What happens with enlarged veins in the testicles
Testicular varicose veins are not an independent disease, but a consequence of insufficiency of the testicular (seminal) vein valves. It occurs against a background of congenital or acquired vascular pathology - the inferior vena cava or renal veins. In 9 out of 10 cases, the left testicle (testicle) is the first to be affected, due to the peculiarities of its blood supply.
The left spermatic vein flows into the left renal, and the right vein into the inferior vena cava. With a congenital absence or damage to the vascular valves, a retrograde (reverse) blood flow occurs. Subsequently, blood pressure rises significantly.
High hydrostatic pressure is created in the area of venous trunk connection. This leads to the progression of varicocele - vasodilation, oxygen starvation of the sex glands. Circulatory disorders in the scrotum leads to:
- stagnation of venous blood in the genitals,
- overheating of the testicles
- violation of spermatogenesis.
Right-sided varicocele occurs extremely rarely and only against the background of secondary pathologies or injuries of the renal vein.
Stage and classification
Varicocele is a vascular disease caused by expansion and retrograde blood flow in the vessels of the spermatic cord. During ultrasound examination of the scrotum, it is diagnosed in 35% of patients of reproductive age. Left-sided varicocele in men is detected in 95% of cases. This is due to differences in the structure of veins and blood supply to the right and left testicles.
Depending on the cause of varicose vesicular plexus, there are 2 forms of varicocele:
- primary (idiopathic) - an independent vascular pathology, which in 89% of cases is asymptomatic,
- secondary (symptomatic) - varicose vessels of the scrotum caused by background diseases or the influence of external factors.
According to the degree of circulatory disorders in the genitals and testicles, 4 degrees of the disease are distinguished:
- I degree - the expansion of the veins is not determined by palpation, is detected only by ultrasound or Doppler ultrasound.
- II degree - lying varicose vessels are not palpable. Varicocele is diagnosed only when straining the patient in a standing position.
- III degree - varicose veins of the spermatic cord is determined visually without palpation. The density and size of the testicles remain within normal limits.
- IV degree - the scrotal veins are enlarged, and the testicle on the affected side is reduced.
Depending on the degree of blood flow disturbance, 3 types of varicocele are distinguished in the scrotum:
- first - blood is thrown into the spermatic vein from the renal,
- the second - the injection of blood into the testicular vein comes from the iliac,
- the third - retrograde blood flow due to the injection of blood into the seminal vein from the renal and iliac.
According to the symptoms, 2 types of varicocele are distinguished - with and without symptoms. Asymptomatic disease is potentially more dangerous, as it is fraught with rupture of blood vessels, irreversible extinction of testicular function.
What causes varicocele in adult men
Normally, vein valves interfere with retrograde blood flow, blood stasis, and testicular overheating. But with an increase in load and blood pressure, the vascular walls expand, due to which tumor-like nodes form. Often the disease is recorded in adolescents. Depending on the cause, varicocele is idiopathic or symptomatic.
In boys aged 14-16, primary varicose veins are more often detected, which provoke:
- hereditary weakness of the walls of blood vessels,
- malformations of the inferior vena cava,
- underdevelopment of the vessels of the testicles and spermatic cord,
- muscle atony in the spermatic vein.
To find out why there was stagnation of blood in the genitals, an instrumental examination is performed. The most likely causes of symptomatic varicocele include:
- exhausting physical exertion,
- testicular vein failure
- venous hypertension
- chronic constipation
- tumors of the scrotum,
- increased abdominal pressure,
- kidney disease.
Any condition leading to an increase in blood pressure is fraught with insufficiency of the valve apparatus of blood vessels. Over time, a workaround for blood flow forms in the testicle region. Venous blood begins to be thrown from the renal vessels into the vein of the testis.
How to determine the varicocele yourself
The signs of varicocele on the left and right depend on the intensity of retrograde blood flow and vasodilation. With 1 degree of varicose veins, the symptoms are practically absent. In case of stagnation of blood in the groin area, pulling pains occur.
In 45% of cases, varicocele is asymptomatic, so men are in no hurry to see a doctor.
