First of all, I would like to talk to you about varicocele. The questions that we encounter from patients every day are the following.
1.How are varicocele caused?
2.How does varicocele cause infertility?
3.Which treatment is better? What kind of surgery?
4. Can the surgery guarantee pregnancy? And so on. Here I will give you a brief and then detailed explanation.
I. Overview of the disease
Varicocele is a common disease in men, which refers to the dilatation, tortuosity and elongation of the blood vessels of the spermatic trapezius plexus (venous plexus) caused by the stagnation of blood flow in the spermatic cord. Varicocele can be accompanied by testicular atrophy and impaired sperm production, which in turn also becomes the main cause of male infertility, and it is known that about 30% or 40% of infertility patients are due to varicocele.
During the evolution of man from crawling to standing, there are some diseases that only human beings have: such as varicose veins in the lower limbs, internal and external hemorrhoids, varicose veins in the spermatic cord (male), which are caused by high venous pressure and venous valve lesions. There are arteries and veins in human blood vessels, arteries can quickly inject arterial blood to all parts of the body because of the huge function of the heart as a pump. The veins, on the other hand, need to return to the heart slowly, one by one. The venous valves are like dams that prevent the backflow of blood. The superficial veins can be seen as the position of the valves on their course. Varicose veins can be caused by standing and sitting (habits and occupations), heavy physical effort, prolonged strenuous activity, and congenital venous valve abnormalities.
Lower limb varicose veins have large and small saphenous varicose veins, easy for everyone to notice: calf surface has a mass of varicose mass like earthworms, walking for a long time legs will be painful, legs touched not easy to get well; hemorrhoids are ten people nine hemorrhoids, you suffer, you stool blood, so often draw attention to everyone. And the spermatic vein location hidden, they do not pay attention to this location, feel no obvious discomfort, not pregnant, men do not consider themselves in the first place.
In fact, varicocele is very common for men. In the past, people started a family early, varicocele has less effect on sperm, so it is easy to get pregnant. However, with the growth of age and the increase of family burden, varicocele is a gradual aggravation process, and of course, sperm and sexual function are getting worse.
What causes varicose spermatozoa? (See IV. Factors) There are four causes, the most important of which is the valvular factor. To put it figuratively, the dam breaks and the sewage (toxic substances from the kidneys and adrenal glands) enters the ground where the crops are grown (testicles).
How does varicocele cause infertility? (See III. Causes of infertility: there are 8 points) It is the damage to the crops caused by sewage and climate, etc. (Nutritional disorders, increased scrotal temperature, endocrine dysfunction of the testes, the damaging effect of oxygen free radicals, congenital vascular valve insufficiency of the spermatic veins are the main causes of varicocele, blood stagnation, varicocele damage to the interstitial cells of the testes, toxin action).
Generally speaking, this disease often occurs among males, at this time the male reproductive organs are basically developed and mature, and will not have any effect on the patient’s reproductive function, however, if this disease persists, it will still bring serious effects, so when this disease is found, it must be treated in a professional hospital in an effort to make this disease disappear completely and avoid unnecessary effects.
Second, clinical symptoms
1, varicose spermatozoa can sometimes affect fertility. Varicocele accounts for 10-15% of normal men, and 30-40% of male infertility is caused by varicocele. In severe cases, it can cause testicular atrophy. The reason is that the temperature in the scrotum of the affected side increases and reflects to the opposite side, making the spermatogonia degenerate, atrophy and reduce the number of sperm; or because the pentraxin or steroid secreted by the left adrenal gland flows back into the testis through the left spermatic vein, causing a decrease in the number of sperm.
The scrotum or testicles on the affected side have a feeling of swelling or pain, the scrotum is enlarged, and the scrotum and testicles on the affected side are lower than those on the healthy side when standing up. The scrotal surface can be seen as dilated and tortuous veins. There are earthworm-like soft masses when touched, and the symptoms can be reduced or disappeared by lying down.
Patients may have symptoms of neurasthenia, such as headache, fatigue, hypersensitivity, etc. Some patients have sexual dysfunction. Some patients have sexual dysfunction.
4, the patient may be completely asymptomatic, only found during physical examination.
