What are the causes of varicocele?
Causes of varicocele in men
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.
Causes of varicocele in men
Indeed, the cause of varicose veins of the spermatic cord is local damage to the valvular apparatus of the venous vessels. But for the development of the disease, starting points are needed, which are the following reasons:
- The weakness of the inner and middle layer of the wall of the vessels of the testis, spermatic cord is inherited by the dominant type. Therefore, the disease is transmitted from father to son, and in children often the pathology is more severe. In this case, the weakness of the vessel wall is accompanied by insufficiency of the valve apparatus. The number of valves is also less than normal.
- Increased pressure in the portal vessels (portal hypertension), the inferior vena cava, and hepatic veins, the cause of which are tumor diseases of the liver and urinary system. In this case, the vascular walls of the venous system are deformed due to compression. As an option for development - the death of tissues (gangrene) of the testicle.
- Frequent constipation, tumors of the abdominal cavity and functional disorders of the intestine lead to stagnant processes in the testicle.
- Predisposing factors include scrotal injury, inflammatory disease, burns and diarrhea.
A possible reason for the development of increased pressure in the pelvic organs and scrotum is malignant tumors of the organs of the retroperitoneal space and the abdominal cavity, which compress the veins of the testicles, forming stagnation of venous blood.
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.
Symptoms of varicocele
The initial stages of varicocele are almost not manifested, the man is not disturbed by any symptoms. Perhaps a feeling of discomfort due to slight swelling after walking to a distance of more than 500 m or significant physical exertion. In the future, as progression begins, painful symptoms begin to appear.
More often, the first signs occur after taking a bath. Varicose veins are clearly contrasted on the scrotum. More than half of the cases of the disease are diagnosed by examination for male infertility. Prior to this, the family may not be aware of the disease for a long time.
There are four stages of varicocele:
- Vasodilation is not determined by conventional methods. Helps diagnose the Valsalva test.
- Varicose veins can be detected by palpation, especially when standing. Visually, pathology is not determined.
- Vasodilation is easy to determine both standing and lying down.
- Varicose veins are visible even with a visual examination. Enlarged veins press on the surrounding tissue.
Diagnosis and treatment methods
Diagnosis is by palpation of the lesion, taking into account the medical history, genetic predisposition. Additionally, instrumental methods are used: ultrasound, dopplerography of the appendages. Objective methods include the Valsalva test (palpation of the appendages when straining), marching (examination of urine after exercise) and X-ray. Valsalva's test is also used for ultrasound examination. Sometimes an analysis is prescribed for the level of hormones in the blood.
Therapeutic methods are used in the early stages of varicocele, as well as if the man already has children. Treatment with drugs is carried out if a man has contraindications for surgical treatment. At the first stages of varicocele development, men are recommended to reduce physical activity, give up alcohol, and smoke. The diet should limit the use of salt, spicy foods. General healing measures in the early stages can slow the progression of the disease.
If the symptoms are not expressed and sexual dysfunction in men is not observed, then a wait-and-see tactic is recommended, which consists in monitoring the patient's condition. In this case, a positive effect is achieved by taking specialized preparations of L-carnitine with the addition of zinc, selenium and folic acid. These agents restore reproductive function, contribute to the synthesis of normal, motile spermatozoa.
In the case of an acute pain symptom, circulatory disorders in the tissues of the testis and appendages, pathology of spermatogenesis, surgical treatment is indicated. Apply more than 120 types of similar operations, which are selected individually. All of them are divided into two types: with the preservation of the message of the veins of the cord with the renal artery, and with the violation of such a message. For treatment, the technique of surgery is selected individually. After surgery, as a rule, medications are prescribed to the man that normalize spermatogenesis for the speedy restoration of reproductive function. Studies have shown the high effectiveness of Speroton after varicocelectomy.
The European Organization of Urology has developed recommendations aimed at preventing the development of varicocele. Based on the causes of the disease, experts recommend:
- Men with a hereditary predisposition should categorically avoid physical exertion associated with weight lifting. All types of weightlifting and work as loaders are contraindicated for them.
- Given the close anatomical location of the organs of the genitourinary system, it is necessary to pay attention to any deviations from the norm associated with the release of urine and the onset of an erection.
- Avoid anything that causes an increase in intra-abdominal pressure. It is better to take food in fractional doses, to prevent flatulence, to quickly respond to all deviations of the food system. Regularly undergo examinations and do an abdominal ultrasound.
- A common cause of varicocele is thrombosis. This complication can be avoided if thromboembolic complications are treated in time.
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Primary Varicocele Factors
Primary varicocele is the so-called idiopathic form of the disease, which usually occurs without any external causes. Up to a point in a man’s life, such a condition can be completely invisible, asymptomatic and not progress to a serious health problem. Most often, for the manifestation of this form of varicose veins, there are two factors:
- anatomical features of the structure of the vein system,
- hereditary predisposition.
From the point of view of anatomy, a varicocele can develop in cases where in the male body the left spermatic vein is connected at right angles to the vena cava, located noticeably below the junction. That is why blood flow on the left side can be difficult, which is why the likelihood of stagnation is potentially high.
The second variant of anatomical problems is the structural features of the muscle fibers that form the plexus of veins around the testicle. In some men, they are so weak that the high pressure of the blood moving along the renal vein stretches and damages them.
Varicocele can develop due to underdevelopment or complete absence of valves in the left testicular vein
Also, varicocele with the anatomical features of an individual organism can develop for the following reasons:
- congenital insufficiency of valves
- underdevelopment or complete absence of valves in the left testicular vein,
- longer testicular veins on the left side than on the right.
Probable reasons for the presence of varicocele in men can also be hereditary factors, the so-called genetic predisposition, in particular:
- flat feet
- congenital weakness of the walls of blood vessels,
- varicose veins affecting the lower extremities,
- heart valve abnormalities,
- phimosis (narrowness of the foreskin, not allowing to expose the glans penis),
- insufficiency of development of connective tissue.
Regardless of whether anatomical or genetic factors are the causes of varicocele, the culprits that the disease appears at some point are certain external causes, such as gaining excess weight, having irregular sex life, or “acquiring” certain diseases.
The causes of varicocele secondary
Varicocele of secondary origin usually occurs as a consequence of the transfer of certain diseases, as well as due to other factors. This happens mainly because in the veins of the scrotum or pelvis, high blood pressure is pumped, because of which the left testicular and left renal veins begin to undergo anatomical changes, including:
- narrowing of the lumen,
- disruption of the valves providing venous outflow,
- expansion of the walls of the veins and their loss of tone.
Overweight men can lead to expansion of the walls of veins and loss of tone.
The following phenomena can lead to such problems:
- injuries, surgical interventions, the course of chronic inflammation,
- neoplasms of a different nature,
- intestinal disorders (chronic constipation or diarrhea),
- increased physical (labor or sports) load,
- irregular sexual activity,
- diseases accompanied by inflammatory processes.
Due to various injuries caused by groin injuries, operations in this part of the body or chronic inflammation, characterized by the formation of scar tissue in the tissues, narrowing of the lumen of the veins can occur. This leads to an increase in pressure in the blood vessels, to the stretching of their walls, which is a factor contributing to the development of varicocele. If a man has primary varicocele, due to the anatomical weakness of the vein system, these effects can be the main reason for the “launch” of disease progression.
The blood pressure in the veins of the void or cluster-like plexus around the testicle can be increased due to the fact that neoplasms develop in the pelvic organs, abdominal cavity or retroperitoneal space. Tumors are able to produce a certain effect on the veins of the plexus, causing an increase in blood pressure and stretching of the vascular walls.
With improper bowel function, characterized by frequent constipation or disorders (diarrhea), the likelihood of varicocele is also increased. This happens for the reason that regular straining, like the frequent process of bowel movement, leads to a chronic rush of blood to the pelvic organs. As a result, congestion begins to form, leading to damage to the veins and their varicose expansion.
With improper bowel function, the likelihood of varicocele is increased
Increased stress associated with the professional activities of men or his athletic training, provide a constant increase in intra-abdominal pressure and regular flow of blood to the pelvis. The increase in blood pressure in the veins in the groin is due to the fact that these vessels during physical exertion have to expand dramatically due to muscle tension in the abdominal press. That is why athletes involved in strength training for pumping up the abdominal press, as well as lifting weights and barbells, along with representatives of professions that provide the same load on the press, are at risk for varicocele.
However, the absence of any physical activity in a man’s life is no less harmful, as this helps to gain excess weight. Overweight can provoke varicose veins of the testis for two reasons:
- or there is a “clogging" of blood vessels with fat particles, which leads to a narrowing of their lumen and an increase in blood pressure,
- or the general load on the whole body, including veins, is growing.
In any of these situations, the development of the disease is only a matter of time.
Another factor bringing closer familiarity with the term varicocele for a representative of the stronger sex is an irregular schedule of sexual activity. Normally, a healthy man should have sexual intercourse on average 2-3, at least 1 time per week. This is the optimal number of sexual acts in which the blood supply to the genitals has time to renew, eliminating the likelihood of stagnation, but the veins do not suffer from overcrowding. If the regularity of intimate life is below the average, this leads to the development of congestion in the pelvic organs, and in the long run directly to varicose veins of the plexus plexus.
Inflammatory diseases affecting the male genitourinary system, especially if they are chronic, are also causes of varicocele, capable, as mentioned above,affect testicular vein patency. Reproductive system lesions are characterized by the presence of excess scar tissue or adhesions affecting the blood vessels of the veins, infringing them and leading to an increase in blood pressure. Such diseases can be inflammation of the prostate gland (prostatitis), as well as various viral infections, including sexually transmitted infections.
It is very important to know what causes are potentially capable of overloading the vein system in this way, since a representative of the stronger sex, having this knowledge, can independently correct his condition. Often enough to get rid of excess weight, cure inflammatory diseases, limit yourself to physical activity and normalize a healthy diet to eliminate the negative effects and protect yourself from the disease.
Getting the first time to see a doctor, complaining of pain in the scrotum or its sudden transformation with the acquisition of an asymmetric form, a man should prepare to hear the diagnosis: varicocele. To find out how it could arise, as well as determine the methods of struggle, the patient will have to undergo a series of diagnostic examinations. During their conduct, specific factors of the origin of the disease and possible options for its treatment will be revealed.
To determine the methods of control, the doctor prescribes a series of diagnostic tests
And treatment, especially timely, with this problem with the man’s health, is very important, since this problem is insidious enough not to show symptoms until it is too late, and dangerous enough to lead to serious complications. In particular, a varicocele developed for any of the reasons can lead to the following consequences:
- hyperthermia (temperature increase) of the testicles, which occurs due to congestion in the blood vessels of the spermatic cord, leading to a malfunction of the spermatogenesis process and, as a result, to male infertility,
- reflux (reverse casting) from the adrenal and renal arteries of the blood, saturated with hormones, because of which it becomes toxic, poisoning all organs of the genitourinary system,
- hypoxia (oxygen starvation) of the tissues of the organs of the reproductive system, resulting from insufficient oxygen supply and provoking in the best case, only loss of testicular function and failure of spermatogenesis, in the worst - complete necrosis of the male sex glands.
Since the complications of running varicocele are quite serious and even dangerous to health, you should contact your doctor as soon as possible with complaints about problems with veins in the scrotum. Only a quick identification and accurate determination of the factors provoking this disease will help to cope with the problem in a timely manner and avoid the consequences in the form of impaired reproductive function and even sepsis (blood poisoning).
It is very important to know the causes of the testicular vein disease, since only if the initial factor is identified, the attending physician will be able to help the patient get rid of the varicocele problem. Unfortunately, anatomical and genetic factors cannot be fully treated and eliminated - with such indications, patients are immediately recommended to have a surgical effect on the pathological sections of blood vessels. But the secondary varicocele, which is the result of a disease in the body, can be treated conservatively. After eliminating the root cause, if one was done in a timely manner, the condition of the veins usually returns to its previous state.
Definition of the disease. Causes of the disease
Varicocele is a varicose vein in the scrotum, through which blood must flow from the testicle. In 96% of cases, this process is observed in the left half of the scrotum, much less often on both sides, and very rarely in the right half.Changes in the veins of the testis are similar to those occurring with varicose veins on the legs - the veins increase in diameter, acquire a characteristic tortuosity.
Varicocele is a very common condition, observed in 11.7% of adult men. The prerequisites for the development of varicocele are laid from birth, but it appears in adolescence, it is during this period that the testicles increase in size and begin to function actively.
The cause of varicocele is the innate structural features of the vascular system of the body, leading to high pressure in the venous vessels collecting blood from the testicle. That is why varicocele often occurs on the left, as the vein of the left testicle flows into the left renal vein at a right angle, contributing to the creation of adverse conditions for the outflow of venous blood from the testicle. The vein of the right testicle flows at an acute angle into the inferior vena cava, which significantly less often disrupts the flow of venous blood.
Most often (76% of cases), pressure in the left renal vein increases, as it is compressed between the aorta and the artery, extending from the aorta to the intestine. This condition is called aorto-mesenteric forceps. This anomaly is often observed in tall and thin men, which explains the more frequent presence of varicocele in them.
Much less often (in 17% of cases), a varicocele occurs when pressure in the left common iliac vein rises due to its compression between the right common iliac artery and the spine. This condition is called Maya-Turner syndrome.
Another reason for the occurrence of varicocele is congenital weakness of the vascular wall, even when there is no high pressure in large venous vessels, a progressive violation of the venous outflow from the testicle occurs. Then varicocele is often combined with other diseases of the veins: varicose disease of the legs, hemorrhoids.
Occasionally, a varicocele is secondary, i.e. arises not at puberty, but at a more mature age (more often after 40 years). In this case, it is necessary to exclude tumor diseases of the kidney, which may be accompanied by the formation of a tumor thrombus, which disrupts the outflow of venous blood in the renal or inferior vena cava and thereby leads to the formation of varicocele. In 9% of cases, a combination of these two mechanisms of varicocele formation is observed.
A certain role in the occurrence of these vascular abnormalities is played by heredity. Varicocele in the father increases the likelihood of this disease in the son by 4-8 times.
Symptoms of varicocele
As a rule, varicocele is asymptomatic and is detected by chance during examination by a urologist.
Pain in the scrotum is observed in 2-11% of men with varicocele.
Pain with varicocele can have a different intensity: from mild discomfort to severe pain. It is characteristic that the pain occurs or intensifies against the background of physical activity, especially prolonged. This is due to an additional reverse discharge of venous blood into the veins of the scrotum with increasing pressure in the abdominal cavity. As a rule, the pain decreases and disappears if the patient takes a horizontal position.
With varicocele, the size of the scrotum can increase, the disease can lead to deformation of its contour, which can become a significant cosmetic defect for young men.
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.
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.
Conclusion: Varicocele is not contagious. This pathology is associated with organic disorders of the male body.
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:
- Adrenaline 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 enhances the release of blood by the heart muscle, which can cause excessive stretching of the walls of the veins, as well as local stagnation of blood.
Conclusion: frequent stresses, neurosis are accompanied by a change in the hormonal balance of the man’s body, which is the reason for the wear of the veins, as well as the venous valves of the small pelvis, leading to the development of varicose veins.
What else are the causes of varicocele in men, why it develops, we will consider further.
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.
Pathology of the kidneys. 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.
Increased abdominal pressure is 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, when used regularly, 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.
The use of anabolics and steroid drugs changes the hormonal balance, which causes 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 dictates 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.
Varicocele in men
The causes of male health disorders are many, as are diseases. Moreover, not every disease is widespread, and if a person becomes ill, he simply may not know about the developing ailment. One of these diseases in men is the pathology of the testicular spermatic cord - varicocele.
Testicular varicocele in men: what does the diagnosis mean?