At 2 and 3 degrees of the disease, patients complain of:
- discomfort in the groin while walking,
- testicular lump,
- scrotum enlargement,
- recurrent groin pain,
- excessive sweating
- protrusion of the plexiform plexus after physical exertion.
At stage 2 of the disease, the relationship between stress and pain disappears. The pain is lasting and intensifies after a long walk.
What does a varicocele look like:
- at the lower pole of the testicles, dilated vessels are found,
- the scrotum swells and becomes cyanotic,
- the shape of the scrotum changes due to a decrease in the testicle on the affected side.
You can find out about the degree of blood flow disturbance in the testicles by instrumental examination. Therefore, with cluster-like protrusions and soreness, the scrotum turns to a phlebologist.
Complications after surgery
After listening to the doctor’s instructions, the man himself decides how to treat varicocele. If he makes a choice in favor of surgery, then he must know the features of the postoperative period.
With varicocele, recovery after surgery takes about a month.
Within 6-7 days after surgery, a home regimen is indicated. You can take a shower in a week. It is necessary to limit physical activity for 1 month. A visit to the doctor is necessary after a month, then after six months and a year.
Observation will help to identify the development of complications or the appearance of relapses. Since the purpose of treatment, in addition to eliminating pain symptoms, is to restore sperm quality, the appointment of tests to determine sperm motility is necessary.
Prevention of recurrence of the disease is swimming, wearing supportive hosiery (suspensoria - devices supporting the scrotum to improve blood circulation). Prescribe drugs that affect the elasticity and strengthening of the walls of blood vessels, therapeutic exercises.
Complications after surgical treatment are rare. Typically, complications are associated with a technical error during surgery. These include: testicular dropsy (edema), lymphostasis (lymph congestion) in the tissues of the testicle, vein thrombosis, which can provoke a repeated or secondary development of the disease. In case of recurrence of varicocele, your doctor will tell you what to do.
An additional complication may be that the veins remain dilated even after a successful operation.
Is it possible to carry out the correction using tablets and injections, the specialist determines. He decides whether there is a need for surgery. If a man does not have painful symptoms and does not worry about possible infertility, he may not undergo surgery.
Statistics show that male varicocele is treated without any problems and in 2/3 of cases does not lead to infertility.
The expansion of veins on the testicles is diagnosed by a urologist or phlebologist. During a visual examination and palpation, the doctor pays attention to:
- testicular density and size,
- the degree of swelling of the veins,
- state of the cord during straining.
With symptoms of varicocele are prescribed:
- Ultrasound of the kidneys
- sperm analysis
- venography of the renal testicular veins,
- Ultrasound scrotum,
- blood on the hormonal panel.
According to the results of the examination, varicocele is distinguished from hydrocele, epididymitis, testicular tumors, orchoepididymitis.
What is dangerous male disease
Varicose veins of the testis in men are accompanied by stagnation of blood, due to which the temperature of the testicles increases. If untreated, tissues do not receive nutrients and oxygen. This causes a violation of spermatogenesis and a decrease in male fertility.
Possible complications of varicocele:
- dropsy of the testicle
- rupture of varicose veins,
Constant pain in the inguinal zone reduces the quality of life, negatively affects the psycho-emotional state. Therefore, half of men with varicocele experience depression.
Can a varicocele go by itself
The probability of self-healing depends on many factors:
- causes of vascular damage,
- degree of testicular damage,
- the presence of complications
- eliminate provoking factors.
Primary varicocele is provoked by congenital anomalies of blood vessels and / or organs of the reproductive system. Therefore, self-healing in most cases is impossible. Secondary disease occurs against the background of other diseases:
In the case of timely elimination of pathologies, the tone of the veins increases. But recovery is possible only in the absence of pathological changes in the testicles. In 75% of cases, varicocele disease in men is treated only promptly.
What is varicocele and why does the disease appear
Varicocele - These are changes in the peripheral veins of the spermatic cord and a violation of the standard outflow of blood. Veins swell strongly, become sinuous and acquire a bluish color. More often, pathology is determined in young men during puberty of 14-15 years, but sexually mature men do not bypass such ailment.
Varicocele appears with excessive physical exertion on the veins and disruption of the seminal valves. Features of the location of venous vessels in men in the inguinal region are diagnosed by varicocele on the left side. Varicose change of spermatic cords is rare, but meets a bilateral type.
