Varicocele: causes, symptoms, treatment, consequences
Varicocele on the right is a disease that occurs exclusively in men, manifested in pathological venous reflux and varicose veins of the spermatic cord and testis on the right, the consequences of which may be a decrease in the fertilizing ability in men.
Varicocele on the right is a less common variant of the disease than varicocele on the left or bilateral varicocele. As a rule, this is due to the anatomical feature.
To the right of the vein from the testis and spermatic cord, the papillary plexus forms, which collects venous blood into the testicular vein, which, in turn, flows into the renal vein, at an acute angle to the right, which contributes less to venous congestion than to the left, where the testicular vein flows into the left renal vein at right angles.
If the testicular vein flows into the inferior vena cava, as well as in the case of the development of the valve apparatus of the inferior vena cava and venous system, varicose development develops on the right side.
Primary reflux occurs in children and adolescents and its main reason is congenital changes in the valves of the vessel, when the valve is either absent or insufficiently closed, which leads to stagnation of blood in the venous system.
Secondary reflux develops at an older age, when the main factor is an increase in pressure in the inferior vena cava, renal vein, in the abdominal cavity and small pelvis, in particular, in the case of retroperitoneal tumor of the right kidney, its germination and compression of the lumen of the inferior vena cava.
As a rule, varicocele in men does not threaten life, but if a representative of the stronger sex wants to have children, then he definitely needs treatment.
According to the WHO classification, the following stages of this disease are distinguished:
- Zero, subclinical. At this stage, there are no complaints or visible changes. With ultrasound - dopplerography, a pathological discharge of blood in the venous system of the scrotum on the right is determined - reflux. Already at this stage, blood stasis and a local increase in testicular temperature appear, which is dangerous for spermatogenesis. If you catch a disease at this stage in a child or in adolescence, then the terrible consequences - infertility - can be avoided.
- First degree. At this stage, varicose veins are detected with a Valsalva test (deep breath and simultaneous straining). The patient may notice dilated veins in the scrotum during severe exertion, sexual intercourse, and complaints of severity and pain may appear. There are signs of impaired testicular function while maintaining its morphology.
- Second degree. Varicose veins are determined by palpation, can also be felt in a prone position. The size of the testicle is preserved. At this stage, the man complains of severity and pain during exertion, sexual intercourse, and an increase in the scrotum.
- Third degree. Varicose veins are visible during examination, the testicle itself is reduced in volume despite the large size and swelling of the scrotum, its consistency changes, is the most severe. Varicose veins are determined visually during examination. The diseased testicle decreases in size, becomes more pasty, and dropsy of the testicle joins. Scrotum skin also changes due to trophic disturbance.
Varicocele on the right: causes and symptoms
For varicocele on the right, a unilateral pathology of the venous system of the right testicle is characteristic.
With varicocele on the right, the causes can be primary, with a congenital change in the connective tissue of the wall of the vein and venous valves, and secondary, associated with an increase in pressure in the small pelvis and large veins.
One of the causes of right-sided varicocele may be the germination of a tumor in the right kidney and compression of the inferior vena cava. The scrotum veins on the right do not fall. The pathological process at an early stage is reversible.
- The veins of the plexus plexus, which removes venous blood from the testicle and spermatic cord, suffer.
- There is stagnation of blood, expansion of the veins, they take a cluster-like form.
- Outflow is reduced, there is a violation of the evacuation of carbon dioxide and products of cell metabolism.
- The local temperature rises, which is accompanied by sweating of toxins and metabolites into the tissue.
- All this negatively affects sperm maturation. They become less mobile, lose fertility.
At a late stage, the secretory function of the testis is also disturbed, its morphology changes, it acquires a testy consistency and decreases in size.
With varicocele on the right, the symptoms usually correspond to the stage of the disease and differ little from the symptoms of left-sided lesions.
Varicocele appears when there is a violation of the outflow of blood through the seminal veins. It can be primary and secondary, that is, a consequence of other diseases. The most common primary left-sided varicocele.
There is a disease with congenital weakness of the walls and valves of the testicular vein, as well as with abnormalities in the structure of the renal vein, into which the left testicular vein flows. The right testicular vein flows directly into the inferior vena cava, therefore, obstacles to venous outflow in this case occur much less frequently. Right-sided primary (idiopathic) varicocele is a very rare pathology.
Predisposing conditions for the development of varicocele are puberty, weight lifting, excessive sexual activity. This explains the young age of patients. All these factors contribute to increased blood flow in the scrotum and increase intra-abdominal pressure.
Secondary varicocele develops more often in middle and old age and is associated mainly with compression of the renal vein by a tumor or enlarged lymph nodes. It can also be caused by venous thrombosis. When a disease appears at this age in a patient, it is first necessary to exclude kidney cancer.
The disease is accompanied by stagnation of blood in the testicle and a violation of its function. The structure of the organ, up to its atrophy, is also gradually changing. In this case, sperm can be produced that damage sperm in a healthy testicle.
Is it worth it to operate the varicocele on the right?
First you need to conduct a full examination to identify its causes. The question of the need for the operation of the patient should be decided by the attending physician according to the results of the examination in each case.
At the subclinical stage, the patient may not be aware of the problem, because the visible state of the organ is good, and nothing bothers him.
At a later stage, a pulling pain may appear along the spermatic cord, in the groin, more on the right, which increases with physical exertion, sexual intercourse. The appearance of a right-sided enlargement of the veins in the scrotum and the appearance of pain and pulling sensations on the right at an older age should be a reason to consult a doctor to identify pathological processes in the abdominal cavity and right kidney.
In most cases, the disease is not accompanied by complaints and is detected during a physical examination.