If a man is diagnosed with varicocele, then initially you might think that the disease is somehow connected with varicose veins, since both names have the same root. Indeed, the names are similar, as are the mechanisms for the development of pathology.
Testicular varicocele is a varicose vein of the spermatic cord. This disease is noted mainly in adolescents aged 14-15 years and in young men of reproductive age. Statistics show that in general, pathology occurs in 15% of men.
Symptoms of testicular pathology in men
Varicocele disease in men belongs to the category of pathologies that occur without vivid symptoms. Most often, originating during the puberty of a young man, it quickly develops to some extent and then stops. There are also cases when the disease independently regresses and then completely disappears.
Nevertheless, such alarming signs of this disease may indicate a developing varicocele:
- An increase in the size and prolapse of the left testicle (if the pathology is localized on the left).
- Mild pulling pains in the scrotum and groin. During walking or during heavy physical exertion, these sensations can become more pronounced and cause discomfort.
- If the scrotum is strongly omitted from one side, this can interfere with normal walking.
- Pain in the scrotum, the bulge of its veins, a decrease in the left testicle (with severe varicose veins of the testicle).
If signs of varicocele are detected, it is better to immediately go to a specialist, and not wait for the pathology to regress.
Degrees (stages) of development and varieties of the disease
The more dilated the veins of the testis, the deeper the degree (stage) of varicocele development:
- Zero degree. As a rule, the disease to this extent is detected by chance if the patient is prescribed an ultrasound of the scrotum with a Doppler to study signs of other male pathologies (for example, hernias, tumors, and so on). On palpation, testicular vein expansion is not palpable.
- First degree. It is possible to detect dilated testicular vein by palpation only when the patient is standing.
- Second degree. Testicular veins affected by varicose veins are well felt in any position.
- The third degree - the expansion of the veins is noticeable during a visual examination of the scrotum.
Left-sided varicocele is the most common pathology. The cause of varicocele is the special location of the vein surrounding the left testicle. It is connected to the renal vein, which, in turn, due to plethora, often suffers from the influence of various internal and external factors. In 98% of the total number of identified pathologies, it is precisely the varicocele of the left testicle (varicocele on the left) that is diagnosed.
Bilateral varicocele or testicular varicocele on the right can develop due to an abnormality of the vessels, which, in turn, is congenital or due to vascular disease.
Is varicocele dangerous and how: what complications and consequences of the disease can occur in men
Despite the fact that varicocele often has mild symptoms and may not affect the normal life of a man, this disease has complications. The first and most important thing that threatens varicocele is infertility in men.
The chain of formation of an unpleasant complication is as follows: blood flow is disturbed in the scrotum, the testicles do not receive adequate blood supply, harmful compounds and free radicals begin to accumulate in them. A consequence of these factors is impaired spermatogenesis. In the sperm of a man, there are fewer sperm or their morphological qualities are sharply reduced. In other words, the sperm of a man with varicocele cannot fully participate in the fertilization process. In this case, you should not literally think that varicocele always leads to infertility. It is only about individual observed cases.
Another consequence of the presence of varicocele is phimosis. The problem is more common in boys and is expressed in the absence of the opening of the penis due to the narrowed foreskin.
What is the danger of varicocele in each case, the doctor will be able to explain to the man after the diagnosis.
Ultrasound diagnosis for a diagnosis of varicocele
When visually or upon palpation, the doctor (or maybe the patient himself) detects the presence of enlarged, thickened veins, a decrease in the size of the testicle from the side of the lesion, an ultrasound with a Doppler is prescribed to clarify the diagnosis.
An ultrasound probe is applied to the scrotum, and the doctor begins to study certain parameters. Ultrasound technology allows you to compare the size of the testicles, determine their consistency, and also assess the size of the vein surrounding the testicle. You also need to evaluate the speed of blood flow in this vein, which determines how correctly and fully the testicle will function.
If veins are visible on the ultrasound monitor, on which thickenings are noticeable (there may be several, they look like dark circles), a varicocele is confirmed.
What treatment is prescribed for men if they have a varicocele testicle?
Before talking about treatment, you need to decide which doctor to go to if you suspect a varicocele. Urologists deal with this problem. Very often, the first meeting with a urologist in young men takes place back in school, when various medical checks at the military enlistment office begin in high school.After such checks, young people first learn about their problem, after which they can only make an appointment with a urologist for a more detailed diagnosis.
Treatment of varicose testicular spermatic cord involves surgery. But it is important to know exactly whether surgery for varicocele is necessary, or is it not indicated for everyone?
If the boy has pain, there is a decrease in the testicle from the side of the lesion and there are signs of underdevelopment of this testicle - surgery is needed. It is also prescribed to men with varicocele who cannot have children. A preliminary study of sperm (spermogram), which shows the presence or absence of impaired spermatogenesis. However, the doctor does not give a one hundred percent guarantee that after eliminating varicocele, the patient will have the opportunity to have children.
If there is no special indication for the operation, varicocele is simply observed in dynamics.
Pathogenesis of varicocele
An increase in resistance to venous outflow leads to the fact that the testicular veins expand, the valve apparatus is destroyed and venous blood flows back through them. In this situation, the vascular system of the testis and spermatic cord is filled with venous blood, leading to a decrease in arterial inflow to the testicle and a violation of its blood supply. With a significant violation of blood flow, the testicle decreases in size (hypotrophy), less significant changes disrupt its function: initially this is a violation of sperm production, and subsequently the production of sex hormones decreases.
An important point is that against the background of accumulation of warm venous blood in the scrotum, its temperature rises. It is well known that the testicles in men are not accidentally brought out; this is necessary for the adequate course of spermatogenesis. The scrotum in this case performs the function of a thermostat, bringing the testicles closer and moving away from the body, it maintains their temperature at an optimal level of 34-35 ℃. Numerous studies using heat metering have shown that the temperature of the scrotum against the background of varicocele rises to 36-37 ℃, which negatively affects spermatogenesis.
Many patients wonder why with varicocele, detected on one side (mainly on the left), both testicles suffer. This is due to the fact that due to varicocele, the temperature of the entire scrotum increases, and spermatogenesis in the neighboring testicle is disrupted.
Another mechanism of the negative effect of varicocele on the testicles is associated with the discharge into the testis of a large number of adrenal hormones, the concentration of which in the renal vein is high due to the influx of the adrenal veins into it. Adrenal hormones have a negative effect on spermatogenesis, and their high concentration in testicular veins with varicocele has been proven in a number of studies.
Classification and stages of varicocele development
Today, the classification of the World Health Organization, proposed in 1997 and including 4 degrees, is used:
- III degree - dilated venous plexuses protrude through the skin of the scrotum and are easily palpated,
- II degree - dilated veins in the scrotum are not visible, but are easily palpated
- I degree - dilated veins are not visible and are not palpable, with the exception of their expansion during Valsalva manvra (a test with straining, leading to increased pressure inside the abdominal cavity and discharge of venous blood into the scrotum),
- Subclinical degree - there are no signs of varicocele during examination, but it is detected by ultrasound in the Doppler mode.
In addition, varicocele is divided into three hemodynamic types, according to previously considered reasons:
- Renospermic type - there is a reverse flow of venous blood from the renal vein to the veins of the testis,
- Ileospermic type - there is a reverse flow of venous blood from the iliac vessels into the veins of the testis,
- Mixed type (a combination of a renospermic and an ileospermic type of varicocele).
Complications of varicocele
Possible complications of varicocele include:
Infertility is understood as the absence of pregnancy for more than 1 year in a couple who regularly have sex without the use of contraception. Infertility is the most common pathological condition observed in men with varicocele, and in the structure of the causes of male infertility, varicocele is in the first place.
The greatest information about the degree of influence of varicocele on the ability to conceive is provided by the study of sperm (spermogram). Changes in spermograms with varicocele vary widely: from the complete absence of sperm (azoospermia), observed in rare cases, to moderate impaired sperm motility (asthenozoospermia). In addition, varicocele can cause a positive MAR test (immune infertility test). Numerous studies have shown that curing varicocele leads to a significant increase in the chances of conception, which confirms the role of varicocele in the occurrence of infertility.
Testicular hypotrophy is indicated in cases where the testicle is reduced in volume by more than 10% compared to the opposite. Data on the frequency of this condition in men with varicocele vary widely from 10 to 77%. The cause of malnutrition is a violation of the blood supply to the testicle on the background of varicocele. In most, though not all cases, the cure of varicocele leads to the restoration of normal testicular volume.
Male hypogonadism is a decrease in the level of male sex hormones, primarily testosterone, to a level below normal values. Symptoms of this condition are very diverse. These are sexual disorders in the form of erectile dysfunction, loss of sexual desire, and psychoemotional changes in the form of decreased performance, concentration, as well as a decrease in muscle mass, an increase in the amount of adipose tissue, etc.
Normally, in men, testosterone begins to decline from about 30 to 1-2% per year. In the presence of varicocele, as shown in a number of studies, this process can proceed much faster, and, in general, men with varicocele have lower testosterone levels in relation to healthy men. The cause of this condition, with a high probability, is also associated with a violation of blood supply in the testis as a result of varicocele, which leads to a decrease in the activity of enzymes involved in the synthesis of testosterone, and naturally reduces its concentration. The cure for varicocele allows us to hope for an increase in the concentration of testosterone in the blood.
Causes of the disease
With poor functioning of the spermatic valve valves, a varicocele may develop. Valve veins, which must counteract the outflow of blood during high physical exertion, cannot perform their functions with high pressure. For increased pressure, the venous vessels become wider, resulting in venous nodes similar to a tumor.
Studies of medical specialists in phlebology revealed a number of reasons for the appearance of the initial stage of the disease.
- Insufficiency of the tissue that forms the wall of the vein.
- Changes in the venous vessels of the testis or spermatic cord.
- Improper formation of the inferior vein.
Various anatomical features of the body can also cause high blood pressure. Renal vein hypertension leads to testicular valve venous failure. Over time, another way appears for the outflow of blood from a vein to the testicle, from where it falls into the plexiform plexus.
Another factor that can cause the development of Varicocele is high pressure inside the abdomen.This happens with too much load on the front wall of the abdomen, this is expressed in constipation, overstrain of muscle tissue in training, too long a stay in a standing position.
The symptomatic nature of the disease can be a complication of diseases in the pelvis, kidneys, or gastrointestinal tract. In this situation, the cause of the appearance of pathology is the outflow of blood from venous vessels.
Diagnosis of varicocele
The diagnosis of varicocele is made on the basis of a patient examination, but the diagnosis must be confirmed by ultrasound with dopplerography of the scrotum vessels.
Ultrasound examination allows you to determine the presence of varicose veins of the papillary plexus of the scrotum and evaluate their diameter. The extension of the veins of the plexus plexus to a width of 2.5 mm or more allows the patient to be diagnosed with varicocele. In addition, with ultrasound, the condition of the testicle and its size are necessarily assessed in order to establish the possibility of hypotrophy.
Ultrasound should be supplemented with dopplerography. This mode allows you to evaluate the direction of blood flow through the veins. Normally, the blood through the veins should flow from the testicle, but if there is a reverse flow of blood to the testicle at rest or during the Valsalva test, we can state the presence of a varicocele in the patient.
Symptoms of the disease
The clinical manifestations of varicocele depend on the stage of the disease. With 1 and 2, the symptoms are practically absent. The expansion of venous vessels in most cases is diagnosed during a routine examination of a medical specialist.
At the third stage, patients have complaints of pain in the scrotum. The intensity of pain in people can vary greatly. It all depends on the individual characteristics of the body. Some patients complain of discomfort only while walking, in some, the disease is accompanied by sharp pain. Sometimes patients have a burning sensation in the scrotum, severe sweating.
A large number of patients note a violation of the functioning of the reproductive system. A physical examination by a medical specialist reveals an expansion of the venous vessels that reach the lower testicle. In the affected area, it falls, there is an asymmetry of the scrotum.
At the fourth stage of the development of the disease, there is no connection between physical stress on the body and pain. The pains become permanent and begin to bother the patient at night. During an external examination, large clusters of venous vessels appear. The scrotum increases in size, the asymmetry becomes more pronounced.
Varicocele treatment is only surgical, no other treatment methods, including lifestyle correction and medication, are effective.
Surgical treatment of varicocele is indicated if:
- scrotal pain
- testicular malnutrition,
- male infertility.
Over the entire history of varicocele treatment, more than 300 different surgical aids have been proposed.
Today, four types of operations are used:
- Ivanissevich operation,
- laparoscopic venectomy,
- X-ray endovascular occlusion of the testicular vein.
- microsurgical subingual varicocelectomy
All presented treatment methods are aimed at blocking the reverse flow of venous blood due to the most effective intersection of the testicular veins at different levels.
Operation Ivanissevich - The simplest and least effective way to treat varicocele. An incision is made in the iliac region on the left, in the retroperitoneal space there is a testicular vein, represented by one or two or three trunks, bandaged and intersected.The advantages of the operation are simplicity of execution, the disadvantages are high invasiveness, poor cosmetic result (incision 5-7 cm) and a very high frequency of complications, for example, relapse of varicocele (re-occurrence of varicocele) - 29% and hydrocele (dropsy, the accumulation of a large amount of liquid between membranes of the scrotum, increasing its volume and requiring surgical treatment) - 5-10%.
Laparoscopic venectomy differs from the operation of Ivanissevich in that an endoscopic technique is used to access the testicular vein. Small incisions are made on the front surface of the abdomen (3 by 1.5 cm), through which the camera and endoscopic instruments are inserted into the abdominal cavity, with the help of which the testicular vein is located, extracted, clipped and intersected. The advantages of this technique include the best cosmetic effect in relation to the Ivanissevich operation. The disadvantages are a rather high risk of relapse (7%) and hydrocele (5.8%), as well as the possibility of developing severe complications associated with penetration into the abdominal cavity (trauma to the intestines, large vessels and nerves, pulmonary embolism, peritonitis, postoperative pain in the right shoulder (due to diaphragmatic extension during pneumoperitoneum).
Endovascular embolization of the testicular vein - An operation performed not by urologists, but by vascular surgeons. Under local anesthesia, a small incision is made on the thigh, access to the venous system is provided. After that, a catheter is inserted into a vein and is carried out first into the renal and then into the testicular vein. Throughout the testicular vein, obstacles to the flow of shelter in the form of spirals are placed. The advantages of this technique are low trauma, the procedure is performed under local anesthesia and there is no risk of such a complication as hydrocele. The fact is that the cause of hydrocele is the accidental ligation of the lymphatic vessels along which the interstitial fluid moves. This operation is performed from the lumen of the vein, which eliminates damage to the lymphatic vessels and, accordingly, the development of hydrocele. The disadvantages include radiation exposure (the operation is performed under x-ray control), the high frequency of unsuccessful interventions is 9-27%, i.e. situations where the surgeon, due to anatomical features, cannot reach the testicular vein, a high relapse rate of 10% and other complications is 11% (hematomas, perforations, bleeding). Today, this technique is not used as a primary treatment for varicocele; it can be used for relapse when other operations have failed.
Microsurgical subingual varicocelectomy (Marmara surgery) - The "gold standard" for the surgical treatment of varicocele. With this technique, a 2-2.5 cm incision is made at a level just above the base of the penis. Access is made to the spermatic cord, which is secreted from the surrounding tissue and excreted into the wound. Then, under the optical magnification, the spermatic cord is opened and its vessels are separated, while the veins are ligated, and the artery and lymph vessels must be preserved.
The advantages of the technique include low invasiveness, good cosmetic result, low probability of relapse - 1% and hydrocele - 0.4%. The disadvantages are the difficulty of implementation, which requires long training, and the dependence of the result on the experience of the surgeon (at least 100 such operations per year are required to ensure the optimal result), as well as a violation of the arterial blood supply of the testicle in case of damage to the testicular artery, which is extremely rare (less 0.01% of cases).