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Before treating varicocele on the left testicle, determine the stage of the disease.
Indications for open surgery:
- inefficiency of conservative therapy,
- frequent relapses of varicocele,
- violation of spermatogenesis,
- persistent pain in the scrotum.
The main goal of surgical intervention is ligation or excision of pathologically dilated veins in the scrotum.
The operation is performed under general anesthesia and takes no more than 30-40 minutes.
What should recruits know?
When a varicocele is detected, young people are sent to a military commission. After a full examination and diagnosis, they are exempted from military service.
If there are indications for surgical treatment, it is performed. After the rehabilitation period, a young man may be called upon to fulfill his military duty.
In the event that the patient refused the operation or he has a 2nd degree of the disease, he is taken to the service with restrictions on health.
Laparoscopic surgery belongs to the group of minimally invasive treatments for varicocele. The essence of surgical intervention is to place clips on the testicular vein with access through small punctures in the peritoneum. Laparoscopic ligation of the veins in the testes takes 20-30 minutes. As an alternative, they resort to laser obliteration (sealing) of the affected vessels.
Endovascular embolization is an X-ray surgical procedure during which an embolus (“plug”) is placed in the dilated vessels of the testicles. It is carried out in several stages:
- a small incision is made in the groin on the right,
- a catheter is inserted into the femoral vein, which is advanced to the vascular plexuses of the scrotum,
- under the control of an endoscope, an embolus is inserted into the dilated veins in the testes.
After the procedure, a radiopaque substance is injected into the vessels of the scrotum to ensure complete clogging of the dilated veins.
Surgical removal of varicocele reduces the risk of relapse several times. Depending on the condition of the inguinal vessels, the following surgical methods are used:
- microsurgical anastomosis - the creation of an artificial path for the outflow of venous blood,
- Marmara operation - removal of a deformed vein through a small incision in the lower abdomen,
- retrograde sclerotherapy - sealing of the veins of the testicles with a hypertonic glucose solution, Varicocide.
With minimally invasive operations, the rehabilitation period takes from 2 to 5 days, but the likelihood of recurrence of varicocele reaches 18-20%.
Possible postoperative complications
Male disease responds well to treatment, so relapses occur infrequently. Postoperative complications appear mainly after embolization and laparoscopy:
- genital atrophy,
- scrotum lymphostasis,
- dropsy of the testicle
- hematoma in the groin,
- swelling of the scrotum.
The likelihood of complications after an open operation does not exceed 1%. After the embolus is inserted into the vein, allergic reactions and perforation of the vascular walls are possible.
Non-surgical treatment of testicular varicocele
Based on the diagnostic results, the phlebologist determines how to cure varicocele. With secondary varicose veins, background disease is treated. Conservative therapy is aimed at restoring blood circulation in the pelvic organs. Men of reproductive age are assigned:
- venotonics (Venovital, Proven phytoconcentrate) - increase the elasticity of the walls of the affected vessels,
- vitamin-mineral complexes (Vitakap, Vitrum) - restore metabolism, have a restorative and tonic effect on blood vessels,
- probiotics (Enterol, Maxilac) - normalize the intestinal microflora, prevent constipation and increase pressure in the pelvic organs,
- non-narcotic analgesics (Indomethacin, Piroxicam) - relieve pain in the groin and inflammation,
- antibiotics (Loflox, Zanocin) - destroy a bacterial infection with varicocele caused by pyelonephritis.
To improve blood circulation in the testicles, it is recommended to wear a suspension - a supporting elastic bandage for the scrotum organs.
The approximate cost of treatment in Moscow clinics
The cost of treatment for varicose veins of the scrotum depends on the method used:
|Method of treatment||Price in rubles|
|laparoscopic removal of blood vessels||45000-46000|
Varicocele is a progressive disease that does not go away on its own. With timely access to a doctor and treatment, the risk of infertility, vascular thrombosis is reduced by 4 times.
Varicocele in men. What are the causes?
Varicocele is one of the varieties of varicose veins. It is also called varicose veins of the plexiform plexus. The essence of the disease is varicose veins of the testicle.