Some patients complain of aching pain in the corresponding half of the scrotum, aggravated by exertion, sexual arousal, staying in a bath or sauna. The pain decreases or completely disappears in the supine position, since at rest the outflow of venous blood from the testicle improves.
Infertility with varicocele is rare and is associated mainly with the activity of antisperm antibodies that damage normal sperm of a healthy testicle. Cases of bilateral varicocele, which is also accompanied by a deterioration in reproductive function, are extremely rare.
Examination of the patient is carried out in a standing position and lying down. In the initial stage of the disease, dilated and convoluted veins are visible only when the patient is strained. In the future, they are determined in the form of a ball of crimped cords, entangling the testicle. In severe cases, there is flabbiness of the testicle and its decrease in size.
Instrumental diagnostics may include the following methods:
- Ultrasound examination of veins with color mapping allows you to visualize veins and their plexuses, determine the speed and direction of blood flow through them, and evaluate the state of the testicle.
- Radiography of the renal and testicular veins with contrast (venotesticulography) provides information on the causes of varicocele.
- To diagnose the causes of secondary varicocele, ultrasound, computer and magnetic resonance imaging, angiographic methods are used.
Varicocele must be differentiated from inflammatory diseases of the testis (orchitis, epididymitis), tumors of the testis and epididymis, hydrocele and spermatocele.
Treatment and prognosis
At the first stage of the disease, observation is permissible. It is recommended to limit weight lifting, streamline sex life. In some cases, a testis supporting suspension is useful.
In more severe cases, a surgical operation is performed. There are many varieties of interventions for varicocele. Most often, they are aimed at stopping blood flow through the testicular vein. It is usually bandaged, less often embolization (artificial blockage of the lumen) of the vein is used.
Modern varicocele treatment technologies include laparoscopic access and microsurgical ligation. These are low-impact interventions that do not cause serious complications.
Embolization and other x-ray endovascular techniques are used for relapses of the disease, as well as for an initially large number of testicular vein collaterals that need to be "turned off" from the blood circulation.
With a timely operation, testicular function is fully restored. If treatment has not been carried out, testicular atrophy is likely, and in some cases male infertility.
The first channel, the program "Health" with Elena Malysheva on the topic "Varicocele: symptoms and treatment":
Features of a bilateral violation
Bilateral varicocele can be asymptomatic for a long time, while a man feels only a little discomfort. Less often, already in the early stages, pain manifests itself, and a man observes an increase in the testicles. Localized varicose veins on both or one side.
The disease develops due to circulatory disorders. There is stagnation of blood in the vessels, the temperature rises in the scrotum, the release of toxic substances begins. This process affects excretory function and sperm formation.
The risk group includes adolescents 13-17 years old, men who have sedentary work and a sedentary lifestyle, hard physical work or a genetic predisposition to the disease.
Etiology of the disease
Common causes of the development of bilateral varicocele:
- congenital malformations of the vascular system,
- pathologies of the inferior vena cava, which occurred already at an older age,
- violation of the position of the renal and inferior vena cava,
- vasoconstriction on the background of drug treatment,
- blockage of blood vessels and fistula.
Disorders in the pelvic area can be decisive in the appearance of varicose veins of the testicles. Men with benign and malignant tumors in the scrotum are also at risk.
Treatment methods for varicocele in the right testicle
If the varicocele of the right testicle is symptomatic due to inguinal hernia or volume lesion, then it is first necessary to eliminate the underlying disease that violates the venous outflow.
Conservative treatment for varicocele is not effective enough. Convincing data on the effectiveness of folk methods and tools has also not been proven.
Drug treatment is indicated in the absence of factors causing secondary reflux, as well as if the development of varicocele is observed in adulthood and older age, when infertility is no longer of great importance.
Varicose veins of the right testicle affects only one side and does not lead to complete infertility. To address the issue of surgical treatment, the size of the affected organ, the form and degree of the disease are important.
The most famous operation is the operation of Ivanissevichwhen bandaging a varicose testicular vein at the confluence.
Microsurgical operations are also performed, for example, the Marmara operation, which allows you to remove small varicose-enlarged tributaries and areas of the vaginal plexus.
The cost of surgery is very different depending on the severity of the disease and the complexity of the operation.
In Moscow, such an operation can cost from 19,000 rubles for a simple ligation of the testicular vein, up to 120,000 rubles for a microsurgical operation of the third category of complexity. Prices in other cities, for example, Dnepropetrovsk and Vladimir, are slightly different from Moscow to a lesser extent. Treatment of varicocele in Israel will cost from 13 to 18 thousand dollars, including accommodation.
After surgery, recovery of testicular function is expected, with a high percentage of improvement in male fertility and subsequent pregnancies.
Symptoms of the disease appear in each man in different ways, which depends on the cause and severity of the course of bilateral varicocele. There are specific signs that are observed in each patient, confirming the diagnosis.
- a feeling of heaviness in the groin,
- acute pain, especially after intercourse,
- drawing pains spreading along the spermatic cord,
- burning scrotum, discomfort give up in the leg,
- increased pain during walking and after physical work,
- visual changes, organ enlargement,
- rarely sexual dysfunction occurs.
These manifestations are not observed in all men. Quite often, symptoms are completely absent until complications develop.
Varicose veins of the scrotum are treated comprehensively, both surgical and conservative methods are used. Treatment for varicocele begins with the prevention of complications, the most dangerous of which is infertility.
Surgical treatment is performed according to the following indications:
- violation of spermatogenesis, a change in spermogram,
- actively developing atrophy of one or two testicles,
- family history of infertility or missed pregnancy,
- severe pain that does not resolve medically,
- inefficiency of conservative therapy,
- relapse of the disease.
Before the operation, the following studies are indicated:
- Pelvic ultrasound, testicular dopplerometry,
- blood test for immunodeficiency virus, hepatitis,
- biochemical and general analysis of blood, urine,
- spermogram and coagulogram,
- determination of blood group and Rh factor.