Most doctors are of the opinion that varicocele is a progressive disease that gradually more and more significantly disrupts the functioning of the testicles.This, in particular, can explain the high frequency of secondary infertility in men with varicocele. In this case, a man with varicocele achieves pregnancy at a partner at a young age (up to 25 years), and subsequently, when the couple is planning a second child, difficulties arise, which is probably due to a progressive violation of spermatogenesis against the background of varicocele. At a later age, after 40 years, a varicocele spreads its effect on the testis production of male sex hormones - a function much less sensitive to negative factors than spermatogenesis. This can lead to a decrease in testosterone levels in the blood.
In the vast majority of cases, varicocele is a condition predetermined from birth, so we do not have effective methods for its prevention. And the only method to prevent the progression of the disease is its surgical elimination.
Diagnosis of the disease
In almost all situations with Varicocele treatment, there are no problems. A patient is interviewed to determine the cause of the disease, as well as determine its stage. All possible injuries in the lumbar region are also taken into account.
In some situations, when examined by medical specialists, a large number of cluster-shaped nodes are found. The soft and winding venous vessels in the form of clusters are determined by palpation. In some cases, in patients, the testicle decreases in size, becomes flabby.
With this disease, the examination by palpation is carried out not only in a vertical, but also in a horizontal position, as well as during straining. If the dilated venous vessels are not found in a standing or lying position, in most cases the disease is at the primary stage of development. If the expansion of venous vessels is easy to feel in a supine position, this is an indicator of the symptomatic process.
To exclude the formation of volumetric nature, which can be caused by the symptomatic nature of the disease, medical specialists conduct an ultrasound examination of the kidneys and gastrointestinal tract. During CT or RMT, blood vessel thrombosis and other pathologies can be detected that can cause secondary Varicocele.
For adult patients, sperm analysis is prescribed for a more accurate diagnosis. This is explained by the fact that with Varicocele in most cases there is a decreased activity of the reproductive system, as well as a decrease in the number of sperm.
Before determining the course of treatment for a patient, various contrast studies, venography and testiculophlebography are performed. In some situations, antegrade venography is prescribed during surgery.
How is the disease treated
In the symptomatic course of the disease, treatment of the main pathology is required. In the initial stages of Varicocele, surgery is not necessary. The treatment includes procedures that are aimed at eliminating blood stasis in the pelvic area. This is done by preventing chronic constipation or limiting physical stress. In some cases, elderly patients have a positive effect with a suspension. In the second and third stages of the disease, when it is characterized by severe pain, surgery is performed.
There are a number of reasons for surgery.
- Painful sensations.
- Low sperm count and dysfunction of the reproductive system.
- Inhibited development of the affected testicle during puberty.
- External defect.
There are three methods of surgical intervention for the disease.
- Medical experts raise the testicle.
- Embolization of venous vessels.
- Excision of venous vessels.
The third method of surgical intervention can be performed at different levels of access to the inguinal canal. Recently, medical specialists are increasingly using ligation of dilated venous vessels. This reduces the risk of relapse and complications. In some situations, patients had positive results from occlusion of the venous system of the testis.
To avoid complications with Varicocele, it is necessary to get rid of stagnation of blood in the pelvic area. Medical experts advise you to avoid physical stress. Closely monitor your stool. Refuse alcohol, smoking. Take vitamin complexes, regularly engage in sexual intercourse. It is advisable to normalize the rest mode.
Types of operations
Today, doctors use several methods and types of surgical operations in the treatment of varicocele:
- Laparoscopy with varicocele involves punctures of the skin in several places to provide access to the veins of the instrument (laparoscope). If dilated veins are found, they are ligated.
- Endovascular sclerotherapy involves gluing pathological vessels by introducing a special therapeutic substance into them.
- Open surgery of a varicocele involves an incision in the pubic part with further ligation of the vein.
From the last group of operations, it is worth considering the technique of Marmara surgery for varicocele. The doctor makes an incision in the pubic area close to the ilium, then dissects the integument and subcutaneous tissue, allocates the spermatic canal and performs a vein ligation.
To determine the patient’s state of health before the operation with varicocele (laparoscopy, Marmar or others), tests are prescribed: blood for sugar, for coagulability, for the Rh factor, for HIV, hepatitis, urine analysis, fluorography, ECG.
Is varicocele treatment possible without surgery? Non-surgical conservative treatment for varicocele, as a rule, is unsuccessful and only makes sense in preparation for a surgical operation.
Varicocele: ICD code
Testicular pathologies pose serious problems for the reproductive system. Improper blood circulation often does not cause any serious pain, but it greatly affects the likelihood of having a baby and other possibilities. Varicocele according to ICD 10 code have I86.1. This includes varicose veins of the scrotum and spermatic cord. The classification I86 includes all diseases of this kind related to other localizations.
The name of the disease is translated from Latin as "a tumor in the venous node." In many ways, there is traced with the expansion of veins on the legs, as the reason may be the poor functioning of the valves, which leads to a reverse blood flow. Thus, the veins become larger and the blood supply suffers. Manifestation of testicular vein is manifested.
What are the features of varicocele ICD code
According to the international classification of diseases (ICD), varicocele refers to varicose veins. This is quite logical, although specialists from urology and andrology are engaged in the treatment of such a disease, and not those who are more associated with cardiovascular diseases. With this disease, the veins on the spermatic cord expand, which over time leads to the appearance of pain in the scrotum, when a man is subjected to strong physical exertion. In the later stages of the disease, pain may occur during intercourse, but in most cases, patients do not attach particular importance to the disease.
With varicocele, the ICD 10 code in men can even develop infertility. This is due to the fact that due to the expansion of the veins, the blood supply is disturbed and the proper amount of oxygen is not supplied to them so that the spermatozoa can develop normally.The ICD code for varicocele on the left remains the same, since there is no dependence on where the pathology formed. Despite this, most often a varicocele appears precisely on the left. On the right testicle, the formation of expansion is also possible, but it happens less frequently. It is also possible that all this will occur on both testicles, which is also not the most common occurrence.
ICD 10 varicocele in children and adults: statistics
According to statistics, most often this disease manifests itself in people from 15 to 25 years old. This is due to the fact that at this time, the body is growing up and restructuring. Accordingly, it is at this time that pathologies can occur much earlier than in other periods. Another role is played by the fact that it is possible to detect varicocele during a routine examination by a doctor. Naturally, to clarify the diagnosis, an ultrasound examination will be required, but suspicions of it can be determined by palpation by a specialist at the examination.
General statistics say that the disease is diagnosed in 15% of men. If we consider those who suffer from infertility, then in their case, approximately 40% show this pathology. In varicocele, the ICD 10 code for children is the same as for adults. In adults, the disease is often detected in an already more developed form. Often, due to the fact that a person does not undergo preventive examinations, pathology cannot be detected in a timely manner. Among those men who were diagnosed with secondary infertility, they also simultaneously find varicocele in 80% of cases.
If the ICD code for varicocele in children is detected due to congenital abnormalities or during puberty, and here the statistics remain, approximately the same for everyone. But there are certain risk groups in adults in which this disease can occur in almost 70% of cases. As a rule, these are spheres with heavy physical exertion. The main factor here is that a person constantly met with this, at work, with active sports and so on.
Varicocele on the left ICD 10: detection and stages
The disease is often chronic and does not go away on its own. It can progress depending on the state of the cardiovascular system, the strength of the influence of complicating factors causing the disease, and other causes. In any case, the longer the pathology affects the body, the more obvious the signs of its presence become. The stages can be recognized even during the initial diagnosis at the examination:
- If a varicocele can be felt only when the patient begins to push, and visually nothing is visible, then this is the very initial stage,
- If all this can be determined visually, but no serious changes in the shape and consistency of the testicles can be traced, although everything feels great to the touch, then this is the second stage,
- If the appearance of the testicles changes and the shape becomes unnatural, which entails a change in consistency, then the third stage is traced.
Despite all the differences in the occurrence, diagnosis, and course of the disease, the varicocele on the left is always classified equally according to the ICD 10 code. After all, the methods of solving the problem become the same, but they do not give fundamentally new complications, whatever the cause of the occurrence. In any case, if there are pains in the scrotum, which are especially characteristic during physical exertion, then you need to see a doctor for an examination. Only he will help determine whether the disease is in an operable stage or can still be solved with more conservative methods.
Signs of a varicocele
The definition of this disease, as a rule, is not very difficult for specialists. The signs of varicocele are quite obvious and are largely manifested in a change in the shape of the testicles or veins themselves, which come from them.If in an ordinary state the veins have a fairly fine structure, then with this pathology they noticeably expand and become more friable. This is very noticeable when probing. In the later stages, a change in form becomes commonplace, while with the initial form, external changes are practically not observed. On ultrasound, all signs are noticeable almost immediately.
Rehabilitation and recovery after surgery for varicocele
The postoperative recovery period in the case of surgery to eliminate varicocele may have different periods:
- 1 month with microsurgery or laparoscopy,
- 2 months with open operations.
For normal recovery after surgery to remove varicocele, a man / boy needs:
- exclude physical activity,
- to observe sexual rest
- exclude visits to saunas, pools, baths,
- exclude the use of alcohol.
What can be the consequences and complications after surgery to eliminate varicocele in men?
Any operation is always associated with risk, so with varicocele, you need to clearly determine whether it is indicated or not. The main complications after surgery on varicocele include:
- the appearance of puffiness, hematoma in the scrotum,
- pain in the testicles,
- purulent and serous discharge from the puncture, incision,
- redness of the skin,
- penile temperature increase,
- violation of spermatogenesis,
- infectious infection as a result of the use of non-sterile surgical devices.
Varicocele relapse: is it possible to re-return the disease after surgery
Before surgery, many patients are wondering if the varicocele can recur after surgery? I must say that the likelihood of varicocele recurrence is small, but there is.
The reasons for the return of the disease can be manipulations carried out by the doctor poorly, the patient's non-observance of the rules of behavior in the postoperative period, a genetic predisposition to the disease, an abnormal structure of blood vessels. Also, the cause of recurrence of varicocele can be a pathology of the cardiovascular system, against which varicose veins of the lower extremities develop.
Causes of varicocele
Varicocele: why it appears in adolescents
Varicocele disease most often manifests itself at a young age, but it is then that it passes almost asymptomatically. Due to its features, it turns out to be quite easy to identify the disease during a routine examination in schools and upon admission to higher educational institutions.
Varicocele in men: what causes the pathology
Often, the cause of varicocele in men at this age is a congenital pinched vein that leads from the kidneys. This provokes the creation of additional increased pressure in the plexiform plexus. This is supplemented by all the rapid growth of the body during adolescence and various hormonal changes, which in the presence of pathology creates an increased load on the vessels.
Otherwise, the causes and symptoms of varicocele in adolescents do not have any serious differences with what happens in adults. In the young body, although much less frequently, weak neural walls, tumors in the pelvic organs, and high blood pressure still appear. This becomes the cause of varicocele.
Varicocele: causes and symptoms for other diseases
In addition to the fact that there are certain factors that lead to the appearance of varicocele, this disease itself can also cause the appearance of some diseases and negative phenomena. They are mainly associated with the reproductive system. Symptoms of varicocele and the causes of its occurrence can lead to infertility. This is due to several factors. On the one hand, a strong expansion of the veins creates conditions in which the testicles begin to heat up.Their overheating causes the development of defective sperm and poor sperm production in general. This also includes insufficient supply of organs with oxygen, which causes varicocele. It also affects the quality and quantity of sperm in the body.
A more serious obstacle may be the physical squeezing of the vas deferens with dilated veins. This blocks sperm output and leads to stagnation. Even if its amount is produced according to the norm, then it will not be able to completely exit the body. Over time, this is reinforced by pain.
Varicocele can also affect hormone production. As a rule, this is primarily noticeable in FSH. You have to take hormonal analysis to determine the situation. To correct the situation, sometimes it is necessary to apply hormone therapy, and sometimes everything returns to normal after the operation, after a certain period.
In any case, it is very important to know the causes of the disease in order to understand whether you are at risk or not. If one of the factors is very obvious, then you should try to exclude it from life so as not to encounter this disease. The reasons can be manifested in a complex, which only exacerbates the situation. Doctors can easily identify the disease and understand what led to its occurrence after questioning the patient. Some reasons can only be determined after analysis.
Varicocele: etiology and pathogenesis
For the development of varicocele, there are many different etiological factors. The most common mechanical, in the presence of which the vessel expands due to the high pressure that forms in the lumens. The etiology and pathogenesis of varicocele involves obstruction and compression of the left iliac vein. This can cause the development of collateral circulation, which goes along the pelvic anastomoses.
Despite the presence of many factors for the development of the disease, the main causes include hypertension, renal and venous insufficiency of testicles. In turn, compression of a vein in a given area can lead to renal hypertension. It can acquire a ring-shaped structure. Previously, doctors, when ascertaining the etiology and pathogenesis of varicocele, referred more to valvular insufficiency, now experts are already inclined to believe that the general inferiority of the vessel is to blame. Thus, vein failure can occur together with valvular insufficiency. The etiology in the form of testicular venous insufficiency is caused by the inferior development of mesenchymal tissue. Such changes can be incorporated in the body during embryonic development, so that in a child this is all directly connected with genetics. Vein weakness is congenital and the appearance of the disease is a direct consequence of this pathology.
How can varicocele affect conception and is pregnancy possible after surgery to eliminate male pathology?
Urologists often hear the question: can a woman become pregnant from a man with varicocele, or can he conceive and have children after surgery?
Diagnoses of varicocele and infertility may overlap - that is, the first causes the second. But this does not always happen. It is difficult to give an unambiguous answer when it is possible to become pregnant after the removal of varicocele. Exactly not earlier than 1-2 months after the operation, since a man needs sexual rest during this period.
Studies do not give specific figures about what statistics on the occurrence of infertility with varicocele or what is the percentage of successful pregnancies after eliminating the pathology. It is worth saying only that if varicocele is the only pathology in the male body and it is this disease that affects the quality of sperm and the lack of conception, then after the operation is performed, the probability of becoming pregnant will be high.
In principle, children can also be present with varicocele, if this pathology does not cause underdevelopment of the testicle and impaired spermatogenesis.
All pathogenetic mechanisms that relate to the development of this disease relate to a violation of the outflow of blood in the vein. Most often, this applies to the left renal vein, but sometimes it can also touch the right side. Valve venous insufficiency can also be attributed to this. The pathogenesis of varicocele largely depends on an increase in venous pressure. After all, it affects the amount of inflowing blood and this phenomenon regulates the tone of blood vessels in this area.
When clarifying the etiology and pathogenesis of varicocele, as well as analyzing patients, it was possible to identify some patterns that relate to pressure standards.
- In healthy men, in the testicular vein, it is from 8 to 84 mm century. inclusive,
- In sick men in the testicular vein, it is about 240 mm long.
- In the lower and left renal vein in patients, when they are in a horizontal position, the pressure is 3.8 mm Hg.
How to treat varicocele (testicular disease) in men without surgery and how to determine the expansion of the veins (varicose veins) of the scrotum on the right (left) on the eggs themselves
Varicocele in men is a pathological condition, accompanied by an expansion of the lumen of the scrotum veins. Another name is varicose veins. In this case, sexual dysfunction develops, blood circulation is disturbed. The worst prognosis is infertility. To eliminate the signs, different methods are used, they are selected taking into account the type of disease: conservative therapy, surgical intervention. Folk remedies are used as an adjunct treatment for varicose veins of the scrotum. You can only use them at the initial stage of the development of pathology.