5, sexual dysfunction: many male infertility diseases will appear the symptom of sexual dysfunction, varicocele infertility will also appear the symptom of sexual dysfunction. Men who suffer from varicocele infertility will have symptoms of sexual dysfunction such as low libido, early impotence and premature ejaculation.
6, scrotal swelling or testicular enlargement: In general, men who suffer from varicocele infertility will have symptoms such as scrotal enlargement, swelling and pain, falling sensation in their scrotum or testicles. Sometimes swollen blood vessels like earthworms can be felt or seen in the scrotum of men.
Third, the causes of infertility
1, nutritional disorders: because of the depressed venous blood flow, the blood circulation of the testes and epididymis is affected, and the lack of nutrients and oxygen required by them will affect sperm production.
2.Increased scrotal temperature: After varicocele, because of the depressed blood flow in the spermatic vein, the temperature in the scrotum will gradually increase, on average 0.6℃ higher than normal, thus affecting sperm production.
3, testicular endocrine dysfunction: because the local temperature in the scrotum is elevated, the blood supply and oxygen supply to the testes are not sufficient, which will inevitably affect the endocrine function of the interstitial cells in the testicular varicocele, thus affecting the sperm production.
4, the destructive effect of oxygen free radicals: research shows that when varicocele occurs, oxygen free radicals increase in testicular tissue, and lipid peroxidation is aggravated, thus affecting the occurrence of spermatozoa and sperm function.
5, congenital vascular insufficiency of the spermatic veins is the main cause of varicose veins, and it also causes stagnation of blood in the spermatic veins, which affects the blood circulation of the testes. The blood circulation of the testes, so that the testes. The testicular tissue ischemia and oxygen deprivation and the supply of essential nutrients are impaired, thus affecting the spermatogenic function.
6, blood stagnation, damage to testes: testes and epididymis blood flow stagnation, small blood vessel embolism, making the tissue lack of oxygen and carbon dioxide accumulation, damage to testicular spermatogenic epithelium, sperm birth quantity and quality will naturally decline.
7, varicocele damages the interstitial cells of the testis, reducing testosterone secretion and peripheral blood testosterone content, while blood FSH and ICSH increase, endocrine disruption, which interferes with the occurrence and maturation of spermatozoa
8, the role of toxins: because of the spermatic vein and testicular veins between the rich side circulation, when the varicocele, resulting in blood countercurrent, can be the left adrenal gland and the left renal vein blood carries a high concentration of toxic metabolites, before detoxification that flow into the bilateral testes, resulting in sperm production is disturbed, the formation of different degrees of sperm too little, abnormal morphology and movement disorders.
Fourth, the factors that cause varicocele
1, the envelope factor.
Under normal condition, the myofibrous tissue in the spermatic cord envelope can produce the role of pump and promote venous reflux. When the above-mentioned muscle fiber tissue is atrophied or relaxed, it is not conducive to venous reflux and causes varicocele.
2.Valve factor.
Venous valve has the role of preventing blood reflux, when the spermatic vein valve is absent or malfunctioning, the left internal spermatic vein near the left renal vein has no valve, so the blood is easy to backflow. This is the main factor.
3, physiological factors.
The sexual function of young and strong people is more vigorous, and the blood supply of the scrotal contents is strong. In addition, standing for a long time and increasing abdominal pressure are also factors that trigger varicocele.
4, compression factors.
Retroperitoneal tumor, renal tumor, hydronephrosis, etc. compressing the internal spermatic veins can cause symptomatic or secondary varicocele. It is very rare.
V. Hazards
1. Causes physical discomfort in men.
Patients with varicoceles often have the feeling of swelling and pulling pain at the scrotum, and patients can also have the symptoms of neurasthenia due to some bad emotions, such as emotional perversity, weakness, insomnia and other uncomfortable symptoms, which bring many negative effects to male friends.
2, cause men to appear sexual dysfunction.
When men have varicocele, they often have low libido, painful intercourse, erectile dysfunction and other sexual dysfunction, which causes disharmony in family life.
3, lead to male infertility.
Clinically, varicocele can be accompanied by testicular atrophy and lead to sperm abnormalities such as dead sperm, little sperm, weak sperm, etc. It is the disease with the highest incidence in male infertility, and patients often have a reduced number of sperm, low motility, increased malformed sperm and other semen abnormalities, which endanger male fertility and cause male infertility.