The results of surgical treatment can be seen in six months. The man passes a spermogram, and if there are no deviations, the operation was successful. Otherwise, postoperative complications arise, including dropsy of the testicles.
Consequences and Complications
If you refuse surgical treatment, a man may suffer from such complications:
- hydrocele or dropsy - develops most often in the event of fluid accumulation between the shells of the testicles,
- malnutrition - reduction of the scrotum when squeezing the seminal artery,
- violation of spermatogenesis cells - they can completely stop their function, then infertility develops,
- oxygen starvation leads to cessation of sperm formation,
- with a disease of one testicle the process goes to another.
The consequences may develop after surgery. Surgical treatment does not give a 100% guarantee, and this is also important to consider. After the operation, a hematoma may form, the skin turns red, tissue swelling, severe soreness, and infection are also possible.
Secondary infection in case of non-compliance with the rules of the postoperative period can lead to suppuration of the wound, the release of pink exudate from it.
In order to avoid the above consequences, it is important to consult a doctor in time if pain occurs, the shape and size of the scrotum changes, in case of edema, high fever, or discomfort.
These symptoms are typical for several diseases of the genital organs, therefore it is important to conduct a comprehensive diagnosis, differentiate varicocele with dropsy, benign and malignant processes.
Varicocele on the right: symptoms
In order to consult a doctor in a timely manner, you need to know all the possible symptoms of varicocele. There are not many of them and some of them are obvious, but only at a high stage. The main symptoms include:
- Sensations of pain in the groin, not only in the right testicle, but also in the adjacent areas, down to the lower back and thighs,
- Changing the appearance of the genitals, as with the expansion of the veins they begin to bulge, creating a large asymmetry of the scrotum,
- The sizes of the right testicle begin to change, and it begins to decrease, and the area around it grows and loosens, as happens with inflammation,
- Lowering testosterone levels, which leads to a decrease in sex drive and a weakening of potency,
- Deterioration of spermogram indicators, especially in terms of sperm count and motility.
With varicocele on the left and right, or when it starts on only one side, the disease often freezes for a long time when a certain stage is reached. The time when development will continue depends on the intensity and number of complicating factors.
About prevention a few words
It is possible to prevent the development of bilateral varicocele, and it is especially important to take preventive measures in case of a genetic predisposition. It is difficult to completely protect yourself from the disease, since it develops for many reasons, which are not always known.
Prevention of testicular vein expansion:
- timely treatment of systemic diseases,
- balanced nutrition, with the inclusion of vitamin food,
- regular physical activity, but the exclusion of hard work,
- quitting smoking and alcohol.
Men with a hereditary predisposition should take a spermogram every six months in order to see any changes on time. Prevention is simple, based on a healthy lifestyle, but many men neglect some simple but important criteria for healthy lifestyle.
Testicular varicocele on the right: treatment
Having figured out what the symptoms of the varicocele of the right testicle are and having passed the examination by a doctor, it is worth starting treatment immediately. Most doctors claim that the only effective treatment is surgery. This is partially true, since it is thanks to the operation that it is possible to get rid of most of the problems. But do not exclude additional treatment methods that must be used during recovery. The main methods of treatment include the following:
- Operation. With it, the veins can be ligated, filled with a blocking or constricting substance, removed and so on. Everything is aimed at removing problem areas from the blood circulation. There are operations of varying degrees of injury. Patients tolerate some of them very easily, while others can be very difficult.
- Medicines Medicines to strengthen blood vessels and protect them from the negative effects of pathologies of the circulatory system become good support after surgery and the prevention of the disease. They should be selected only by a doctor and should not engage in self-medication.
- Suspensory. Physical support of the scrotum greatly simplifies the recovery period, as it relieves pain from tension and does not create additional aggravating factors. Instead, you can use even more simply fitting underwear, which will also give the desired effect.
- Massage and gymnastics. Preventive measures that help even when a disease occurs. They improve blood flow and help get rid of congestion. The regular implementation of these procedures strengthens the circulatory system.
Varicocele disease is understood as varicose veins, which are located in the scrotum, and lead directly to the blood supply to the penis. There are varicocele left-sided, right-sided, and bilateral.
Most often, according to the statistics of urologists, patients with left-sided varicocele turn to them.
That's why, left-sided varicocele is considered the most common, and among 100% in cases of illness, about 60% are in the left testicle. But this does not mean that right-sided varicocele or bilateral is an exception.
Right-sided varicocele: causes, symptoms, consequences
If you consider the anatomical structure of the scrotum, then you can see that the circulatory network that surrounds the testicles is asymmetric.
The veins that supply blood to the scrotum take different beginnings, for example, the right vein flows into the inferior vena cava.
The left side is most often susceptible to genetic pathologies, but also the right side of the scrotum is vulnerable to varicocele. The thing is that the inferior vena cava, which provides blood supply to the right testicle, is often pinched, which leads to the onset of the disease. The main symptoms of varicocele on the right are the following factors:
The thing is that the inferior vena cava, which provides blood supply to the right testicle, is often pinched, which leads to the onset of the disease.
The main symptoms of varicocele on the right are the following factors:
At the first stage, the varicocele of the right testicle does not cause a person any discomfort, and cannot be detected with the naked eye. In the second stage, during palpation, one can well feel the varicose veins, this can be done by both the man himself and the urologist.
The third stage is accompanied by pain, tense vessels, lumps in the veins. The consequences of the lack of treatment for varicocele law, or improper treatment can be infertility, the presence of future cancers, tumors and infectious diseases.