What to do for treatment
In most cases, unpleasant and dangerous signs can be eliminated only with the help of surgical intervention. If varicocele develops, conservative treatment in this case is carried out by means of drugs aimed at restoring blood circulation, spermatogenesis, and eliminating pain. This method allows you to reduce the intensity of discomfort, but does not remove the cause.
Sometimes varicose veins of the testis in men develop imperceptibly. In this case, surgery is not required. If the pathology began to develop in adolescence, but there were no pronounced signs, after some time a male illness can manifest itself under the influence of negative external factors (severe physical exertion, trauma, etc.). Only then is it permissible to consider a variant of the operation, not earlier.
If varicocele develops in men, the causes and symptoms are interrelated. With this in mind, it becomes possible to stop the emergence of new signs of pathology, to start a course of therapy in time. Direct factors:
- increased pressure in the pelvic area,
- vein fusion at right angles: testicular and transverse,
- genetic predisposition
- lengthening of the testicular vein.
Varicose veins on the scrotum develop if there are indirect causes:
- chronic constipation,
- the need to often be in the same position (standing, sitting), for example at work,
- another cause of the disease is an inguinal hernia,
- neoplasms in the kidneys
- the lumen of the vein is reduced
- dysfunction or lack of vascular valve,
- weak tone of the venous walls.
These causes of varicocele in men can aggravate the condition. However, under the influence of indirect factors, varicose veins of the spermatic cord of eggs rarely begin to develop if other pathologies are absent. When a varicocele is diagnosed on the right, the causes of this kind of disease can be the same as with the appearance of signs on the left in men in the scrotum. The difference is only in their localization.This happens in the presence of individual physiological characteristics (on the one hand, the pressure is stronger or there are no vein valves).
How to determine yourself
At the initial stage of varicocele, there are no symptoms. You can find out about this only by chance, for example, during a physical examination during a visit to a urologist. In this case, the disease develops slowly. Varicocele is determined on the right or left by a number of signs, and the nature of the symptomatology differs depending on the stage of the pathology:
- Stage 1: painful sensations, arise periodically (during physical exertion, sexual arousal),
- Stage 2: pain with varicocele in the right testicle or on the left side of the scrotum intensifies, there is discomfort in the kidneys, decreased libido,
- Stage 3: the manifestations listed above are also characteristic for cases when the patient is at rest (there is no physical strain).
Left-sided varicocele in men is diagnosed much more often than pathology on the right side of the scrotum. This is due to the structure of the body.
In this case, pain also appears, discomfort in the lower abdomen and in the liver.
External signs of varicocele on the left: veins appear only on one side, pain in this area is more pronounced. Other signs:
- testicular shape
- scrotum prolapse,
- violation of the function of urination.
Diagnosis in the clinic
Varicose veins of the spermatic cord are detected by palpation. In this case, the following methods are used:
- modified Valsava test: the patient is invited to inhale, straining is a prerequisite for this,
- Segond test: it is necessary to take a horizontal position, the doctor compresses the outer ring in the groin area, then the patient needs to sit down.
In both cases, varicose veins on the testicles are detected due to the appearance of swollen veins. With varicocele on the left, the pathology appears only on one side. Diagnostics is performed using special equipment:
- Ultrasound Testes are examined. This is the most effective research method in cases when varicose veins of the left testicle develop or veins appear on the right side of the scrotum. At the same time, dopplerography is performed, which makes it possible to assess the state of the vessels.
- Spermogram. This research method helps to identify a number of changes: a decrease in sperm activity, their number. Sperm can become non-viable. Another sign is the lack of sperm.
- Dynamic testicular nephroscintigraphy. This method allows you to detect impaired renal function. They study the structure of this organ with the help of urography.
- Analysis for sex hormones allows you to diagnose infertility along with other methods.
- Determination of Farris fertility rate. In this case, sperm count is estimated relative to sperm volume.
How to treat without surgery
It is necessary to eliminate the negative factors contributing to the development of varicocele on the left testicle or on the right side of the scrotum: physical activity, physical inactivity during sedentary work, alcohol, constipation, increased gas formation (which increases pressure in the pelvic area). In addition, a complex of vitamins is prescribed: Vitamax, Triovit. It should contain folic acid, vitamin E, selenium, L-carnitine, zinc. Thanks to this, the mortality is restored.
Treatment without surgery implies the need for medications that support vein tone, restore microcirculation. Before prescribing therapy, you need to determine what causes varicose veins on the eggs. If the cause is increased pressure in the pelvic area, agents can be used to normalize stool and gas formation.
The conservative method is used at the initial stage, when the signs are still absent or weakly expressed.If the question is solved, what to do for the treatment of severe varicose veins, it must be borne in mind that the drugs in this case are an auxiliary measure.
It is impossible to cure a varicocele without surgery if this pathology has already begun to develop. However, you can maintain the condition with the help of drugs:
- The restoration of microcirculation occurs through the following medications: Agapurin, Trental, Arbiflex. They help improve blood properties, and at the same time normalize the process of oxygen delivery to tissues.
- Venoprotective drugs: Detralex, Ginkgo Biloba, Eskuzan. The actions of this group include: normalizing the tone of the walls of blood vessels, improving the properties of capillaries, reducing their fragility and permeability.
- Hormonal drugs. Assigned based on test results strictly according to indications.
Self-medication is not recommended; therapy should be carried out under the supervision of a physician. This is due to the fact that some methods can significantly expand the vessels, which is contraindicated in severe forms of varicose veins.
It is possible to cure varicocele without surgery in this way only in conjunction with traditional methods of therapy. To get rid of unpleasant symptoms, use recipes:
- Mummy. Take 150 mg of the substance, add 1 tbsp. l water. Use the drug on an empty stomach 2 times a day.
- Tea from hazel leaves. Take 1 tbsp. l dry, pre-ground raw materials. Pour 1 cup boiling water. The tool is infused for 15 minutes, then it can be consumed. The recommended daily amount is 4 cups.
- Lotions with wormwood and kefir. Take a handful of dry color and leaves of the plant. Add kefir in an arbitrary amount to make a slurry. The tool is applied to gauze, folded 2-3 times, applied to a painful area of the skin. The duration of the course is 4 days.
If varicose veins of the testicles have developed in men, treatment involves the need to repair damaged sections of the veins. In this case, different methods are used. The choice is made taking into account the stage of the disease, the clinical picture, the state of the vessels and the presence of contraindications for the operation according to one or another method.
This method of surgical intervention was common in the recent past, today more modern techniques are used. In order to get rid of damaged veins, a ligation of the vessel, the walls of which are deformed, is performed. Then it intersects.
Such a measure is considered effective in the case when testicular varicosity provoked reflux. The reverse outflow of blood stops. For such an operation, general anesthesia is required. An incision is made on the skin up to 5 cm long. Through it, ligation and intersection of the veins in the iliac region is performed.
This option wins in comparison with the previous one, since a small incision is made - up to 2 cm. Considering that in this case less tissue is damaged, the restoration is faster. The principles for performing such a method and the operations of Ivanissevich are similar. If the varicocele on the right has substantially developed, an incision is made in the inguinal region, the spermatic cord is removed, and trimming and intersection of the veins is performed. The probability of relapse in this case is not more than 5%.
When carrying out such an operation, it becomes possible to save the artery. However, there are several drawbacks to this method:
- the risk of adhesions increases
- there is a need for intubation anesthesia,
- the likelihood of bleeding increases.
This method is often used for bilateral lesions of the scrotum. If there are manifestations of varicocele on the left or only on the right, other, more effective methods can be considered.
In this case, surgery is performed with minimal tissue damage. Local anesthesia is enough for this. The patient can go home a few hours after surgery. When using a laser, vessels are sealed under the influence of high temperatures, which prevents the development of complications in the form of bleeding. Scars do not form during healing. This method of treatment for varicocele involves rapid recovery.
Moreover, this operation is characterized by minimal coagulation necrosis, which is important, given the high sensitivity of the tissues in the inguinal region. The level of pain is small. Another advantage is the high accuracy of laser movements when performing manipulations.
Consequences and Complications
Sometimes pathologies can occur after surgery with varicocele on the left or right, as well as bilateral damage to the scrotum:
- lymphostasis: there is swelling, to reduce the intensity of this manifestation, it is recommended to wear suspensories during the first days after the manipulations,
- persistent pain, often a consequence of the absence of the plexiform plexus, latent lymphostasis or other genital pathologies,
- tissue atrophy: rarely observed, but only after sclerotherapy or classic surgery,
- hydrocele: manifested by fluid retention in small quantities, this symptom disappears some time after the operation,
- with laparoscopy, bleeding may appear, air enters the retroperitoneal space,
- perforation of blood vessels,
- the re-occurrence of signs of the disease: more common in children under 18 years of age, due to the development of the body, the relapse of varicose veins in the testicles in men is minimal.
Diagnosis of varicocele
Determining the presence of this disease is not difficult for experienced specialists, so doctors try to find all possible manifestations at the first examination. The initial diagnosis of varicocele occurs at the doctor’s appointment, when he can independently determine the presence of the disease, or first find out that it can be sent for a more detailed examination, which often happens in the first stages of the disease.
How to diagnose varicocele during examination by a doctor
On examination by a specialist, a varicocele is checked with a simple palpation to determine the condition of the veins in the scrotum. This may not even be determined by the most experienced specialist, since in most cases problems begin with the left testicle and you can simply compare the state of the vessels in the left and right side. Sometimes doctors ask the patient to push, which with the expansion of the veins will give a greater effect.
With more serious stages of the disease, examination of varicocele becomes much easier. Then the veins can be seen without probing. Sometimes the scrotum changes its shape due to a strong pathological expansion. Anyway. If palpation is performed, then the friability of the state of the veins will be clearly noticeable, which is very characteristic of such a disease. Such an initial examination is called the “Valsalva test”.
Varicocele: diagnosis and treatment using technical means
In many cases, the doctor gives only the initial diagnosis, which further determines whether the patient has varicocele or whether there are other diseases. This will require more serious diagnostic procedures. These include:
- Ultrasound examination of veins. The use of ultrasound is one of the simplest and most affordable diagnostic methods, since there are devices for it in almost every city. Moreover, this technology allows you to determine the result with high accuracy. The big advantage of ultrasound is a passing analysis of other organs of the genitourinary system, which is carried out at the same session and helps to find tumors.
- Dopplegraphia of the scrotum veins. This method also provides a very accurate result.This technique makes it possible to determine the features of blood flow in veins susceptible to disease damage. Dopplegraphy is based on the use of an ultrasound device, only the receiving sensor is not a standard ultrasound, but a special device that catches a signal, studying it using the Doppler effect.
- Spermogram. In the diagnosis and treatment of varicocele, sperm analysis is often used. Given that the disease itself can be completely asymptomatic, semen analysis may show that something is wrong with the reproductive system. Inhibition of the reproductive system through problems in the blood circulation can be detected precisely with the help of a spermogram. This is an indirect sign, after which many specialists will be able to immediately send the patient to an ultrasound scan.
- Urinalysis after exercise. It is very important that all parameters are respected, since otherwise there is a risk of serious errors. With physical exertion, the veins lend themselves to even greater expansion. The method is not always accurate and difficult to use, therefore, it is not always used.
Understanding what kind of diagnosis of varicocele can be made taking into account the stage, specialists can apply several different diagnostic methods. The main thing here is to determine everything as early as possible and the earlier the stage of the disease, the more complex methods for its recognition are applied.
How to determine the varicocele yourself
There are ways to independently detect the disease. If you know what to pay attention to, then this is quite possible without going to the doctor, although after that it is still recommended to consult a specialist for further treatment. The main way to check for varicocele yourself is to examine the scrotum. Also, some symptoms characteristic of this disease can indicate a disease.
Varicocele in men: how to determine and what to pay attention to
Inspection, even independent, does not just start. Any suspicions and symptoms that the man begins to feel lead to him. Such phenomena that can be determined independently include:
- Noticeable aesthetic changes in the appearance of the scrotum. Moreover, it is constantly changing for the worse and if nothing is done, then this phenomenon is only progressing.
- Changing the size of the testicle. Varicocele often progresses only on one of them and a significant difference begins between the size and shape, which should alert the patient.
- Pain in the groin and scrotum. At first, it manifests itself only with additional physical exertion, and then it can occur in other moments, which is associated with a deterioration in blood supply.
These are the first signs of how to recognize a varicocele. These methods only help to suspect the presence of the disease, but in order to determine it with a higher probability, it is necessary to undergo another independent examination.
How to determine testicular varicocele during examination
You can detect the disease even at an early stage of development. The main thing is to pay attention to the right moments, so as not to confuse this ailment with anything else. One of the main ways to determine the varicocele itself is as follows:
- It is necessary to examine the veins that are visible through the skin and determine the presence of seals and too much tortuosity, noticeably different from the state of the opposite testicle.
- It is worth considering the symmetry of the scrotum. One testicle is always above the other in the normal state, but when the size begins to change, then this is noticeable even with a simple examination.
- It is necessary to pay attention to the consistency of the scrotum. If one testicle becomes noticeably more loose than the other, then this is one of the signs of the disease.
- The presence of a feeling of heaviness, tingling, and periodic pain are additional signs that indicate the presence of a varicocele.It is especially characteristic if these signs appear in the evening after work or heavy physical exertion.
How to determine the degree of varicocele
During an independent examination, you can also try to determine the degree of the disease. At the first stage, the symptoms pass almost imperceptibly. Burning and pain in appropriate places do not occur. Independent palpation does not always give the proper result, so at this stage you can find out about the presence of the disease only when examined by a urologist or an ultrasound scan. It can also be determined by spermogram or dopplerography.
With the second degree, vein expansion is already more characteristic. It is already easier to find them yourself. The dimensions of the gonads also lend themselves to change. Lingering pains in the groin and specifically in the testicle, which occurs after hard work, may be additional symptoms. This stage is treated with both conservative and surgical methods.
Ways to determine the varicocele yourself in the third degree are even easier. This can be done with the naked eye. The skin becomes like a dough, inside there is noticeable inflammation and significant deformations. The genital glands are almost constantly in a swollen state. The patient is accompanied by periodic burning sensations and pains that arise not only after physical exertion. All this indicates a serious stage of the disease, which can no longer be solved without surgical intervention.
With the fourth stage of varicocele, the pain becomes very strong, sometimes painkillers do not even help. This degree most often leads to infertility. The extent of damage and changes in blood flow and internal seminal canals is already reaching a critical point. If after the onset of the disease more than 5 years have passed, then the chances of a successful treatment become minimal.
Despite the availability of methods for determining varicocele at home, the patient will not be able to accurately diagnose himself. A more detailed examination is required here, for which additional tests and diagnostic procedures are needed. However, if such disorders are found, it is best to consult a doctor immediately. Delaying with treatment sometimes leads to irreparable consequences. Doctors recommend going to preventive examinations twice a year.
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.
When a doctor suspects this disease, then certain tests need to be done to clarify the diagnosis. This is required in order to exclude other ailments from the same area with similar symptoms. Analyzes on varicocele help determine the degree of the disease, its presence and what complications the disease leads to.
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.
The collection of tests is performed both in the diagnosis of the disease and before the operation. If it is clearly visible that the disease is at the third or fourth stage, then the patient is asked to immediately pass the entire kit so that it is possible to begin treatment soon. The main analyzes here include:
- Spermogram. It shows how much this disease affects the reproductive system. With its help, you can find out exactly how the oppressed glands and seminal channels manifest themselves due to their overlapping with dilated veins. Several spermogram factors are analyzed here and additional analyzes may be required.
- Conclusion after ultrasound. Here they analyze the state of internal organs, not only genital, but also related systems. This is one of the main analyzes that provide a clear example of the appearance of internal organs.