The vessels around the testes increase (it looks like a bunch of vessels), which prevents normal heat regulation in them and contributes to overheating.
Thus, the nutrition of the testis is disturbed and its gradual atrophy occurs.
Varicocele is mainly observed on the left side, this is due to the anatomical features of men. The disease in most cases occurs from 15 to 30 years, but can appear both earlier than this time period, and later. It affects 15-17% of men.
Is varicocele prevention possible?
If the appearance of varicocele is not due to genetics, then the development of this disease can be prevented by a complex of actions that consist in taking care of your body.
In order to keep the vessels and capillaries healthy for as long as possible, it is recommended to play sports (without lifting weights) - swimming and athletic walking, daily exercise are especially welcome. Hardening, douche, rubbing with a towel - all this contributes to good blood circulation.
Well, and, of course, proper nutrition is of great importance - low-fat food with an abundance of vegetables and fruits. Constipation is extremely harmful to the body, their development should not be allowed. The intake of vitamins, regular preventive visits to the doctor should also be a habit.
Can a varicocele relapse occur after treatment or surgery?
Unfortunately yes. Varicocele is not appendicitis, it is impossible to get rid of it once and for all. Symptoms of relapse are the same as with the initial onset of the disease. These are pains, swelling of the scrotum, expansion of the veins, etc. Therefore, after treatment or surgery, you should be especially attentive to your body, and then this delicate and uncomfortable disease will not return.
We suggest that you make sure that everything is in order with your health and that you do not have a threat of developing varicocele. Make an appointment with our specialist phlebologist and he will definitely determine if you need to worry about varicose veins of the plexiform plexus.
Varicocele in men - what is it, danger and treatment methods
- One of the most unpleasant and dangerous diseases for men’s health associated with expansion of the veins is varicocele.
- With this disease, the veins located in the testicles expand, often on the left side.
- In the absence of timely medical care, the disease almost always leads to infertility, so it is important to know everything about varicocele in men - what it is, what is dangerous, how it manifests itself and is treated.
Regarding the disease under consideration, the World Health Organization has its own data, based on which it follows that the incidence of varicocele among men is observed in about 17% of cases. Significant fluctuations in the incidence rate can be noted depending on the territorial location, as well as on the age of men. For example, about 19.3% of cases of varicocele are present in adolescents, while the draft age indicates the presence of this disease in young men already in 5-7%.
Quite often, the course of the disease is characterized by the absence of symptoms, as a result of which, accordingly, men are in no hurry to provide them with appropriate medical care. An ultrasound scan determines the presence of signs of the disease in 35% of cases in men who have reached puberty. In this case, the vast majority of cases indicate a left-sided form of varicocele, caused by those anatomical differences that venous systems have on the right and left sides. The development of the right-sided form of varicocele is relevant in 3-8% of cases, bilateral - in the range from 2 to 12%.
As for the symptoms characteristic of varicocele, it is determined based on the degree of expansion to which the veins underwent. Stage I is characterized by the absence of any symptoms, the determination of varicose expansion is done randomly during a physical examination.
As for the features of stage II, it is characterized by the presence of complaints from patients on the pain localized in the scrotum, while the severity of their manifestations can vary significantly. In some cases, there is inconvenience during walking, sometimes sharp pains are also possible, and their nature makes them more similar to neuralgic pains.
There may be increased sweating, a burning sensation may occur in the scrotum. Often, patients diagnosed with varicocele experience sexual dysfunction.A physical examination determines the dilated veins that reach the lower pole, descending from the testicle below. In the affected area, the testicle drops, which leads to asymmetry of the affected half of the scrotum and to sag.
Stage III disease is characterized by a loss of connection between physical activity and pain. In this case, pain becomes a constant phenomenon for the patient, and this manifestation does not disappear even during sleep. An external examination determines the presence of multiple clusters of veins. In addition to this, an increase in the size of the scrotum, the severity of the asymmetry characteristic of it in a disease, becomes an urgent phenomenon.
Diagnosis of varicocele
Diagnosis of varicocele often enough occurs only on the basis of an examination in combination with palpation of the plexiform plexus (which has the form corresponding to the name) when the patient assumes a standing position. Palpation at a more distinct level is carried out using a Valsalva test (that is, a strained test, which implies an increase in pressure through the abdominal cavity, resulting in increased blood supply to the testicle veins).