Varicocele, developing from two sides: features
Bilateral (bilateral) pathological process of expansion and plexus of testicular veins accounts for 36% of all detected cases of varicocele. At risk are: adolescents 11-17 years old, men over 40 years old, burdened by heredity, overweight, without a permanent sex life, with psychosomatic disorders, physical workers and athletes.
Bilateral varicocele: causes, symptoms, consequences
Bilateral varicocele is as rare as right-sided.
But still, is no exception. Bilateral varicocele is a varicose vein that girdles the testicles on both sides.
Symptoms of this disease develop gradually, and often, the situation is neglected due to the fact that it does not give the patient any discomfort for a long time.
In order to understand whether you are at risk for this disease, it is necessary to familiarize yourself with the causes of this urological disease.
- Varicocele on both sides arises from the appearance of vascular anomaly, which was obtained from birth, as well as as a result of acquired diseases associated with the vascular network.
- In addition, adolescents aged 13 to 16 years are at risk because of the onset of active growth, athletes, as well as men who engage in heavy physical labor.
The symptomatology of this disease is pain, which can be traced in the inguinal region, bulge in the standing and lying position, redness of the scrotum, change in skin condition, soreness in the testicles.
Do not treat this disease without special attention. The consequence of varicocele can be cancer, infertility, infectious diseases. In addition, a man may lose sensitivity, and having sex will not bring him any joy, but only pain and discomfort. In order to protect yourself from such consequences, it is worth considering the treatment methods carefully.
Venous vessels on the right side of the testicle form a plexus that directs blood flow to the testicular vein. This is followed by a renal vein, the location of which prevents stagnation of blood. When the veins of the spermatic cord and right testicle are dilated, venous reflux is formed, causing varicocele on the right side. This is a brief description of the disease. Consider the causes, diagnosis and treatment of this male ailment.
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Right-sided form has serious consequences. The following physiological disorders of the body are direct factors in the onset of the disease:
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- genetic predisposition
- lack of elasticity of the tissue walls of blood vessels,
- valvular insufficiency of subcutaneous, perforating, deep veins.
The disease is insidious, it can occur without pain and visible physiological changes. From childhood, it is necessary to teach a child to be attentive to his body. This will help in time to notice the first manifestations of the disease. Signs of a varicocele can be:
- pulling and squeezing sensations in the groin,
- while walking, running, in the heat, sagging of one or both chambers of the scrotum,
- change in the color and size of the genitals,
- lower back pain
- lower abdominal pain,
- burning in the testicles and perineum,
- problems with urination
- pain during intercourse and dysfunction.
Men are often embarrassed to talk about their problems in the genital area and delay the trip to the urologist. Mom and wife should also be vigilant. The older the person, the greater the consequences of the disease.
Testicular varicose veins treatment
Despite the abundance on the Internet and in the incompetent literature of various methods of treating varicocele with medicines and folk remedies, getting rid of this ailment is possible only surgically. Medications are prescribed in the postoperative early period to support the body's defenses, and in the late period to stimulate spermatogenesis. These are drugs of the hormone group, therefore, their purpose is carried out after passing all the necessary tests and subsequent laboratory monitoring of admission.
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Treatment of testicular varicose veins begins with preparation for surgery. The patient passes a set of necessary tests, namely:
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- General blood test (to assess the status of hematopoiesis),
- Urinalysis (to analyze the functioning of the kidneys),
- Blood test per group and Rh factor (if there is a need for transfusion),
- Blood biochemistry (to determine the composition of blood),
- Electrocardiogram (for assessing heart function),
- Various studies to exclude pathology in organs and systems, in case of concomitant symptoms.
Also, the attending doctor and anesthesiologist collect surgical and allergic medical history from the patient in order to eliminate the causes of the complicated course of the operation. After which the patient, depending on the operation chosen by him, is notified about the progress of the process and the type of anesthesia.
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Is relapse possible?
Surgery involves a minimum percentage of relapse. If you treated the disease at home yourself, then the percentage rises. In any case, the possibility of a recurring varicocele is up to you.
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If you do not adhere to a measured lifestyle, the recommendations of doctors, and also do not systematically visit a urologist for a scheduled examination, then it is entirely possible that you will soon have a relapse.
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An organism that has suffered a disease once is inclined to acquire it again, therefore, even surgical intervention is not a panacea for varicocele disease.
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What is dangerous varicocele
The disease does not pose a threat to the life of a man, however, it can cause male infertility. The causes of infertility in men with varicocele are:
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- An increase in testicular temperature to body temperature.
- Biologically active substances from the adrenal glands and kidneys are thrown into the testicles (reflux).
- Disruption of blood supply and, as a result, a decrease in the level of oxygen (hypoxia) of the testicle
- Free radicals accumulate in the tissues of the testis, which damage them.
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How to treat varicocele
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As with any varicose veins, varicocele treatment is possible only by surgical methods. But, since this disease is safe and, often, has an asymptomatic course, the detection of pathology itself is not an indication for surgery.
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Factors affecting the prognosis of the postoperative period
- The age category of the patient - the older the patient, the lower the effectiveness of surgery.
- A significant decrease in testicular volume - in this case, surgical treatment has a low prognosis of effectiveness.
- In the case of bilateral varicocele, significant disturbances develop during spermatogenesis (up to azoospermia).
- At ІІ-ІІІ degrees, spermatogenesis disorders are more pronounced, and surgical treatment has a low prognosis of effectiveness.
- 5. Poor prognosis in patients with subclinical varicocele against a decrease in testosterone and a decrease in testicular volume.
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Varicocele and methods of its treatment
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Consequences, complications and prevention
If a person does not agree to surgery, then the following problems can be expected:
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- a disease that collects a lot of water in a man’s testicles is dropsy,
- a disease that will reduce a man’s testicles at times - malnutrition,
- a disease that will be characterized by a lack of healthy sperm in the semen is infertility.