- Dopplerography is a method very similar to ultrasound, in which the Doppler effect is used, as a result of which the receiving device changes, and the apparatus for sound research remains the same.
- With varicocele, a urine test is taken after exercise. But if it comes to the operation, then you may need to take an ordinary general analysis.
- Analyzes for syphilis, AIDS, hepatitis C and B, as well as other similar diseases, are necessary both for identifying complications of the disease and before surgery. This is one of the common mandatory analyzes.
- Kaulogram - a comprehensive analysis that determines the possibility of blood clotting.
- During varicocele surgery, a blood test for the Rh factor and group become mandatory if the patient does not know these parameters.
- An electrocardiogram is also necessary before surgery.
- Blood chemistry.
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.
Ultrasound diagnosis of varicocele on ultrasound: description
Ultrasound with varicocele is one of the main diagnostic methods that helps to determine the disease even at an early stage. In addition, with its help you can learn about other diseases that may occur along the way. The popularity of this method is accompanied by the fact that ultrasound machines are available in many hospitals and are not very rare.
Preparing for an ultrasound of the scrotum varicocele
Unlike many other studies, in this case, special preparation or waiting several hours is not required, as is done with an ultrasound scan on prostatitis. Here you only need to carry out hygienic treatment of the genitals and apply a special composition to the body that will help the apparatus. This is due to the fact that the study concerns the circulatory system, which is rarely susceptible to any dynamic changes, only after strong physical exertion.
Ultrasound technique for varicocele
With varicocele, the scrotum is examined, for which it is necessary to adhere to the special technique of the procedure. It should go as follows:
- The patient is laid on his side or on his back,
- A special gel necessary for ultrasound examination is applied to the scrotum and other places in which the study will take place (this is required for safe contact between sensitive areas of the skin and the ultrasound machine),
- Next is listening to the desired areas using the device’s sensor,
- The study can be conducted in several positions, if you can’t see all at once,
- The doctor immediately fixes all the necessary indicators.
When an ultrasound diagnosis of varicocele is performed on an ultrasound scan, the description of this procedure is faster than it is. The study itself, along with the preparation, takes about 10-15 minutes.
Varicocele: ultrasound diagnosis and its results
After the examination, a conclusion is drawn up, which displays all the data that were identified during the ultrasound, and also draws a conclusion based on them. In varicocele, signs on ultrasound can be detected even in the early stages.
When examining the testicles, their size is determined. In an adult male, they are 3 to 5 cm long and 2 to 3 cm wide. In this case, the contours should be clean and even. If they are not clearly traceable, then the presence of this disease is quite possible. The echostructure must be isoechogenic and homogeneous. The main thing is that they should not show additional formations, since this is a serious sign that the disease is developing.
In the study of appendages, they also need to be compared with normal indicators. The size of the head of the appendages is from 1 to 1.5 cm. During ultrasound, the body and tail of the appendages should not be visible. If they are visible, then this may indicate that ultrasound signs of varicocele became more noticeable than with a visual examination. The echo structure should correspond to those indicators that are present during the examination of the testicles. Smooth contours and the absence of a neoplasm is considered the norm, and everything else is already becoming a sign of deviation.
A study of free fluid in the scrotum is also performed. Its structure should be homogeneous, and the amount should be about 1.2 ml, depending on the size of the organ itself, the skin wall thickness of which should be no more than 8 mm.
Varicocele: ultrasound, diagnosis and risks of this procedure
The use of ultrasonic waves, which are the main tool for this analysis, is quite safe. There are no radiation elements that would harm the genitals or other parts of the body.
In order to reduce any risk of injury, irritation and damage, parts of the apparatus and the skin itself are lubricated to improve contact. Also, those parts that come in contact with the body are disinfected after the session so that there is no chance of catching the disease from any other patient. The gel is removed with a disposable paper towel, which is typical both for cleaning the device and for the patient
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: varicose vessels are detected 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:
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: ultrasound diagnosis, what the result looks like
After the examination, the doctor receives three tomograms of the left and right parts of the scrotum. This includes oblique, longitudinal and transverse tomograms. On the basis of them, a conclusion is drawn, since it becomes possible to measure everything when receiving analyzes. When the study is completed, the doctor draws up a conclusion, on a special form in which the necessary items are already indicated, which are mandatory for grading. It displays signs of varicocele on an ultrasound scan and other diseases that the analysis may fail. In conclusion, all data are displayed and a diagnosis is made. It is not necessary that the ultrasound be performed by the same doctor who conducted the examination for this. It is necessary that the conclusions of the doctor, his seal and painting be on the conclusion.
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.
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.
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.
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.
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.
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.
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.
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.
What is the danger of an ailment?
The most important consequence of varicocele is male infertility. Excessive pressure adversely affects the function of the testicles, which leads to this result. But patients should consider that dilated veins can be symptoms of other, more serious testicular diseases - tumors of various localization.
At the initial detection of varicocele, it is necessary to conduct a comprehensive examination of the body and especially the genitourinary system.
Manifestations of varicocele
We will analyze the disease according to the classification in 4 stages:
Varicocele is also divided into primary and secondary.
- Stage 1 varicocele practically does not manifest itself. The disease can be detected during a routine examination by a urologist.
- Stage 2 - during this period, the patient appears pulling non-intense pain, discomfort. On palpation, the doctor can determine the dilated veins in the scrotum, but only in a standing position when pressure increases.
- Stage 3 of the varicocele is manifested by deformation of the scrotum (its asymmetric sagging), severe pain, burning in this area during physical exertion. The doctor can already identify the dilated veins on the testicles in men in a standing and lying position.
- At stage 4, you can see the expanded veins yourself, the scrotum is significantly deformed, the pain is pronounced even at rest.
Sperm are analyzed after abstinence from sex for 3-5 days. In some patients, certain violations of the sperm composition, its consistency, sperm motility and their quality (pathospermia) are determined.
Laboratory tests and a general analysis of urine will show changes in its composition towards proteinuria and microhematuria.
Oligospermia (decrease in sperm count) is determined in 60% of varicocele patients.
Drug therapy is carried out after surgical treatment in order to activate sperm formation.
Prescribe vitamins, drugs with selenium and zinc, as well as hormonal drugs (androgens, chorionic gonadotropin). Treatment proceeds with mandatory laboratory observation, medications are prescribed individually with a clear dosage. Unfortunately, conservative methods cannot get rid of varicocele. Surgical techniques remain an indispensable method of combating the disease.
Surgical intervention to treat varicocele
Surgical removal of varicocele
To date, more than 120 operations have been developed to get rid of varicocele. Some techniques have not been used for a long time, others are quite relevant.
All of them can be divided into two groups:
- preserving renocaval shunt,
- not preserving renocaval shunt:
a) supra-anginal non-selective,
b) supra-anginal selective,
Next, we’ll talk about some surgical methods in more detail.
Varieties of operations with varicocele
Microsurgical technique is aimed at carrying out revascularization of the testis. The procedure is carried out under a special microscope. The essence of the operation according to Marmar is that it is necessary to transplant the testicular vein into the epigastric. Resume the return of blood from the testis using the system of superficial vessels.
Cons of the operation: the procedure is quite long and there is a risk of touching the testicular artery.
One of the modern methods, low-traumatic surgery with a quick recovery period. Surgical intervention is carried out through three punctures on the skin, into which instruments are inserted to eliminate the varicocele and a small video camera: it feeds the video image to the monitor in the operating room. Thus, the surgeon controls the course of the operation and the location of the instruments. This technique has a very high level of security.
Treatment proceeds with mandatory laboratory observation,
The most popular open equipment today. During the operation, the testicular vein above the inner ring of the inguinal canal bandages and intersects. Thus, the flow of blood from the hepatic vein back to the plexus is blocked. As a result, the pathology of varicose veins in the testicles in men is eliminated.
Disadvantages of the operation: risk of damage to the testicular artery and the appearance of dropsy of the testicle.
X-ray endovascular surgery
A sclerosing substance is introduced into the lumen of the venous vessel, after which the vessel is clogged.This is a good alternative for treating varicocele in children. The procedure is carried out using sclerotherapy, tissue glue, spiral emboli, wire umbrella devices. Complications are possible: if the drug sclerosant enters the pulmonary arteries, a very life-threatening condition develops.
Do not neglect a healthy diet, moderate physical activity, personal hygiene
Varicocele on ultrasound: a lecture on the Diagnostic
Studying how to conduct an ultrasound scan is a very important point, since in many respects the final result depends on the one who conducts the examination. This is especially true of the initial stages of the disease, which can not immediately be detected with the naked eye. A lecture on the Diagnostic helps to supplement knowledge and will show practical examples with the results of ultrasound analyzes, on which there are various signs of the disease. This will help to distinguish controversial cases when there is a disease and when it is absent, as well as to understand in more detail what exactly to look for and what to pay attention to.
It shows a detailed analysis of the finished ultrasound of patients with various degrees of the disease. Of course, people who have not encountered such problems may not understand anything. Therefore, the lecture is more designed for specialists who work in this field or study this area. The main thing to remember is that ultrasound refers to one of the simplest and safest methods of examination.
What are the causes of varicocele?
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, a return flow of blood (reflux) through the left spermatic vein occurs, and 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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If there is suspicion of varicocele, dopplerography becomes one of the main methods for detecting the disease. Unlike ultrasound, it provides more detailed information. Using this analysis, you can evaluate blood flow, as well as learn about the appearance of retrograde blood flow, which occurs as a plexiform plexus after performing any physical work. In other words, this technique not only helps to detect the disease itself, but also to find out what causes led to it.
Dopplerography of the scrotum vessels with high-stage varicocele becomes the main method for diagnosing the disease, since here you need to find out a lot of nuances for further treatment. The technique allows you to determine the qualitative state of the vessels through the use of the Doppler effect in ultrasound. They mainly study vascular torsion and how it affects blood flow, the appearance of tumors, and other important things.
Special training for dopplerography is also not required. The method is as safe as ordinary ultrasound, since the basic principle of signal delivery does not change here, because the same devices are used.
There are several types of this disease that can occur in the body. If the classification of varicocele is carried out at the location of the focus of the disease, then the following options are distinguished:
- Left side
Most often, left-sided, therefore, bilateral and right-sided varicocele is a relative rarity, since up to 10% of cases occur in the total number of diseases.
According to the manifestation of symptoms, there are:
- Subclinical - passes without symptoms,
- Clinical - passes with symptoms.
Classification of varicocele, types of complications:
If we consider the classification of the disease according to etiology, then the following varieties are distinguished:
According to the stages of the disease:
- First, pathological changes almost do not appear outwardly,
- The second - when the veins expand, they become enlarged, so that they become visible with the naked eye,
- Third - the veins are visible and palpable regardless of the position of the person,
- Fourth - leads to noticeable changes in the shape of the scrotum.
Do not be afraid to remove smegma. This is important and needs to be done daily. The fastest way to get rid of the accumulated secret is daily showering. Frequent washing is especially important for men with the foreskin removed, as their grease accumulates in the furrows of the frenulum (if it was not removed during the circumcision) and the coronal groove.
Basically, smegma causes inconvenience to adolescents, as they often neglect hygiene, which is why they complain of various kinds of inflammation. As a young man, guys consider grease to be a putty, wait until it hardens, and then they tear it off with dirty hands, bringing bacteria into the genitals. It is the lack of proper hygiene that leads to the infectious processes of the genitourinary system. Smegma is harmless only if the man properly cares for his body, in particular, for the genitals.
The purpose of the seminal fluid
Sperm is the secretion of seminal fluid during ejaculation, consisting of prostate secretion, seminal vesicle fluid, vitamin-mineral complex, sperm. The chemical component of the ejaculate is most useful due to the presence of elements such as zinc, sulfur, calcium, iron. Seed secret has a favorable effect on the contraction of the muscles of the genitourinary system, normalizes venous blood flow, and helps to widen the blood vessels.
IMPORTANT. Semen is not only the fertilizing caudate tadpoles, but also the mixed secret of the man’s gonads. Sperm in the ejaculate make up only about 10%, the remaining 90% are actively biological substances secreted by the adnexal glands of secretion, the prostate, and the seminal canal.
If we consider the male seed, then it consists of:
- fluid discharge of the prostate
If the chemical composition of the ejaculate is determined in the laboratory, then it turns out that this seed secret is an energy cocktail, since it contains almost the entire periodic table.
As for plasma, it consists of a protein-mineral vitamin complex. Its main components are hormones, cholesterol, fats, carbohydrates, enzymes, calories.
Nutritional Value of Seed
The ejaculate is very high in calories. 5 ml of sperm in nutrition are equal to a full-fledged daily diet, since they contain all the necessary useful substances that are characteristic of genetic material. All components of sperm perform specific functions in the body that are not inherent in other organs, for example:
- Protein contains a significant amount of enzymes and amino acids, providing a full process of ejaculation.
- Fats are composed of phospholipids, prostaglandins, due to which they saturate the genetic material with fatty acids.
- Free amines provide the seed with creatine, which is responsible for energy metabolism.
- Carbohydrates are contained both in a free state and in a bound form, form sperm activity.
- The mineral complex is necessary for the full formation of genetic material.
- Enzymes liquefy ejaculate, making its consistency ideal for fertilization.
The prostate produces citric acid, which is also beneficial for the male body. It also participates in the liquefaction of the seed, but does not affect the pH environment (seminal fluid has an alkaline environment).
The sperm of a healthy man is a mucus-like, viscous-sticky substance that has an opaque shade and a specific smell. The taste of the ejaculate, like the smell, depends on the diet. Most often, the seed is salty, with bitterness. Frequent ejaculation makes sperm less sweet, enhancing the taste of acidity or bitterness. Within 20 seconds after ejaculation, the seed is liquefied, becomes more viscous, whitish in color, sticky.
The amount of secreted sperm varies between 2-10 ml and is determined by the individual health characteristics of men. This indicator may be affected by age-related changes, the use of alcohol, drugs, the frequency of ejaculation, and smoking. The more sexual intercourse a man has, the less sperm is excreted with each subsequent act under the condition of regular sexual activity. Prolonged abstinence leads to an increase in seminal fluid. Significant amounts of seed secretion are not an indicator of the quality of fertilization. On average, if sexual intercourse occurs at intervals of 3 days, the volume of the seed is 2-6 ml.
The fertilization function is affected by the amount of active sperm contained in 1 ml of ejaculate. For a healthy man, their norm ranges from 20 to 96 million. The percentage of motile sperm should not be less than 70% of their total number. According to the WHO, 20 million sperm in 1 ml of sperm are considered to be the lower limit of the normal quality of ejaculate.
Functionality of the internal organs
The internal genital organs of men include:
- Testes (testicles) are the sex glands, the task of which is to form sperm, to release the hormone testosterone into the blood. As mentioned above, the location of the testicles is the scrotum. The location of the testes is not the same: the left testicle is usually more downward than the right. Testicular volume may also vary slightly in thickness and size. On average, the size of the testes is about 5 cm in length and 2-3 cm in width. The testicles deserve official attention, especially in terms of personal hygiene. It is important to pay attention to the temperature of the organ. It should be below the temperature of the body, on average, 4 degrees. Otherwise, a failure occurs in the seminal fluid formation system. It is enough for a man to take too hot a shower only once, and fertilization problems are provided for at least 6 months. A long sitting position is also dangerous for men, since in this state the body is very hot, the temperature in the inguinal region and in the testicles themselves increases, stagnant blood supply processes occur, resulting in problems with sexual function.
- The ejaculatory ducts are the tubules along which the seed is ejected during ejaculation. They are a continuation of the canal from the appendages to the testicles. Their location in the body lies through the inguinal canal. Clinging to each other, these tubules form the only sperm ejection duct passing through the prostate. This duct opens into the urethra. Thus, the sperm initially moves by the vas deferens, then at the time of orgasm, it is released into the urethra through the ejection channel and poured out in wavy contractions (during masturbation) or into the female vagina (during sexual intercourse).