With a significant increase in veins and the absence of doubts about the diagnosis, there is no need for additional examinations.
With a slight degree of severity of the disease in question, it is required, in this case, to conduct an ultrasound of the scrotum or its dopplerography. These examination methods are mandatory and carried out in a prone position, and in a standing position, otherwise there is simply no sense.
In addition to the above, the diagnosis of varicocele requires a spermogram, and it is done at least twice, with an interval between procedures of 4-12 weeks. Sexual abstinence for spermogram is necessary within a period of 2-7 days.
Similar to varicose veins, in which the localization of the pathology is concentrated in the leg area, with varicocele, the only effective way is surgery that can be performed in any of the existing forms.
Considering the fact that the disease itself is not dangerous, and, as a rule, the symptoms during its course do not bother the patient, the appropriate solution is to exclude the need for surgical intervention if a varicocele is detected in an adult male.
A mandatory operation becomes in the following cases:
- in the presence of severe pain in the testicle,
- with infertility on the male side, which arose against a background of decreased mobility, quality and quantity of sperm,
- with an aesthetic defect formed on the background of the disease in the scrotum,
- there is a halt in the growth of the testis, affected by the disease, which is particularly relevant during puberty of the patient.
In general, it can be noted that the issue of the close relationship between varicocele and infertility is quite controversial today, as, in fact, the need for surgical intervention is disputed.
A number of specialists in this regard are of the opinion that, as a preventive measure of subsequent infertility, surgical intervention in case of incidence of children / adolescents is necessary regardless of the situation and stage of development of the disease, because the development of blood in the testicles leads to irreversible damage to the spermatogenic epithelium, which according to this feature, under no circumstances and treatment is not restored, causing, thereby, certain problems in the reproductive sphere.
Meanwhile, there are allegations regarding the fact that varicocele is not the cause of infertility; moreover, surgical intervention for this disease is required only when a severe pain syndrome appears and if the testicle is underdeveloped on the affected side, that is, with specific indications for surgery
With a more detailed examination of the disease in the context of possible infertility, an interesting point can be made. In particular, the question is considered regarding changes in spermatogenesis, which was depressed before surgery.
On this account, a study was once conducted that lasted about 2 years when considering 986 cases of the disease, accompanied by problems with fertility. The results after surgery were indicated in the indicated number of patients with a diagnosis of varicocele. As it turned out, after about 70%, the qualitative characteristics of sperm were improved, while in 53% of the cases, the wives of the tested men had a pregnancy. It is also known that men with varicocele, who refused surgical intervention, become fathers only in 10-15% of cases.
As for the operational methods of therapy used today, they include open surgery and mini-access surgery, endoscopic surgery, as well as microsurgical revascularization of the testicle.
When examined by a specialist, the main thing is to determine the causes that provoked the varicocele, because in some cases the appearance of the disease is caused by a kidney tumor. If there are symptoms characteristic of varicocele, a consultation with a urologist and a phlebologist is necessary.
Causes of varicose veins of the testicles
The reasons for the development of varicocele can be:
- intense and prolonged physical exertion, when the venous valve does not cope with the pressure and does not cause a return flow of blood,
- the underdevelopment of the connective tissue that forms the wall of the veins,
- altered state of the veins of the testis and spermatic cord, during fetal development,
- compression of the renal veins,
- diseases of the intra-abdominal cavity, which cause a change in pressure on the site of the scrotum.
The occurrence of varicocele can not always be noticed, only after a while under the influence of certain factors symptoms begin to appear and pathology in the area of the intimate zone of the body becomes noticeable.
The main symptoms and signs of the disease
Increased sweating is one of the symptoms of varicocele
Depending on the condition of the veins, the symptoms of varicocele are manifested by the following symptoms:
- swelling of the testicle
- soreness in the scrotum,
- inconvenience when standing upright and walking,
- sagging of a diseased testicle,
- burning sensation in the scrotum
- increased sweating
- decreased sexual function.
It is difficult to determine the varicocele at the initial stage. Men rush to see a doctor after the manifestation of pronounced symptoms of pathology.