But it is worthwhile to understand that after surgery on a varicocele from both sides, relapse can occur, as well as infection in the wounds. If a man does not monitor his operated genitalia, then infection can also occur. If in the postoperative period a man observes a situation such as swelling of the scrotum, pain, temperature and redness, then he should immediately consult a doctor.
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Speaking about preventive measures, it is worth noting that for a person who has a certain predisposition for a genetic factor, it is very important to prevent this disease.
Of course, there are difficulties in this phenomenon, since it is very difficult to identify factors that really became the founders of the disease:
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- Firstly, people need to monitor their diet, include only the freshest and most natural foods in it, excluding all junk food.
- Secondly, they should be observed by a doctor if they have any serious illnesses.
- Thirdly, a man needs to exercise regularly, but exclude all hard work and workload.
- And finally, a person needs to quit all his bad habits, for example, smoking.
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Features of diagnosis and treatment
After collecting an anamnesis, the doctor prescribes an examination. An expanded clinical picture of varicocele can be obtained by hardware research. For this, the patient is prescribed a referral for ultrasound and Doppler ultrasound. The examination is performed in two planes: when the patient lies down and assumes a standing position. Then the man gives a spermogram. The procedure is performed several times to compare the results.
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Typically, the initial degree of varicocele is treated with the necessary preventive measures.In the case of diagnosing more severe forms of the disease, medication or surgical treatment is prescribed. The operation is the most effective method of eliminating the symptoms of varicocele.
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The essence of surgical intervention is the ligation of pathogenic veins. In modern conditions, the laparoscopic surgical method is popular. It allows the doctor to perform medical manipulations through a scanty incision. The whole procedure takes place under local anesthesia.
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After 14 days, such a ban is lifted and the man can prepare his body for procreation, since most patients after the operation acquire the reproductive ability of the body.
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Testicular varicocele on the right can be prevented by following simple recommendations and carefully monitoring your health.
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- stool regulation
- systemic sex life
- avoidance of frequent excessive physical exertion,
- refusal of excessive consumption of alcohol, as well as smoking,
- regular visits to fitness clubs,
- full sleep
- balanced diet.
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Often the disease is diagnosed already in the late stages, since men seek medical help in case of acute discomfort in the inguinal region. Every man needs to visit a urologist annually for a routine examination. Early diagnosis of the disease will prevent undesirable consequences and help painlessly get rid of discomfort with varicocele.
Treatment of bilateral varicocele
The decision to treat the disease depends on the patient's symptoms, and on his desire to have children. Men who do not have signs of varicocele usually do not need treatment. For men with moderate or rare symptoms, the following steps may be enough to eliminate discomfort:
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- to wear a bandage during exercise or a long stay while standing,
- Avoid activities that cause discomfort
- apply ice to the scrotum or groin,
- rarely take over-the-counter painkillers such as ibuprofen or acetaminophen.
If these non-invasive measures do not help relieve the symptoms of varicocele, or if a person is worried about their ability to fertilize, then the disease can be treated with a surgical procedure or a procedure called embolization, in which the veins are deliberately blocked from the inside, causing them to clot. During the operation, varicocele veins are clipped or ligated. With an asymptomatic disease, the doctor, as a rule, can not feel for the enlarged veins, therefore, resorting to a Doppler examination.
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There are 4 methods of treating the disease with the surgical method: conventional surgery, microsurgery, laparoscopic surgery, and x-ray occlusion with a balloon catheter.
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Operation with varicocele
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In conventional surgery, a small incision is made in the groin. The spermatic cord is pushed out of the scrotum, and the veins stretched with blood are pulled. This is the most common method. The risks of such an operation include:
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- recurrence of the disease (about 20% of cases), since small veins may not be noticed during surgery, and therefore not tightened,
- the formation of hydrocele (about 5% of cases). Since the lymphatic vessels also indirectly bind, this leads to the accumulation of fluid around the testicles,
- inadvertent damage to the testicular artery, which can actually reduce sperm formation.
Microsurgery is a newer method in which, under an operating microscope, the surgeon individually binds the dilated veins in the spermatic cord. The testicular artery and lymphatic ducts are protected, as the operation is performed with an enlarged image.
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Laparoscopy is a surgical procedure that uses a special thin instrument called a laparoscope to examine the body or perform certain operations. A laparoscope is placed in the body through a small incision in the skin. This procedure is performed under general anesthesia.
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Laparoscopy - a modern method of surgery
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X-ray occlusion with a balloon catheter is not done very often. During this procedure, a silicone balloon catheter is inserted into the testicular artery using an x-ray. The balloon is inflated and remains at this place constantly, thus blocking the dilated veins and curing bilateral varicocele. Many surgeons combine surgery with medical therapy to try to increase sperm count, making the testes work more actively, but how effective this method is still not clear.
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The most effective treatment for varicocele is surgery. And if at the initial stage it is possible to do without surgical intervention, then in the presence of pain in the testicle, diagnosed with male infertility and aesthetic defects in the scrotum, it is necessary.
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However, often surgical treatment is carried out in children and adolescents as a prevention of infertility with varicocele.
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To date, 4 types of operations with varicocele are known and successfully applied:
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- Open (normal) operation.
- Operation from miniaccess.
- Endoscopic surgery.
- Microsurgical revascularization of the testis.
Open operation (according to Ivanissevich)
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The essence of the operation is an isolated ligation of the testicular veins above the level of the inner ring of the inguinal canal. The surgeon makes an incision in the iliac region, and then after dissection of the skin and subcutaneous tissue, makes an incision in the tendon and muscle layer. The final stage of the operation: testicular vein ligation.