- The cord is the ejaculatory paired organ, extending from the appendage and connecting to the tubule of the seminal vesicle. Performs blood supply (provides venous outflow to the testes), excretory function (promotes ejaculate from the appendage to the vas deferens).
- The prostate is designed to produce the secret of smegma, a large amount of which is observed during ejaculation. Its size is determined by the age of the man. The organ is located in the capsule of connective tissue. Consists of glandular tissue. The organ is located between the rectum and the bladder. Smegma from the prostate is excreted by reducing the smooth muscle of the gland.
- Excretory juice of the prostate in appearance resembles a cloudy substance of a white hue, it is necessary to thin the seminal fluid, to activate the movement of sperm. Also, the prostate gland performs a transport function, providing the process of ejaculation and the movement of sperm by the vas deferens. The initial stage of libido and the orgasm itself do not pass without the participation of this body.
- Seminal vesicles - have a glandular structure, are involved in the production of smegma. They contain: fructose, oxygen, a viscous protein liquid, which gives energy to sperm, enhancing their resistance.
Causes of the onset of the disease in adolescents
As a rule, varicocele in adolescents is asymptomatic and is diagnosed only at preventive 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.
The causes of varicocele in adolescents as a whole do not have any significant differences, from the causes of the disease in adult men - weak vessel walls, valve pathology, increased pressure in the peritoneum and pelvis.
Among men suffering from varicocele, infertility is detected only in 40%, so the expansion of the veins of the plexus 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.
The mechanism of infertility in varicocele is caused by a violation of the thermoregulation of the testicles and is progressive in nature, that is, the production and maturation of spermatozoa does not deteriorate immediately, but gradually. Spermatogenesis stops when the temperature rises above the permissible level.
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.
There is also a deterioration in hormone production, an increase in the level of FSH (follicle-stimulating hormone) is observed - this indicator indicates a serious violation of the epithelium responsible for spermatogenesis.
Subsequently, 13% of men experience immune infertility - a situation where the patient's body begins to produce antibodies against their own sperm. Infertility is the most common reason for surgical treatment of varicocele.
Having an idea of the reasons for the development of varicocele in the testicle, it is possible to analyze the necessary preventive measures. 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.
The main recommendation of specialists is the timely passage of examinations - this applies, in particular, to young men under the age of 20, because at this time there is a peak in the diagnosis of varicocele
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.
There are several stages of development of Varicocele.
- At the first stage, palpation of the disease symptoms are not detected. Varicose venous dilatation is determined only by ultrasound.
- In the second stage, venous vessels in a person in a supine position are not palpable. In a standing position, expansion of the veins is palpated.
- In the third stage of varicocele of the veins in any position, dilated venous vessels are felt.
- At the fourth stage of the development of the disease, the wide guilt of the testicle or spermatic cord is visible to the naked eye.
Testicular varicocele: symptoms
The main symptoms of this disease include:
- Drawing dull pain, which is given in the scrotum, which is especially pronounced after physical exertion,
- The feeling of heaviness in the testicles, as if there is a foreign object,
- Bad spermogram, which also threatens infertility,
- Changes in the morphological structure of the testicles and attachments, which are caused by the expansion of the veins, which is displayed on the size and shape of the scrotum,
- The occurrence of autoimmune inflammation in the same area (but this symptom does not occur so often).
- Varicocele: symptoms, treatment
In determining varicocele, treatment and symptoms may manifest in different ways. For example, pain may not be permanent. This situation suggests that the symptom is only temporary and may not apply to this disease, or occurs only after physical exertion. This is a more pronounced indicator of varicocele. If the pains are more permanent, then here we can already talk about the third or fourth stage of the disease, where surgery is required.
Another symptom that is not immediately visible and almost not felt and does not appear until it comes to planning for pregnancy is the deterioration of sperm. As a rule, with varicocele, the number of sperm in the ejaculate begins to decrease significantly. With such indicators, the partner can not become pregnant. In addition to quantitative indicators, qualitative ones also suffer. Sperm morphology and motility are markedly reduced.
Considering what symptoms with varicocele can occur indirectly, it is worth noting autoimmune diseases. Egg cells are not found in immune cells in men. When immune factors occur, they immediately penetrate directly into the tissue of the testis. There, it is perceived as a foreign object, after which antibodies begin to be produced. Due to this, autoimmune inflammation appears, which becomes another symptom.
Sometimes with varicocele, signs and symptoms do not appear. The asymptomatic course of the disease can last a very long time, and it may not be detected, since men do not try to conceive children, because infertility also becomes one of the symptoms. Despite all this, it is advisable to detect and treat the disease as early as possible, as it progresses over time.
An additional symptom, which can only speak of an increased risk of the disease, is the expansion of the veins on the human limbs. Similar diseases in relatives can also talk about this, since this is all transmitted genetically.
How does symptomatic varicocele manifest
In different cases, the disease can manifest itself in completely different ways. If we consider all men with this disease, then approximately 50% will have an asymptomatic course of the disease. Even if we take into account the fact that pain in the scrotum can sometimes appear, it does not become periodic, and the sensations turn out to be so weak that they do not attach any importance.
In 20-30% of people affected by this disease suffer from infertility, but no serious painful symptoms are detected. It is during the diagnosis of infertility that it is possible to identify this disease. The remaining people, who constitute a minority, manifest just all the acute symptoms in the form of pain, inflammation, feelings of heaviness and so on. Along the way, this can be accompanied by infertility, but often the disease can be detected earlier than it is possible to conduct a spermogram.
Varicocele: symptoms and consequences
One of the main negative consequences that almost always accompanies this disease is an increase in temperature in the scrotum. In normal condition, it should be at how many degrees lower than in the rest of the body. This is necessary for normal spermatogenesis. With increasing temperature, sperm are produced less, and defective sperm are also more common. This is created due to a kind of “cushion” that interferes with the outflow of heat
When a varicocele occurs, a power failure of the testicles occurs. This is a serious consequence that leads to atrophy of the gonads.Not receiving proper nutrition, the testicles first gradually reduce their performance, and then completely lose it. This is very strongly displayed on their sizes.
Symptoms and treatment of varicocele is difficult only from a technical point of view. Given the prevalence of this ailment, modern medicine has extensive experience working with such patients. Therefore, most operations end successfully, even if acute symptoms appear. A set of all the factors that indicate the presence of varicocele always requires clarification of the diagnosis before treatment.
Testicular varicocele: treatment
In urology, there are several methods that are used to treat varicocele. When choosing the appropriate technique, the doctor considers several factors that affect the final decision. With varicocele of the testicles, treatment is determined based on the reason for which the disease appeared, the nature of the symptoms, their severity, patient age, previous surgery, and so on.
For example, if there are no pains and the patient is diagnosed with the first degree of the disease, then it may be enough just to drink the medicine and wear a support bandage. In the fourth stage of the disease, an operation will already be required.
Varicocele: treatment without surgery: reviews and effectiveness
One of the most common methods in the early stages of the disease is the use of medicines. If you use only medications in the third stage, it will be ineffective, therefore, they are taken only in addition. Medicines are relevant in the first and second stages of the disease. Specialists select the type of medication, depending on the state of the body and the susceptibility of the person.
- Venoprotectors and venotonics contribute to the effective strengthening of the walls of blood vessels. This helps to establish blood circulation in this area. With their help, stagnant processes are eliminated and puffiness is removed. If varicocele treatment with ointments is prescribed, then it is applied directly to the affected area. Most often, it must be applied once a day, rubbing for several minutes. Average. The course of treatment with venotonics is about two months. With combined medicines, tablets are prescribed for one to two weeks, and ointments for several months. Patient reviews show the high effectiveness of such drugs.
- Antioxidants. A group of drugs that work to improve the general condition of veins. Thanks to them, internal organs are better saturated with oxygen. These medicines include vitamin E, C and A. The tablets are taken for a month, after which you can take a break.
- Preparations for improving venous circulation. With their help, blood viscosity decreases, blood flow improves, tone increases and fewer obstacles in the way of blood become.
On the treatment of varicocele without surgery, information on the use of a special support dressing often pops up on the forum. This practice also exists. By wearing this dressing, the tension of the spermatic cord and scrotum is reduced.
Conservative methods of treatment also include gymnastics. For this, a special complex is used, which can be done at home. It has a fairly high efficiency in the early stages and can serve for prevention. Regular exercise stops the development of pathology, increases the tone of the veins in the groin.
It is possible the use of folk remedies for treatment. This is due to the fact that many of them serve to strengthen the veins, which has a beneficial effect on the treatment of varicocele. In this case, can be used:
- Fresh Hypericum Juice
- Melilot broth with wild strawberries, dandelion root, oat straw and birch leaves,
- Horse chestnut skin juice,
- Baths with a decoction of oak bark,
- White acacia compress.
Varicocele: surgical treatment
When surgical treatment of varicocele is required, the most commonly used obstructive technique. It consists in conducting several types of operations. During this operation, a varicose vein is removed or ligated. To carry it out on the body, it is necessary to make only a few cuts 3-5 cm long.
When treating varicocele in the Baltmed clinic, you can perform an endoscopic operation, which is carried out using a laparoscope. In this case, the patient has three punctures on his stomach. The main instrument is inserted into one of the punctures. After this, the pathological vein is ligated and everything is stitched back. This operation lasts only 20 minutes. The procedure has several advantages, in comparison with an open operation, as it can be carried out practically without preparation. In addition, patients tolerate it much easier.
Clinic for the treatment of varicocele 1: reviews and where to go
When a disease occurs, the patient opens up many opportunities where you should turn for treatment. This is a very important choice, since a lot of things really depend on the place and the doctor. The experience of a specialist makes it possible to more effectively manage time and money, and also increases the chance of a complete cure without the likelihood of a relapse.
Urologist Kostyukov Sergey Ivanovich: treatment of varicocele
Often people try to go to the specific doctor who was advised or found good reviews on the Internet. Due to the wide dissemination of information via the Internet, you can find reviews about almost any specialist, especially when it comes to regional centers and large cities. For example, you can see how the treatment of varicocele occurs with the urologist Kostyukov Sergey Ivanovich by going to the corresponding page of the site with user reviews. This can be seen in reviews of the particular hospital where he works.
You can also find out how the treatment of varicocele occurs in Almazova and other clinics. Naturally, you cannot precisely choose the appropriate option, since each case is individual. But if there are only negative reviews, then it is worth making the appropriate conclusions.
Many people deliberately delay the trip to the doctor, because they are afraid of surgery and treatment in general. In fact, in most cases, operations are performed in less than half an hour and a few days after them, a man can return to normal life. As a rule, after this, spermogram indices sharply improve. Moreover, the operation significantly reduces the chances of the reappearance of varicocele. Despite the fact that many treatment methods are known, especially conservative, self-medication is not worth it.
Varicocele: what to do with pain
When a patient reveals a varicocele, then he does not always know. What can and cannot be done, and what to do next. If the detection occurred during the examination, then the doctor will deal with the question of how to treat varicocele on the left testicle. The patient is important to comply with all the instructions that the specialist gives.
Varicocele: what can be done
Despite contraindications to excessive loads, it is recommended to lead a more active lifestyle in order to ensure normal blood flow. A recumbent and sedentary lifestyle will lead to stagnation of blood, which also will not affect the condition well. Special gymnastics to strengthen the veins in the groin area is also useful here.
Sexual life can and must continue to lead. Stable contacts with a partner will help ensure the right blood flow. But here, too, do not overdo it, as a strong overstrain will adversely affect the disease.
Preventive massages will additionally stimulate the area for an early cure. This can be done both independently and at appropriate techniques from a specialist.
Using folk remedies after consulting a doctor is also possible.This will help provide additional reinforcement.
What is dangerous varicocele in men
This disease is primarily the development of infertility. It creates a number of factors that lead to a decrease in sperm production, overheating of the testes and worsening sperm morphology. Thus, the genetic material becomes incapable of fertilization. There are forms of the disease without such a phenomenon, but there is no guarantee that after the development of the disease it will not appear.
Disruption of blood supply leads to the fact that the testicle begins to atrophy over time. Accordingly, it decreases in size, changes its consistency and loses all the basic functions. This occurs when nutrition is greatly attenuated and oxygen is not supplied properly.
Persistent pain that occurs in high stages. Men’s daily activities are hindered. Changing the shape and size of the scrotum causes physical inconvenience, and the intensification of pain after physical exertion makes many actions impossible.
What to do if varicocele has disappeared
If after the first stages of the disease it disappeared when a course of pills was drunk or other treatment methods were carried out, then, most likely, the disease was overcome. This does not mean that she cannot return. Based on this, after several months after the end of treatment, you need to consult a doctor again for a second examination so that there are no relapses. Such examinations are preferably carried out once every six months.
Varicocele of the left testicle: treatment with operations
Some people doubt whether they do surgery with varicocele in the second stage of the disease, especially if nothing hurts. Experts say that if a man has plans to have a child, then the operation is required. Only the elderly can not do it, although there are no contraindications to undergo this procedure.
Only a specialist can determine the need for surgical intervention. It seems to many people that if there is no pain, then nothing bad happens. In fact, the need for surgical care is determined by tests. A detailed study will help determine the most effective treatment.
Massage with varicocele
One of the methods of non-surgical treatment is massage. This is a very effective method, which is used in the first stages of the disease. It can serve as both the main and additional method of treatment.
How is massage performed with varicocele
A man needs to lie on his back. After this, you need to raise the pelvis so that the blood flows from this place in a natural way. You will have to wait a while for this. Here it is necessary to ensure that the blood flow in the spermatic cord is significantly reduced. After that, you can proceed directly to the massage.
Doing massage of the testicles with varicocele should be relatively soft so that there is no pain or uncomfortable sensations, but do not forget that this should be a massage, not a stroking. It is necessary to press and gradually go through the entire problem area. Massage can last for 5-15 minutes. To do this for too long and too much is not recommended, so as not to cause complications.
In the later stages of the disease, massage will not help in any way, so you will have to perform an operation. At the same time, with conservative treatment, it well complements the other methods used for treatment.
Which doctor to go with varicocele
When such a disease occurs, or a man is concerned about any of his symptoms, then not all people know where exactly you can turn for help. This is not a serious problem, since there are several options for varicocele to which doctor to contact. This is due to the fact that in medicine there are related specialties, specialists in which may well work with the same ailments, as they will be in their competence.
Which doctor to go with varicocele: urologist
For a urologist, varicocele is one of the direct diseases that relate to his field. This is quite logical, since this doctor deals with everything related to the genitourinary system. If you find any unusual condition of the testicles, abnormalities and periodic pain, then you should make an appointment with him.
He will be able to conduct an examination, prescribe tests and on their basis will already determine the treatment. In addition, he will be able to conduct a survey of other areas to make sure that there are no complicating factors that could affect treatment. Often there are several diseases at once, which leads to a lot of negative consequences.
Which doctor treats varicocele in men?
A urologist is almost the main doctor, which in men treats varicocele. If the patient independently suspects this disease, then it is worth contacting here. Also, it is worth going to him with any complaints about the work of the genitourinary system. But this is not the only doctor who can help in this case. Moreover, he is more involved in diagnostics and conservative treatment, since if more complex situations are found, he can redirect to another specialist.
Varicocele - who to contact: andrologist
A specialist in this field can also help with varicocele, since andrology originally branched off from urology, but with a deepening in the reproductive sphere. Thus, here varicocele is most often found in those situations when the patient comes with problems related to infertility. With a detailed examination, this disease can be detected, and in various stages. Based on the fact that one of the main problems that causes varicocele is the deterioration of spermatogenesis, which becomes the problem of infertility, andrologists have to treat it.