Degrees and types of varicocele
The pathological process in the scrotum may occur more often on the left side.
There are 4 degrees of the course of the disease:
|First degree||No symptoms of pathology are manifested. Determine the venous change in the testis using ultrasound scrotal|
|Second degree||On palpation of the genital organs, an altered state in the testes is clearly felt when the man is in an upright position. In the supine position, it is impossible to determine the varicocele|
|Third degree||The swelling of the veins is determined when examining and probing the scrotum in any position of the man's body|
|Fourth degree||The caterpillar plexuses of the veins in the testicles are visible to the naked eye. The man himself can see the pathology|
The course of each degree is characterized by individual symptoms, and the longer the process develops, the more actively the pathological signs of the disease manifest themselves.
Causes of varicocele
Varicocele is not an independent urological disease. Doctors consider it as a symptom of the pathology of the renal veins or inferior vena cava, a genetic developmental abnormality.
The term “reflux” is used to describe the process of blood flowing through the veins of the spermatic cord in the opposite direction. Reflux happens:
- Primary. It is a consequence of: - lack of valves in the testicular vein (congenital anomaly), - weak venous wall.
- Secondary.It occurs due to valvular insufficiency, which developed due to high pressure in the renal veins and the inferior vena cava. Due to venous hypertension, the blood is looking for additional ways for outflow. A large width section is formed connecting the vena cava and renal veins. Since an enlarged communication occurs between the external and internal spermatic veins and the common iliac vein, it compensates for high pressure in the renal vein. Among the causes of high pressure in the renal veins are: - Localization of the left renal vein behind the aorta. - Spasm of the lumen of the renal vein. - Ring-shaped shape of the renal vein. .- The presence of arteriovenous fistula.
Possible causes of venous reflux (and, as a consequence, varicocele) include conditions that compress the spermatic cord:
- scrotum diseases
- pathology of the inguinal canal,
- hernia of the abdominal cavity.
Varicocele - causes, symptoms, diagnosis and treatment
Varicocele, from the Latin "varicocele", is a deformation of the dilated veins of the vascular system of the membranes of the testis and its epididymis, spermatic cord. The disease does not pose a threat to a man’s life, but a prolonged course leads to atrophy of testicular tissue and infertility.
Varicocele is found in 18% of men under 30 years of age. The hereditary factor becomes the cause of the development of testicular pathology in children from six years old.
The problem is a violation of the outflow of blood from the venous system of the testis to the system of the inferior vena cava. The reason for the development of varicocele of the primary form is inherent in genetic pathology - vascular valve apparatus weakness. As a result, there is a nodal expansion of the veins of the caterpillar plexus of the testicle and spermatic cord. Secondary varicocele has its own causes and development mechanisms.
Complications of varicocele
Regardless of the cause of development, the disease can have a latent course and several years proceed without obvious symptoms. So, for no apparent reason, a man can approach serious complications - sexual dysfunction. There are several types of complications:
- Violation of the production of quality sperm as a result of an increase in temperature in the testicles. It is no accident that the optimum temperature for sperm synthesis is not more than 34 degrees. Stagnation leads to hyperthermia and the formation of weak, inactive sperm. As a result, male infertility develops.
- Adrenal-renal reflux, that is, reverse blood flow - when venous blood rich in catecholamines enters the testes. Adrenaline and its breakdown products are powerful toxins for the spermatic cord and testicles. Under normal conditions, blood enriched with the hormones of the blood of the adrenal glands enters the system of the abdominal veins, where they are diluted, and the concentration in the blood becomes normal.
A prolonged course of varicocele causes oxygen starvation of the testis and appendage. As a result, cells involved in spermatogenesis begin to be damaged by free radicals. This leads to the production of weak sperm, their number is also reduced. This causes the development of sexual weakness (erectile dysfunction).
Swelling of the tissues, which develops with varicocele, prevents the flow of arterial, oxygen-enriched blood to the genitals. This leads to tissue hypoxia. This leads to a cessation of blood flow to the appendages and a negative effect on spermatogenesis. The consequences of the chronic course of varicocele lead to male infertility, the development of scrotum necrosis.