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1 - left testicle, venous plexus, 3 - vas deferens, 4 - left testicle vein, 5 - tendon layer of the abdominal wall, 6 - muscle layer of the abdominal wall
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Marmar operation from miniaccess
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To carry out this surgical intervention, a small incision is made in the projection area of the external inguinal ring (exit site of the spermatic cord) at a distance of 1 cm from the base of the penis. After dissection of the skin and subcutaneous tissue, the veins of the spermatic cord are ligated. And the outflow of blood from the testis subsequently occurs through a network of superficial veins.
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Marmar operation from miniaccess
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This is not the first year that endoscopic surgery has been successfully used in the treatment of a wide variety of diseases. No less effective using this method can be achieved in the treatment of varicocele.
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The operation is performed through three punctures of 5 mm each. One puncture is done in the navel area, and a tiny camera connected to a video monitor is introduced through it. On it, the surgeon monitors the progress of the surgical intervention and sees everything that happens in the operation area with excellent lighting and an increase of 6-10 times.
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Through two other punctures, miniature clamps and scissors are introduced, with the help of which the artery and veins of the testicle are isolated from under the peritoneum. The surgeon carefully selects all the elements of the vascular bundle. And then special titanium brackets are placed on the testicle veins, or the veins are ligated with surgical thread. Operation duration does not exceed half an hour.
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Microsurgical revascularization of the testis
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The purpose of the operation is to restore the normal outflow of blood from the testicle through the testicular vein. And during the surgery, the testicular vein is transplanted into the epigastric.
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Microsurgical revascularization of the testis
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History and causes of varicocele
The pathology of the veins (their varicose expansion) located in the scrotum and entwining the testes is called varicocele.
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Veins are tubes through which blood returns to the heart from body tissues. To prevent blood flow in the opposite direction, the veins are equipped with one-way valves. When they for some reason cease to fulfill their functions, a countercurrent occurs. Blood builds up in a vein (especially when a person is standing) and bursts into it. This is called varicose expansion.
The testicles are surrounded by a whole system of small veins (plexiform plexus). Of these, blood enters the testicular vein (larger), and from there into the renal (left testicle) or the inferior vena cava (right testicle).
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The pressure in the renal vein is much higher than in the inferior vena cava. This fact explains why the veins of the left testicle undergo varicose enlargement. Varicocele is a common cause of infertility in men. This is due to the fact that in the dilated veins blood accumulates, increasing the temperature of the testicle. As a result, their function is impaired (spermatogenesis). Less sperm are produced, and they are inactive.
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The disease has several causes. Depending on the etiology, the following are diagnosed: primary (idiopathic) and secondary (symptomatic) varicocele.
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At this time, there is an increased formation of the reproductive system, which requires increased blood supply. Increased blood flow makes the veins work with increased stress. If there are any pathologies in them, a malfunction occurs, which leads to varicose veins of the plexiform plexus.
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The cause of the development of primary varicocele can be:
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- underdevelopment, weakness or lack of testicular vein valves
- violation of intrauterine development during the formation of the venous system
- venous wall tissue pathology
- interweaving of testicular vein with artery
Symptomatic varicocele is a concomitant process in some pelvic pathologies:
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- prolapse of the kidneys
- genital and lumbar injuries,
- hernial masses
- tumors with localization in the pelvic region,
- renal vein thrombosis,
- scars in the fiber surrounding the renal vein,
- consequences of surgical interventions.
All these disorders cause compression or narrowing of the veins, resulting in increased pressure in it (hypertension). This provokes reverse blood flow from the renal vein through the testicular to the plexiform plexus. Here, blood accumulates, stagnates and causes vasodilation.
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The situation is exacerbated by the fact that prolonged vein expansion leads to malfunctioning of even healthy valves. They stretch, weaken and cease to function normally.
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At what age does the disease begin
Right-sided varicocele affects exclusively men. This is due to the anatomical structure of the male body. The disease has a long course, which is characterized by several stages of the development of the disease:
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- Primary reflux is diagnosed in childhood, usually due to congenital pathologies of the valvular septum of the vascular system. Dysfunction of the septum, as well as its absence, causes blood stasis in the vein cavity.
- Secondary reflux appears in adolescence. Body weight increases following the growth of a teenager, thereby increasing pressure on the venous system. The further process of pathology is influenced by internal and external causes during the maturation of the patient.
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On the first night after surgery, the patient will need help, since he needs to be in a lying position. In addition, the patient should exercise both calf muscles every hour. Walking and muscle training will help prevent the formation of blood clots in the veins of the legs. After surgery, there is some discomfort. Most patients report only mild or moderate pain.
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Healing is fast. Heavy exercise should be avoided for 10-14 days. After 1 or 2 days after the operation, as a rule, you can begin to work, continuing to be observed by a doctor. If the operation was carried out in order to solve problems with infertility, then sperm analysis is carried out after 3-4 months, when new sperm is produced.
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For a while, you need to abandon physical activity
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After embolization, it is necessary to abandon physical activity within 7-10 days. You can return to work after 1-2 days. The recurrence rate for embolization is higher than for surgery.
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There are many things you can do to deal with postoperative pain and make your recovery more comfortable:
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- talk with your doctor about taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen,
- Do an ice wrap on the scrotum and incision area for 20 minutes every hour. It is especially useful in the first few days after surgery,
- place a folded towel under the scrotum to raise it. This will help relieve discomfort and minimize swelling.
- wear a bandage in the first few weeks to minimize discomfort while standing, walking or training
- do not take baths, do not swim or wipe the incision until the wound heals, and this is approximately two weeks.
- resume sex after at least 1-2 weeks.
Patients are usually prescribed sleeping pills as painkillers. They can be taken if the pain level is above "5" on a scale from "0" to "10".
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The disease can cause a decrease in the production and quality of sperm, which in some cases can lead to infertility. In fact, bilateral varicocele is quite rare.