Here it is no longer necessary to think which doctor treats varicocele, since the andrologist will do all this. As a rule, the patient is not referred to a urologist here. Moreover, there may be several reasons for infertility and the andrologist continues to look for them so that there is no such thing that after treatment with varicocele the problem does not disappear. After all, with this disease, some men still manage to conceive a child.
However, there may also arise complications that have to be addressed by another specialist. After all, it all depends on the stage of the disease and the complication of the disease. Each case is unique in its own way and in the presence of several factors of infertility it is necessary to determine the treatment order. If it comes to the third and fourth stages of the disease, then the andrologist can only determine the presence of the disease, and another specialist will be directly involved in the operation.
Varicocele in men: which doctor should I contact
If the course of the disease has gone far enough, then there is no way to do without an operation. Previous specialists are far from always able to conduct it. Naturally, there are urologists and andrologists who can perform operations and receive patients, but this is not always the case. In any case, a surgeon is already required here, the doctor will examine and prescribe the necessary amount of surgical intervention for varicocele.
Here, it’s not the patient who decides which doctor treats varicocele in men with the surgical method, since the doctor who made the examination, who made a conclusion, directs him to the operation. Naturally, surgical intervention is carried out only with the consent of the patient, but given that the operations are quite easy and quick, and also do not have serious complications, do not give up on this.
It often happens that the receiving doctor has the specialty of a surgeon. In this case, a convenient time is selected, or in the clinic there are already pre-allocated days for operations, in which everything happens.For recovery, the patient may need to be hospitalized if it is a non-resident. Local go home, subject to the necessary regimen.
Varicocele in men: which doctor to address, by and large, is not so important, since the main result and experience of the doctor. Regardless of whether the urologist or andrologist does this, the methods of treatment and methods of surgery will be almost the same. A more important point is the timeliness of treatment, because the sooner the doctor begins treatment, the easier it will be for the patient.
Varicocele: do the operation or not
The need for surgery is determined by the doctor, but whether or not to agree to it depends on the patient’s desire. Of course, many people have a fear of surgery and this is justified, as various complications may arise. There are situations when with varicocele the operation is not needed and then everything is solved by conservative methods. In other cases, doctors put everything as the only possible solution to the problem.
Should varicocele be operated on: possible complications
The main fear of those people who are wondering whether it is worth doing an operation with varicocele is its complications. In this case, problems such as:
- Hydrocele. This is the appearance of dropsy on the testicle. This complication occurs with damage to the lymph nodes during surgery. Due to improper outflow of lymph, it begins to accumulate in the scrotum, which will constantly increase in size and will require reoperation.
- Hematoma. Blood begins to accumulate in the scrotum, which leads to this complication. Most often, a hematoma occurs in stage 4 of the disease. In most cases, it passes by itself, but it is better to consult a doctor.
- Testicular atrophy. The cause of the complication is a squeezed seminal canal. With atrophy, the scrotum becomes smaller. A timely solution is required here, since atrophy can become irreversible.
Having become acquainted with all possible complications, it is much easier to make a decision with varicocele to do the operation or not. As you can see, most complications are quite rare and do not represent a serious problem. If you regularly see a doctor for an examination, then none of the complications will flow into a serious irreversible stage.
When varicocele is it necessary to do the operation: how to solve
Some people have heard that even with a high stage of the disease, they were left without surgery. This is quite real, since this situation occurs with those people who do not seek to maintain their reproductive function. This situation applies more to adult men who have children, if they are not worried about infertility, and also do not suffer from any pain.
One of the main psychological reasons why patients decide with varicocele whether or not to have an operation is that nothing hurts them. Almost half of all cases of illness are asymptomatic. Accordingly, if a person does not bother anything, then he has no desire to be on the operating table to correct the situation. It is simply worth understanding here that the consequences of the lack of treatment and the possible complications caused by this disease are much more serious and terrible than the possible negative consequences of the operation.
Moreover, varicocele refers to progressive diseases. Many of the stages can occur for several years and stand still, but few people know at what point the progression will begin and what it will lead to. Accordingly, it is better to resolve the issue as early as possible. Surgery significantly reduces the likelihood of relapse, in contrast to conservative treatment methods.
Is surgery required for varicocele
This issue, from the point of view of medicine and care for the health of the patient, is decided by the attending physician. This refers to a recommendation for its implementation, since the final decision is always made by the patient. Even if we are talking about the fourth stage, when, apart from the operation, nothing helps, and then it gets worse, then no one can force them to go for the operation.
Another thing is whether it is necessary to perform an operation with varicocele. As a rule, if it is possible to avoid surgical intervention, then doctors try to use other methods. When there is a need for surgery and other methods are powerless, this information is also voiced. The most controversial point is when it is more rational to carry out the operation, but you can try to overcome everything with conservative methods.
The operation helps to solve everything quite quickly and completely, therefore, experts most often agree on its application. If the patient is very afraid, then he chooses other methods of treatment, but no one guarantees their effectiveness.
As a rule, the situation has not changed in recent years. In most cases, people agree to carry out the procedure, although there remain those who cannot decide. This is especially true for those cases when the situation with the disease does not complicate the patient’s life. If he is tormented by pain and other problems arise, then the choice becomes obvious. Modern conditions of operations provide a high level of safety for patients.
Varicocele surgery: which is better
Now in medicine, there are several options for operations that can help get rid of varicocele: is an operation necessary? This disease is not always manifested by acute symptoms, therefore, sometimes it is detected already in the late stages, when surgical intervention is indispensable. From varicocele, the operation has helped many people, but the main thing here is to choose the suitable option so that it goes with minimal risk and maximum effect.
Best Varicocele Surgery: Marmara Method
In recent years, specialists increasingly prefer surgery according to the Marmara method. It can be prescribed when a disease is detected in the first, second or third stage. If the patient has pain in the scrotum, this procedure can help even in the early stages.
To understand whether the operation is complicated with varicocele, you need to familiarize yourself with how it goes. In this case, it consists of the following steps:
- The patient is given local anesthesia before surgery,
- After the onset of its action, an incision is made in the area of the inguinal canal at the outer ring (the size of the incision is 2-3 cm),
- The doctor reaches the inguinal canal, where the problem veins are located,
- Under the control of a microscope, the dilated vein is bandaged in two places, where it passes into healthy vessels,
- After that, they flash it,
- Then the vein is excised with special tools,
- The wound resulting from the operation is sutured.
The duration of such an operation is about half an hour. In the presence of any infections, an exacerbated form of chronic diseases, allergies and other contraindications, the operation is not performed, therefore, a detailed examination is necessary before it.
Alcohol after varicocele surgery
Drinking alcohol is contraindicated, both before and after surgery. The fact is that before surgery, alcohol will affect blood coagulation. It interferes with this process, so there is a risk of large bleeding during all procedures. Also, it is not compatible with anesthesia, therefore, it is strictly forbidden to drink alcoholic beverages.
After the operation, it is also not recommended to do this. Alcohol can significantly complicate the recovery process, so it seems that the operation did not help with varicocele. Indeed, from this, the disease can return after some time.Moreover, during the recovery period, doctors may prescribe additional drugs that are incompatible with alcohol. For some time you have to adhere to a special diet, which also does not include alcohol.
Varicocele: pregnancy after surgery and reviews
Many people who are to perform this procedure are interested in the success of their implementation and what to expect in the end. Various forums help people fill up their knowledge base here, where people share their feedback and personal experience in overcoming this situation.
After analyzing the data, we can conclude that the operation most often goes well. After it, it is possible to maintain the reproductive function, because after the removal of varicocele, the quality of the spermogram increases significantly. Often, this particular disease becomes an obstacle to pregnancy, therefore, there should be no doubt about whether to do it or not.
Naturally, complications are not excluded, which depends more on the experience of the doctor. If the testicle is swollen after varicocele surgery, then it should be seen by a specialist. This may be due to hematoma, a common consequence of an operation that goes away with time. In any case, the support of doctors in the postoperative period will help to cope with any problems.
How to get rid of varicocele without surgery
The early stages of the disease not only go away without special symptoms, but can also be cured without serious surgery. As a rule, this option suits both patients and doctors, because there is no risk of complications. Treatment of varicocele without surgery is carried out in several effective ways, the combination of which helps to achieve a reliable result.
Non-surgical treatment of varicocele
The main non-surgical methods of treatment include:
- Wearing a bandage. A special supporting dressing helps to get rid of scrotum retraction and additional stress, which leads to increased varicose veins. This is relevant only in the early stages of the disease.
- Massage. If you do not take into account the specific method of its implementation, then this is a completely effective procedure that can be done independently at any convenient time. The main thing here is to regulate efforts and do everything with a certain periodicity.
- Taking medication. Various medications to strengthen and increase vascular tone helps restore everything to normal. This includes tablets and ointments that help to achieve the desired result within 1-2 courses of treatment.
- Gymnastics with varicocele. Another therapeutic treatment that can serve as a prophylaxis and an additional method for the condition of testicular veins to return to normal.
Despite the fact that there are many methods on how to get rid of varicocele without surgery on their own, they should not be used, since this is all possible only after consulting a doctor. This is especially true for drugs.
Non-surgical treatment of the disease will last much longer and does not guarantee that after some time the varicocele will not show itself again. This depends more on the diligence and duration of the classes, as well as on the precautions that must also be observed during and after conservative treatment. The following restrictions apply to this:
- You should discard heavy foods that can lead to constipation,
- It is necessary to exclude too high physical exertion, which can provoke the appearance of varicose veins,
- You need to lead a more active lifestyle if you have sedentary work,
- Regular sex life should be maintained so that blood stagnation does not form.
Following simple rules will help to avoid big trouble.
Varicocele: how to choose a clinic
Any disease needs to be treated so that it does not develop into an acute stage. In the case of varicocele, this is only a matter of time.Thus, it is necessary to determine which clinic with varicocele to contact. After all, many factors affecting success depend on this factor, as well as on the specific doctor who works in it. Now you can find a lot of useful information, both about the institution itself and about the specialists who work there, therefore, you can make a well-founded rational choice.
What should a varicocele hospital be like?
First of all, you need to pay attention to what equipment is in the hospital, or what operations they can carry out, which again depends on the availability of one or another medical equipment. After all, the wider the range of services rendered, the more suitable the operation can be selected. It also speaks of highly qualified specialists who can cope with all possible cases in this area.
If you are looking for a varicocele clinic number 1, then you should familiarize yourself with the statistics of operations. As a rule, any data on this is mainly provided by commercial hospitals, and there are no government statistics, but there are always patient reviews. This is one of the main parameters by which you can find the most truthful information. Here you should find out:
- what is the percentage of successful and unsuccessful operations,
- what tests are prescribed
- how much does the treatment cost
- who exactly was treated
- what operations were scheduled
- Is there an own laboratory to take tests on site,
- how did everything go.
All these nuances are very important. In the clinic varicocele 1 there may be such operations as are not performed in other institutions. For example, some want to protect themselves and choose those options where there are laser operations. This is sophisticated equipment that is not available in all clinics. But it does not provide significant advantages, although it has a fairly high cost.
Factors such as convenient location should not affect your choice, because it is much more important that everything goes well. Even if you have to visit the clinic several times, it is much more important that they have their own laboratory, where they can be tested immediately and get the results as quickly as possible.
A logical question may also arise whether it is worth changing the clinic of treatment for varicocele 1 if, after prescribing an analysis and prescribing for surgery, there are more suitable options for some reason. In fact, it is quite possible if you have all the tests on hand. It will also be relevant to clarify the diagnosis and treatment method of another specialist. Indeed, the opinion of different doctors may differ and the patient has the right to choose what suits him best. If the technical base of another clinic seems more suitable, then it is quite possible to change it before the operation. But such situations are rare enough and concern mainly provincial institutions.
Complications and consequences of varicocele
What will happen if you do not treat varicocele?
The main consequence of the disease is infertility. There are various theories that explain the complex and diverse mechanisms for the development of the damaging effects of this pathology on spermatogenesis and steroidogenesis in the testes. But varicocele does not always lead to infertility. If the sperm of a man is inherently resistant to negative influences, then oxygen deficiency and overheating of the scrotum will not lead to their complete loss of fertilization.
In addition to infertility, varicocele can cause diseases such as prostatitis, hydrocele (dropsy of the testicle), orchitis, teratozoospermia and, in rare cases, lead to the appearance of malignant tumors and testicular cancer.
Varicocele: testicular pain: causes
Pain is most often associated with the causes of the disease, since circulatory problems can give off unpleasant sensations, which then turn into acute ones.Since the main reason lies in the problematic operation of the venous valves, which create a reverse blood flow in expanding areas, the unpleasant sensations will increase due to that blood flow becomes much larger due to increased pressure.
With varicocele: the testicle hurts at those moments when the varicose veins begin to expand even more, which leads to discomfort. But sometimes pain is felt even without physical exertion. This is more characteristic of the late stages of the disease, when the venous network already forms a loose substance around the testicle. This significantly aggravates the situation, so that even a change in position in space, which leads to a change in internal pressure, will cause pain.
Does varicocele hurt and what factors affect pain
Doctors say that varicocele does not always hurt and the presence of pain does not always mean that the stage of the disease is quite high. Moreover, if there is pain in the scrotum, then this may not always be a varicocele. This can be understood only after passing the examination. You can also pay attention to those factors that increase the discomfort in this disease. These include:
- wearing too loose underwear when the scrotum is not supported by anything,
- during sex and physical activity, the pain intensifies significantly,
- when running or walking intensively, the pain becomes sharper and manifests itself more,
- during hot periods, the symptoms of the disease also worsen.
Considering with varicocele where it hurts, you should not think that everything happens in one place. Each person has this manifested in different ways. Most often, pains cover the lower abdomen, the scrotum itself can be given to the penis, lower back, thigh or perineum.
How to relieve pain with varicocele
The best way to relieve pain is to completely cure the disease, but until this point, when the operation will take place, you still need to somehow get there. Thus, everything should be applied that will help reduce pain. These things include:
- wearing special bandages that help support the scrotum, or tight underwear, which also performs this function,
- you need to take a more lying position, as this helps to disperse stagnant blood in problem areas,
- taking painkillers that help relieve pain in the early stages, since they do not always cope with a more acute illness, and taking potent drugs for a long time is dangerous to health.
The presence of pain suggests that you need to immediately consult a doctor, since he will not go away on his own. If the sensations have become less noticeable in certain periods, then with the appearance of complicating factors, everything will return. Limiting physical activity and avoiding tension in the press and groin will help relieve pain, but will not solve the problem completely.
It should be understood that even if the patient knows what pains with varicocele, how to reduce them and what to do then, you still need to think first of all about the cure, and not the removal of pain symptoms. After all, this becomes only a temporary solution to the problem. After a certain period, some methods will no longer help.
After the operation, varicocele hurts, what to do
Surgery should help solve the problem with pain. But all the same, options are not ruled out when after a while they return. Here you already need to know what exactly becomes the reason and why they arise. In any case, you need to see a doctor.
If a long period has passed, then pain can occur due to a relapse of the disease. The chance for this is relatively small, but you should never completely rule it out. A second examination with a doctor and tests will help you find out all the necessary information.
If pain occurs in a relatively short period after surgery, then this can be a natural restorative reaction. After all, when cutting a vein and the presence of several healing incisions, everything can ache a little. For the most part, it is a dull, prolonged pain that goes away after a few days. If she is very worried, then you should consult a doctor. As a rule, experts warn in advance about the possibility of such manifestations.