Six, self-judgment
Clinically, varicocele can be divided into three degrees.
Degree 1 (mild): When standing, we cannot see varicose veins protruding from the scrotal skin, and we cannot feel the varicose veins in the scrotum; after holding the breath and increasing the abdominal pressure, we can feel the varicose veins in the spermatic cord; when lying down, the varicose veins disappear quickly.
Degree 2 (moderate): When standing, no dilated veins protrude from the scrotum, and more obvious varicose veins can be felt in the scrotum, and the mass gradually disappears when lying down.
Degree 3 (severe): there are obvious thick blood vessels on the surface of scrotum, and there are obvious worm-like dilated veins in the scrotum, and the walls of veins are thickened and hardened; they disappear slowly when lying down.
VII. Examination
1. Physical examination: visual and palpation: when doing this examination, the patient adopts a standing position and lets the scrotum droop, with a room temperature of about 25 degrees; cold can make the scrotum contract, which is not conducive to examination. One visualization, two touching, three breath holding: Inhale and then bulge the stomach and squeeze hard towards the lower abdomen. If you can’t see, but can touch the varicose veins, it’s degree 3; if you can’t see, but can touch the varicose veins, it’s degree 2; if you can’t see, can’t touch, and can touch the thickened varicose veins after holding your breath, it’s degree 1; if you can’t see, can’t touch, and can’t touch the thickened spermatic veins after holding your breath, it’s normal. A professional doctor will also examine the size of the testicles, the epididymis, the vas deferens and various other scrotal disorders. It is easy for a professional doctor to diagnose varicocele.
2. Routine semen test: Since varicocele directly affects the quality of sperm, the test is used to determine how the condition affects the sperm. The purpose of the test is to determine the extent to which the disease condition affects the quality of sperm, to review the comparison and medication, and to observe after surgery.
3. Ultrasound: It is possible to evaluate the degree of varicocele, since the swelling of the affected area may also be a hernia, tumor, lymphadenitis, scrotal edema, etc. Ultrasound is often inaccurate: because varicocele is a disease of standing or sitting, the varicose veins disappear or are reduced when lying down, so you must hold your breath when lying down for ultrasound, but not everyone will hold their breath in place, and it is not the same concept as holding your breath when standing.
4.Intraventricular spermography: It is for men who are intubated through the femoral vein into the internal spermatic vein, injected with contrast agent, and observed the degree of contrast agent reflux by using advanced instruments. If the contrast agent is refluxed to the L1-5 level, it is moderate, and if it is refluxed into the scrotum, it is severe.
5. Other: sex hormone examination, testicular biopsy, etc. Affecting the spermatogenic function of the testes in serious cases can cause irreversible damage to the testes, resulting in azoospermia; at the same time, the testes also produce androgens, which can cause male sexual dysfunction.
Eight, disease hazard
Varicocele is not a minor problem, and the harm to men’s physical and mental health cannot be ignored. In addition to causing male discomfort, it also has a great impact on fertility. The specific hazards are as follows.
1, affect male fertility. According to medical statistics, about two-thirds of men suffering from varicocele will have abnormal semen, so that the number of sperm will be reduced, the mobility will be low, and the number of deformed sperm will be increased, which can lead to infertility.
2. Causes local discomfort. It is manifested as swelling and pulling pain at the scrotum, which is significant when standing and moving and can be alleviated by lying in bed. The patient’s worry and anxiety can be accompanied by neurasthenia, causing mood disorders, fatigue, insomnia, etc.
3, lead to sexual dysfunction. Some patients who suffer from varicocele, if left untreated for a long time, will have low libido, decreased sexual pleasure, painful intercourse, erectile dysfunction, premature ejaculation and other sexual dysfunctions.
Nine, prevention methods
1, there is a saying: standing, sitting shot, lying flat not shot. But we can not work ah, so to combine work and rest, avoid too long standing, sitting, avoid heavy physical labor, avoid the intensity of exercise and exercise. Can lie not sit, can sit not stand, can light work not heavy work.
2, keep the scrotum cool: do not take hot baths, sauna, soak in hot springs, if the scrotum is often wet, you can use the method of cold compress for the scrotum: this is also a general treatment method for mild to moderate varicocele.