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Deviations in the male reproductive tract can manifest as a tumor in the scrotum. In this case, it is necessary to find out the cause of the neoplasm
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It is very important to seek medical attention if any changes in the testicles are detected.
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Since doctors began making smaller incisions on the body, the healing time after open surgery and laparoscopy is about the same. Problems after operations are rare, but they can still occur. Here is some of them:
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- further development of varicocele or its re-manifestation,
- fluid that forms around the testicle (hydrocele),
- damage to the testicular artery.
There is a small percentage that the operation does not fix the problem. In rare cases, damage to the testicle artery can lead to testicular loss.
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Re-development of varicocele after surgery is possible in 1 out of 10 cases
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Open surgery has a low rate of secondary appearance of the disease. In most cases, patients return to normal activity after 2 days. Problems that may occur due to percutaneous embolization:
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- the development of the disease after the procedure or its secondary manifestation,
- the likelihood of infection with the introduction of the tube.
Most medical centers do not use this method.
Natalia, 26 years old: My husband and I have been married for 5 years. Doctors said that there is a direct connection between his varicocele and the fact that we have no children. Last year, he underwent surgery for varicocele. The operation was performed under local anesthesia for about an hour. He was discharged the next day. For about two weeks, my husband took medicine, then vitamins, wore special underwear. After a month he was allowed to have sex, and after a while I found out about pregnancy. Soon we will have a baby.
Anton, 48 years old: When I underwent medical examination, they found a varicocele in mild form. The surgeon advised me not to rush the operation, because it does not threaten life and I already have children. So I did. I was prescribed venotonics and special underwear. I also had to drop the bar. I will not say that the varicose veins become smaller, but I feel good.
Tatyana, 43 years old: Two years ago, a father-in-law found a varicocele in his right testicle. We insisted that he be examined, although he did not want to. We put him in a hospital, and there he discovered a tumor in his right kidney with germination. Surgeons performed an operation on him, then he underwent a course of chemotherapy. Now he is at home, he walks on his own, very grateful to the surgeons for saving his life.
Pathology has the following degrees of development:
- Zero or, as it is also called, subclinical. At this point, the symptoms are almost invisible. To identify the disease, Doppler ultrasound or ultrasound is prescribed. This form of the disease affects the patient's spermatogenesis.
- First degree. In this case, the disease is accompanied by a violation of the functions of one testicle. Abnormal venous enlargement can be detected by applying the Valsava method. In this case, the patient should hold his breath on inhalation. At this point, the doctor can see the expansion of blood vessels under the skin of the scrotum.
- Second degree. At this stage, the patient may experience severity and slight pain in the scrotum. When palpating the affected area, enlarged veins can be detected in a vertical or horizontal position. At this stage, the size of the testicles does not change.
- Third degree. This stage of the disease is the most difficult. In this case, varicose veins can be detected visually without performing special procedures. The testes of the patient are significantly reduced.
If the operation is not done on time, the pathology can lead to dangerous complications:
- Hypotrophy - is a decrease in the scrotum due to compression of the seminal artery,
- Hydrocele - this condition most often occurs with a large amount of fluid between the shells of the testicles,
- Violation of spermatogenesis - this can lead to the development of infertility,
- Oxygen starvation - provokes problems with sperm synthesis.
Negative consequences can occur after surgery. It should be borne in mind that the surgical intervention does not give one hundred percent guarantees. After surgery, there is a risk of hematoma, redness of the epithelium, swelling of the tissues. There may also be severe soreness, infection.
Violation of the rules of the rehabilitation period can provoke a purulent lesion of the wound and the appearance of exudate. To avoid dangerous consequences, you need to consult a doctor in a timely manner. This must be done when a pain syndrome occurs, the shape and size of the scrotum changes, the temperature rises, and swelling occurs.
In order to prevent the development of this pathology, it is important to carefully take preventative measures. This is especially true for patients who are at risk. To prevent the occurrence of the disease, it is worth following the following recommendations:
- Provide moderate exercise,
- To treat pathologies of the pelvic organs,
- Strictly observe the mode of work and rest,
- Stop smoking and drinking alcohol,
- Eat properly and balanced, which will help to supply the body with vitamins and nutrients,
- Have sex systematically
- Avoid stool disorders.
It is very important for men who have vascular pathologies or a hereditary tendency to develop varicocele to be examined 2 times a year by a urologist or andrologist. If necessary, consult a vascular surgeon. The sooner the pathology is detected, the more effective the therapy will be.
Is treatment possible?
Two-way varicocele is successfully treated both in Russia and abroad. The most important thing here is the timely diagnosis of the disease. In the early stages, treatment with medication is possible, as well as full control over lifestyle and nutrition.
If the disease is in a progressing 2 or 3 stages, then here you can not do without surgical intervention. Therefore, before choosing the most optimal treatment option for yourself, consult a urologist about what will be most effective in your situation.
Etiology of violation
The origin of the disease is congenital (primary) and acquired (secondary) in nature. Vascular anomaly is inherited, the father and son often have a similar structure of the valve apparatus and the structure of the tissue of the venous walls. Physiological reasons for the development of primary bilateral varicocele:
- renal venous hypertension,
- testicular vein valve insufficiency,
- combination of these reasons.
Narrowing of the renal vein is accompanied by a persistent increase in blood pressure - hypertension and leads to failure of the testicular vein valves. Provoking congenital anatomical features: narrowing of the lumen of blood vessels (stenosis), ring-shaped structure of a vein, pathological mobility of the kidney (nephroptosis) and others. Valvular insufficiency may also be due to the loss of collagen in the epithelial cells of the vascular walls.
Secondary or acquired varicocele occurs against a background of scarring of the fiber surrounding the renal vein. These can be such pathologies: tumors of the kidneys, abdominal cavity, cyst, enlarged lymph nodes, inflammatory processes, disruption of the pelvic organs, hernia and other consequences of injuries.