Testicular cyst varicocele
Testicular cysts are common diseases of the genitals that periodically occur in men. Varicocele and a cyst of the left testicle are quite similar in symptoms to the diseases and are often confused with each other on a preliminary examination. In this case, a cyst-like formation appears in which fluid gradually accumulates. Most often, it appears in the area of the appendage and has a soft and even shape. The disease appears in those places through which the output of sperm passes during ejaculation.
Testis cyst varicocele: symptoms
As with the formation of varicocele, in the presence of the first degree of a cyst, practically no symptoms appear in a man. This creates a lot of situations when it is discovered by chance at a routine examination, when the man himself does not complain about anything. Later forms of the disease are characterized by an increase in the size of the cyst itself. And, accordingly, the deformation of the scrotum. The following symptoms are distinguished:
- the presence of a round-shaped foreign seal in the scrotum,
- pain in the lower abdomen,
- a feeling of fullness or bloating,
- pain and discomfort when moving,
- increased hair growth on the genitals and other parts of the body,
Cyst of the epididymis varicocele: causes of formation
It is far from always possible to find out the exact cause of cyst formation in a particular case. There are several main factors causing this disease. The following situations provoke the formation of a cyst:
- scrotum injury
- the presence of inflammation in the genitals of a man,
- age-related changes and poor health after 40 years,
- close contact with toxic substances
- genetic predisposition to this disease,
- the appearance of tumors on other parts of the body.
Varicocele cyst and testicular cyst: diagnosis of diseases
Diagnostic methods often coincide with those used for varicocele. The most simple and affordable method for determining the disease is palpation. This helps to understand that there are problems with health and that a further examination is needed.
The next stage of the examination also coincides with how varicocele is determined on the epididymis. This is an ultrasound examination that will show many of the nuances of the development of a cyst, its shape, size and location. But besides this, there is also diaphanoscopy, for which you need a dark room. This is necessary in order to determine the passage of light through the scrotum. If there is a cyst in it, then the problem spot will be noticeable.
A more complicated diagnostic method is MRI. Here it is already possible to determine all the necessary information, since the analysis provides a detailed layered drawing of the internal organs.
The main treatment here is surgery. Surgical intervention allows you to completely get rid of the cyst. The operation is safe for the patient and has only a limited list of contraindications, therefore, it is strongly recommended to patients.
Varicocele: testicular atrophy
With the formation of varicocele, testicular atrophy becomes one of the serious consequences when for a long time no actions are taken to recover. Atrophy, on the other hand, is also an independent disease with irreparable severe consequences.With the progression of varicocele, the gonads cease to function over time, but at the very beginning they simply gradually lose their productivity.
Testicular atrophy after varicocele and other causes of development
When a varicocele begins to progress, the network of veins with varicose expansion grows. This leads to a deterioration in the supply of testicles with blood and oxygen. In turn, this situation leads to the fact that they cannot work as well as before. Gradually, wilting begins. They decrease in size and cease to function. The main reason for this is the formation of a "pillow" of varicocele, which blocks the supply channels.
In some cases, the appearance of the disease is due to genetics and can be laid down during the development of the embryo. The testicles descend into the scrotum in the eighth month of pregnancy. When cryptorchidism occurs, this may not happen. Cases are not excluded when they fall after birth.
Factors that lead to a decrease in the testicle with varicocele are as follows:
- hormonal failure, which suppresses the production of male hormones or leads to other complications,
- excess weight, which impairs blood circulation, together with the progression of the disease,
- the presence of inguinal hernias, which also negatively affect the reproductive system,
- erectile dysfunction, which leads to the fact that the testicles are unused for a long time.
Testicular atrophy with varicocele: clinical manifestations
The presence of this pathology can be detected independently, as there is a noticeable decrease in the scrotum. Any suspicion of this should immediately end with a trip to the doctor. After all, irreversible consequences arise only in the fourth stage, while at another time everything can still be saved.
Atrophy affects testosterone production. This entails a number of other changes, which are manifested in the fading of sexual desire and opportunities. Also, the amount of sperm during ejaculation becomes significantly less.
This also affects the tone of the muscle system, since testosterone is also responsible for muscle growth. A man more and more often has a depressed mood, and over time, hair growth becomes not according to the male, but according to the female type.
With varicocele, the testicle decreased: treatment
Here, treatment with surgery is necessary in order to eliminate the cause of atrophy as quickly as possible and ensure normal nutrition. Together with hormonal therapy, this will help to return everything to normal. When the consequences become irreversible, then it is recommended to remove the atrophied testicle so that no tumors appear in it.
Varicocele: testicular enlargement
Complications after surgery to remove varicocele do not occur so often, regardless of what was the cause of varicocele in the testicle. An increase in the size of testicles is also far from the most frequent manifestation in the postoperative period, but this should not be scared, since in most cases this is a completely fixable problem.
Varicocele, testicular enlargement: causes
Several factors can cause this phenomenon. The main ones include:
- Hematoma. It forms in various sizes and shapes, depending on how much blood has been spilled. The hematoma appears in the subcutaneous tissue, which is located in the scrotum. They provoke pain and increase in size. Often the color of the skin changes. Over time, everything goes on its own.
- Tumor. The appearance of a tumor in the scrotum is already a more serious matter, since it requires surgical intervention. The percentage of tumor formation in the postoperative period is quite small. The main thing is to find it at the earliest possible stages.
- Dropsy. After surgery, the testicle may increase due to the appearance of dropsy, or as it is also called - hydrocele.This phenomenon occurs when the internal organs are affected, after which fluid begins to accumulate in the scrotum. This problem can be solved easily with the help of another operation.
Thus, if after the operation the varicocele enlarged testicle, then you should not panic. It is better to contact a specialist for an examination and not to delay this visit. Most often, such manifestations occur during the first 1-2 weeks after surgery. Others appear several months later, as this happens with the tumor. But this does not change the treatment plan and it is impossible to do without the help of a doctor.
Varicocele: groin pain
Inguinal pain often becomes one of the main symptoms that help to detect varicocele. This is not surprising, since often the disease is asymptomatic and only the appearance of such characteristic manifestations allows you to see a doctor, where the disease is detected.
Varicocele: groin pain: how it manifests
Throughout his life, a person repeatedly feels pain in various places and does not attach any importance to this. This is quite normal, since it is not known what caused this very reason. Only when painful sensations in the groin become permanent or appear after certain actions should you pay attention to this. With varicocele, they can occur:
- In the testicles themselves
- In the lower abdomen,
- In the penis
- In the perineum
- At the hip
- In the lower back.
It may be several places at once or it will constantly give everything in the same area. It all depends on how the disease develops and at what stage it is. Inguinal varicocele in men in the groin can be aggravated in the following situations:
- Abdominal tension
- Sudden pressure drops when a person gets up after prolonged sitting or lying down,
- With high physical exertion, which disperse the blood throughout the body,
- With increasing pressure,
- During sex.
If after such situations the situation with pain becomes complicated, then this becomes an obvious sign that the pain in this area is caused by varicocele. Thus, one more serious symptom can be identified that helps diagnose the disease.
Varicocele in the groin creates a lot of changes in the circulatory system. Everything related to an increase in blood flow leads to the fact that the veins dilated by varicose veins create painful sensations. The pain can be dull and acute and occur at different intervals.
Varicocele infertility forum
The occurrence of infertility during varicocele may occur in the second, third and fourth stages of the disease. It is diagnosed in approximately a third of patients, but with the growth of the stage of the disease, the risk of infertility also increases. On the forum about infertility and varicocele, you can find out the immediate causes that lead to this. These include:
- An increase in temperature in the testicles due to the fact that a peculiar pillow from the affected veins forms on top of them. It prevents the normal outflow of heat. For normal sperm production, the temperature of the testicles should be slightly lower than the temperature of the human body. Due to its increase in sperm, much less is produced, and the sperm themselves have defects.
- There are problems with the supply of testicles with blood and oxygen, which lead to atrophy. Over time, it loses its performance, which leads to infertility.
- Veins can pinch the vas deferens, which results in too little sperm ejaculation.
Considering the problems with varicocele and infertility on the forum, it is worthwhile to understand that they can not appear in every case, but some are irreversible, so you should not ignore them.
IVF with varicocele
Those who have encountered varicocele understand well how many negative phenomena this disease brings with it for the reproductive system.Often it is found when examining a man for infertility, when he is planning pregnancy with his wife. If a number of serious problems are detected, then the question arises whether IVF is done with varicocele.
Taking sperm for in vitro fertilization in a man with a diagnosis of varicocele is quite possible. Moreover, some experts recommend IVF in the first place, and then deal with the treatment of varicocele. This is true in cases where, in addition to this disease, there are many other reasons that interfere with the conception of a child.
If there is only one cause of infertility and this is a varicocele, IVF is not recommended, as it is quite possible to fix it in one simple operation. As a rule, after removal of the disease, the spermogram becomes much better, therefore, the male factor of infertility in the couple in most cases disappears. In such situations, doctors recommend the operation as a much faster, simpler and safer method, which will cost less than IVF.
The most problematic situation is when with varicocele it is not possible to get enough sperm and it is very weak. In this case, I use cryogenic freezing and take several ejaculate samples in one container, gradually getting to the desired level. This is much more complicated than in the ordinary state, but it is quite possible and effective.
Varicocele and IVF for compulsory medical insurance can be carried out if all the necessary documents are collected. These are common operations that in recent years have been included in the insurance policy, but taking into account certain nuances.
Varicocele surgery after 30 years
With age, the body tolerates various loads and injuries worse. It is more difficult to resist diseases and they manifest themselves to a greater extent. Despite the fact that varicocele is most often diagnosed in young men, in men over 30 it can also appear. Surgery is also chosen as a treatment. In this case, patients often have the question of whether the operation will be normal varicocele in 30 years.
According to doctors, even at that age, the percentage of complications becomes minimal due to the development of modern medicine. An exception can only be those cases when the disease has been progressing for more than 5 years and for this period has not been detected. Then there are difficulties with treatment and unforeseen consequences of prolonged inhibition of the circulatory system of the testicles may appear.
In other cases, varicocele surgery after 30 years is the same as in young people. Cases where rejection is practiced concern more people over 50 years old when they do not need to maintain reproductive function. At the age of 30, the weakness of the body is not yet critically manifested and is increasingly dependent on a particular person and his state of health.
Varicocele: prevention, treatment
The main preventive measures that need to be performed regularly, if there is a predisposition to this disease, include:
- The use of special gymnastics to strengthen the vessels in the groin area,
- Moderate physical activity, in which you need to lead a mobile lifestyle, but do not strain much in sports, which would lead to overload of the body,
- Prolonged and regular constipation also causes the expansion of veins, therefore, you need to monitor your diet,
- Alcohol abuse leads to weakening of blood vessels, so such a bad habit should be abandoned,
- It is required to lead a systematic sexual life so that there are no long periods of abstinence causing congestion in the circulatory system of the pelvic region,
- With varicocele, treatment and prevention can be carried out in the form of massages, which the patient is able to perform on his own at home,
- Periodic wearing of dressings (most often used for prophylaxis after surgery).
To prevent the disease, it is necessary to exclude stagnation in the pelvic areas and severe pressure drops that will provoke the onset of the disease. Often, the disease is already beginning to appear asymptomatic and to move it to another stage, you need only a few aggravating factors, which will become the trigger.
Nutrition for varicocele
More soft, easily digestible foods are required. Fresh vegetables and fruits should prevail in the diet. The main thing is that the body receives vitamins of group E, proteins and oils, mainly of plant origin, as well as zinc. Almost all fresh greens are suitable for the diet, nuts and seafood. Heavy fatty meat products should be discarded. Especially it is necessary to monitor the amount of fluid used, since it is necessary to ensure the intake of at least two liters per day.
Prevention of varicocele in men can also be carried out using various folk methods. All decoctions and infusions, which are aimed at strengthening the vessels, are excellent for this disease. Herbal medicine should not last more than a month, since such things must be taken intermittently so as not to cause side effects. For more accurate instructions about prevention, which in each case may have its own nuances, it is worth contacting a doctor.
Can varicocele pass without treatment
If the patient independently discovers that he has had this disease, then almost everyone has a question, does the varicocele itself go away or not. A similar question may also arise during a medical examination, as this becomes a surprise for the patient. Few people want to face analysis and treatment, and everyone is trying to find the easiest way to get rid of the disease.
Varicocele: does it go away
Unfortunately, for many men, this disease cannot go without any treatment. This is especially true of the late stages of the disease, when even conservative methods of treatment do not help and you cannot do with pills and ointments alone. Not for nothing that most experts believe that the most effective treatment is surgery, since it helps to significantly reduce the chances of a re-occurrence of the disease, and also eliminates the main cause of its appearance, problem veins.
Some patients may claim that their varicocele has passed by itself. This is a very controversial point, since in medical practice there are no cases when this disease passed independently and without a trace. There may be several interpretations of this idea:
- Painful symptoms have temporarily gone, which may return over time, and sometimes they simply do not appear for a while,
- The disease is gone after the implementation of preventive measures or the use of any alternative methods, which is also quite likely, but this is already a treatment,
- The patient mistakenly diagnosed himself with a varicocele without going to the doctor, although this could be another disease.
In any case, it is impossible to remove the varicocele without taking any additional measures. This is due to the appearance and nature of the disease. After all, it refers to progressive, which over time only worsen. Even the fact that they somehow managed to overcome it by simple methods in the first stage does not at all say that they managed to get rid of him forever.
Why are there no reasons why varicocele may go away on its own
First you need to understand the nature of the disease. After all, if it is caused by genetic factors, anatomy features that affect the location of internal organs, and some are generally caused by genetics, then such a disease does not disappear without a trace. All the initial causes are listed here, but there are also a number of those that directly lead to the expansion of the veins in the testes.This applies to stagnation and very high pressure in the pelvic area. If all this happens regularly and the lifestyle does not change in any way, then it makes no sense to wonder if the varicocele itself can pass without treatment. After all, the main reasons for its appearance remain and gradually worsen the condition. Even if they are removed after this, then the veins themselves will not narrow, as if the patients did not want to.
No wonder doctors say that the most effective treatment is surgery. Among those who hope that the varicocele can go away on their own, one can often meet those who wait until the third or fourth stage of the disease, when irreversible consequences can occur. Poor outflow of blood from the veins that are located near the spermatic cords will gradually cause other complications, so letting it drift away is not recommended.
Almost all experts say that if someone claims to have independently passed a varicocele, then this is an erroneous statement. The nature of the disease does not allow her to pass on her own. It can be at the same stage for several years and not manifest itself, but it will not go anywhere.
Varicocele treatment: forum
In the modern world, online forums make it easy to find the information you need or ask other people for advice by discussing its results, while remaining completely anonymous, which is very important for medical topics. Looking at the treatment forum for varicocele, you can find a variety of questions that relate to this disease. Some of them will seem too simple and naive to some, but others will prove useful, but still it helps to collect a certain layer of information for those interested.
Is it worth it to learn about varicocele treatment via the Internet: forum
Naturally, only an experienced doctor will be able to give the most reliable information about possible ways to overcome the disease, recommended operations and their risks. At the same time, almost everyone is trying to collect as much information as possible about the issue of interest to him, and here the forum is very suitable. The main questions people ask there are:
- Does infertility occur after surgery and in the absence of treatment,
- Does laser surgery help
- How dangerous is this or that method of surgical treatment,
- What medicines were prescribed to whom and their effectiveness,
- How quickly can I recover from surgery?
- Where did the treatment go and what kind of doctor.
Despite the fact that people often encounter this disease there, it is worthwhile to understand that everyone can have its individual manifestations.
Thus, it is quite possible to learn about the treatment of varicocele without surgery on the forum, as well as about other issues related to this disease. But to completely believe everything that is written, of course, is not worth it. All questions are best discussed with the attending physician, who has tests, no matter how simple they may seem, since he will be able to explain everything about your specific case.