General characteristics of the disease
Varicocele is a varicose veins surrounding the spermatic cord and the testicle.
The disease is often a cause of male infertility - disturbed thermoregulation and supply testicular tissue, which in turn results in the deterioration of morphological parameters and sperm motility, reducing their number.
Varicocele is one of the most common diseases of the male reproductive system. This pathology can be double-sided, right-sided and left-sided, with the share of the latter type accounts for about 90% of all cases.
When varicocele surgery is necessary at the stage of determining the disease, otherwise possible testicular atrophy.
Causes of the disease
The cause of varicocele is a reverse flow in the testicular vein, which may result from congenital weakness of the vascular wall or increased blood pressure in the veins of the scrotum and pelvis. In the first case, the disease occurs as a result of genetic predisposition - his relatives can be observed valvular heart, flat, phimosis, veins of limbs or other diseases associated with lack of connective tissue. In the second case, due to the absence of varicocele, or poor performance of the existing valves in the veins, which should serve as prevent backflow of blood. Disruption of these valves causes that increase pressure in the veins of exertion or when in the upright position causes extension of the veins.
Diagnosis and symptoms of varicocele
To diagnose the disease in several ways: palpation pampiniform plexus, ultrasound and Doppler standing and lying down, Valsalva maneuver (strong exhalation against a closed mouth and nose, with intense abdominal). It may also be examined levels of sex hormones in the blood and semen is made.
Clinical symptoms of varicocele insignificant:
- ptosis of the left;
- half of the increase in the scrotum;
- not very severe pain in the testicles, scrotum, groin, usually pulling character;
- increased pain during exercise, sexual arousal or walking.
If not promptly started treatment may worsen the symptoms of varicocele: constant and prolonged pain reduction in the left testicle, a significant increase in the scrotum, contouring veins of the spermatic cord.
There are four degrees of varicocele:
1. At the first degree the disease can be detected only by means of ultrasound or Valsalva maneuver, which will confirm the increase pampiniform plexus.
2. In the second degree varicocele veins can be seen with the naked eye in a standing position.
3. In the third degree and palpation in the supine position and standing would allow to diagnose the disease.
4. In the fourth degree varicocele veins can be seen with the naked eye, while the egg soft to the touch, and its dimensions are reduced.
In most cases, a varicocele is found during any medical examination, for example doprizyvnikov or infertility.
Treatment of varicocele
Today in varicocele surgery is the only treatment that can save spermatogenesis.
There are several ways to treat the disease by surgery, but usually in varicocele surgery involves removal of the varicose veins or suspension of the lower pole of the testis (using a strip of fascia oblique abdominal muscles).
If the symptoms do not bother, and the man does not plan to have children, varicocele repair can be performed non-surgically, such as the wearing of jockstrap.
Complications of surgical treatment of varicocele
After varicocele in some cases may experience the following unpleasant moments:
- In the early postoperative period ligation and damage the lymphatic vessels can trigger lymphedema. This phenomenon occurs in the first days after varicocele often, however, usually within two weeks of pain and swelling of the scrotum fully tested.
- The most severe complication of surgical treatment of varicocele can become atrophy or wasting of the testicle. This phenomenon can cause random ligation of spermatic artery. Reduction in volume of egg until atrophy is observed in less than 1% of the microsurgical treatments.
- After varicocele pain decreases or disappears in 90% of cases, but each man 3-5 of 100 operated continue to harass pain in the testicle and spermatic cord. This pain can persist for quite a long time, sometimes for several years.
- Crossing the lymphatic vessels through ½-4 years after surgery, and sometimes the first few months, at 0, 5-9% of patients can cause hydrocele (hydrocele). Since microsurgical technique involves maintaining varicoceles lymph nodes, in this case, this complication occurs in less than 1% of patients.
- In adult male varicocele recurrence is less common than in children - 2-9% and 1-20%, respectively. In this regard, many urologists advised to treat the disease by surgery after puberty.
The success of the treatment of varicocele suggests improved quantitative and qualitative characteristics of sperm, surgery is usually observed after 3-6 months.