In older men, venous pathology is due to a decrease in muscle tone and omission of organs.
Mechanism of occurrence
The left testicular vein flows into the renal at a right angle, and the right into the inferior vena cava. The narrowing of the vessel can lead to the growth of a blood column up to 240 mm in the damaged channel. There is a direct discharge from an artery into a vein, a shunt is formed. The tissues of the testicles are located below the line of infringement, in them there is a failure of microcirculation, stagnation of blood. Organ temperature rises, sperm maturation is impaired. Oxygen starvation causes tissue hypoxia and ischemic changes, with time - an abnormality of cell development. The left-side hydraulic pressure is higher, the length of the barrel is longer, so the disease most often manifests itself on this side.
A urologist, if there is no fear that the disease will progress, may prescribe vasoconstrictor drugs.
Moreover, it is necessary to supplement the medication with testicular massage, wearing compression underwear, the absence of heavy physical exertion, as well as a change in nutrition.
You need to go on a diet, stop smoking and alcohol.
You will need to be more in the fresh air, receive only positive emotions.
In addition, varicocele does not imply a prolonged stay in the same position, especially in a sitting position, therefore, you need to think about taking a vacation for several weeks.
If there is evidence in order to conduct the operation, then you need to choose one of the proposed methods. They should direct you to the operation after conducting the appropriate tests. These include:
- blood analysis,
- Analysis of urine.
If the operation is indicated by all criteria, then you can choose one of the proposed methods, which can be performed both under general and local anesthesia.
Stages of development
There are 4 stages of varicocele formation. The degree of development of the disease is primarily determined by the urologist with the help of examination and palpation. At the first stage, the symptoms are not obvious, the doctor collects an anamnesis, if necessary directs for additional research, medication is advisable. At the second stage, dilated veins are palpated in a standing position, at the third - standing and lying, surgical intervention is required. The final stage has obvious signs (nodular veins, asymmetry, hard muscles), surgical treatment is not always justified. In patients with venous expansion on both sides, the manifestations on the left are more pronounced (2-3 degree) than on the right (1-2).
Negative impact on men's health
The consequence of varicocele is infertility. An increase in temperature and venous congestion leads to changes in the seminiferous tubules, damage to the vessels of the testicles and tissue, and the development of autoimmune processes. There is a violation of spermatogenesis, the concentration and motility of male germ cells - gametes, is reduced.
Medical care for bilateral varicocele involves surgery and drug therapy. The choice of treatment method depends on the initial patient data:
- age of the patient
- testicular volume
- degrees of varicocele
- the development of varicose veins on one side or both,
- marker of follicle-stimulating hormone.
Most experts are of the opinion that surgical intervention with varicocele in this category should be carried out on both sides. The gamete concentration indicators, their motility, sperm morphology, and pregnancy rate exceed 43%.
There are more than 100 types of operations, they are divided into two groups:
- occlusal (clogging),
Let's consider some of them:
|Group||Type of operation||The essence of the operation||Pros and cons|
|Occlusal||Open (Ivanissevich, Palomo, Marmara, Bernardi and others)||The intersection of the spermatic vein with an open incision of 5-6 cm||Technically uncomplicated, fast, low price, frequent relapses, the likelihood of developing testicular dropsy - 30%, general anesthesia|
|Microsurgical ligation||Intersection with low invasiveness and high visualization||It does not injure veins, lymphatic vessels and arteries, relapses of 0-2%, laborious, increases the period of testicular rehabilitation|
|Laparoscopic varicocelectomy||Intersection with optical magnification in bilateral and recurrent varicocele||Artery identification, general anesthesia, relapses are possible, dropsy cases - 10%|
|Retroperitoneoscopic varicocelectomy||Intersection with endoscopic mini access 1.5-2 cm||Low invasiveness, minimal anesthesia, good cosmetic effect|
|Endovascular interventions (embolization, coagulation and others)||Stopping the vein with a plug or sclerotherapy through a puncture on the thigh||Low invasiveness, radiation exposure from x-rays, the possibility of relapse|
|Non-occlusal||Microsurgical connection of vessels by anastomosis||The formation of an adequate venous outflow, high cost|
|Plastic surgery to remove and restore a vein||Completely restores normal blood circulation, is expensive|
The rehabilitation period after the operation is short: you need to stay in the hospital for 6-24 hours, home regimen - up to 10 days, avoid physical activity - up to 1 month.
Drug therapy is advisable at the 1st stage of varicocele and in combination with surgical intervention to neutralize inflammatory processes. Depending on the symptoms of the disease, drugs are used: venotonic (prevent thrombosis), to combat constipation and analgesics. Physical therapy and massage have a positive effect on blood circulation.
Reviews of patients undergoing conservative treatment indicate its effectiveness within 30%.
Relapses and the possibility of prevention
Repeated symptoms of bilateral varicocele make themselves felt 6-12 months after surgery and later. The relapse rate varies between 10-40%, depending on the type of intervention. Reasons for the resumption of varicose veins: incomplete examination, additional vein, venous wall defect, slowing blood flow. Primary right-sided pathology can again appear on the left or on both sides. Surgical treatment is not recommended for boys before puberty, at this age most of the relapses.
Prevention of varicocele involves avoiding an increase in intra-abdominal pressure in the pelvic vessels. Prevention of stagnant processes: refrain from significant physical exertion, alcohol, monitor stool, regular sex, rest, walking and vitamins.
Varicocele is not a sentence. A man who does not want to remain infertile should know his predisposition, pay attention to possible anatomical manifestations of the disease and lead a healthy lifestyle. If the disease manifests itself, modern medicine will solve the problem with a high probability of success.