3. Do a good job of regular physiological health education and give them the knowledge about varicocele to eliminate their psychological burden.
4. testicular lifting and anal contraction training: exhaling, contracting the anus, lifting the anus, and lifting the testicles help to develop the testicular muscle and increase the reflux of the spermatic veins.
5. Knee-thorax training method: Knees and chest on the bed, buttocks elevated, help the stagnant venous blood in the scrotum of the testicles to further return.
X. Treatment methods
General treatment
In this item, the main purpose is to reduce the temperature and blood stasis in the scrotum, reduce the venous pressure and improve the venous reflux.
1. Rest and lie down. Avoid prolonged standing and sitting, heavy physical work, and intense exercise and sports. Can lie not sit, can sit not stand, can light work not heavy work.
2, scrotal cold compress. This is also a general treatment for mild to moderate varicocele. The second time a day, once in the morning and once in the evening, use the cool water in the ordinary water pipe, wet the towel and wrap the scrotum, once for 30 minutes, replace the towel after it is warm. Note that you cannot use ice in the refrigerator or use cold compresses with water in the freezer.
3.Testicle lifting and anal contraction training: exhale, contract the anus, lift the anus and testicle, which helps to develop the testicular muscle and increase the reflux of the spermatic vein.
4.Knee-chest position training method: Knees and chest on the bed, buttocks elevated, help the stagnant venous blood in the scrotum of the testicles to further return.
Chinese and western medicine treatment
According to Chinese medicine, there are many factors that cause varicocele in men, such as liver and kidney deficiency and external cold and dampness, as well as qi stagnation and blood stasis and loss of moistening of tendons and veins; long-term weight lifting and long distance walking can easily lead to injury of tendons and veins and stagnation of liver and ligaments; spleen deficiency and qi trapping and weak blood flow can also lead to varicocele. Therefore, the key to treating this disease is to smooth the flow of qi and blood and to release the stagnation of blood and blood. But generally for mild varicocele, herbal medicine may be effective, but for moderate or severe varicocele where the venous valves have been damaged, herbal medicine is not too effective.
Although there are varicocele, many people are still reluctant to have surgery and mostly choose medication first, when the purpose of medication is to improve the quality of sperm and enhance sexual function, not to treat varicocele, which is a cure for the symptoms but not the root cause. If the sperm quality does not change after more than 3 months of treatment, you should opt for surgery.
Choice of surgical procedure
There are many surgical options, no matter which one, as long as the varicocele can be lifted, once it recurs, it is a failure of the surgery. Why is it easy to recur? Because the closer to the end of the vein, the more branches there are, and the more intricate they are, so a higher position (higher) has to be chosen, and this is when doctors have invented many surgical methods. However, no matter which method (except microsurgery) is used, the tiny veins which are invisible to the naked eye cannot be ligated, and after the surgery, they slowly expand again and relapse. The process of recurrence varies from person to person, there are fast and slow, fast one or two weeks, slow several months.
1.Traditional surgery (inguinal incision) has a large incision, takes a long time, has a long hospitalization period, and the patient’s pain is obvious after the surgery, and the position of the ligature is not high enough. Because of the high recurrence rate, it is rarely used nowadays.
2.The retroperitoneal high ligation of spermatic vein (inverted appendiceal incision), the surgical incision is smaller than the traditional operation, the incision is smaller, the position of ligation is relatively high, the recurrence rate is low, but the location of surgical operation is deep and it is difficult to find the vein.
3.Small inguinal incision spermatic vein high ligation, the advantages are: the surgical incision is small 1-2cm, short time, less pain, using the incision intracutaneous suture, hospitalization 2-3 days can be discharged, but the ligation position is not high enough, easy to damage the testicular artery and lymphatic vessels during the operation, easy to appear scrotal edema, sphingomyelia, affect the testicular blood supply.
4.Microscopic spermatic vein high ligation, the advantages of which are that the arteries, veins and lymphatic vessels can be clearly distinguished under the microscope, the ligation of veins is complete, and the recurrence rate is low 0.1%. The disadvantages are: the operation is complicated, the level of the operator is high, special operating microscope and microscopic instruments are needed, and it takes a long time. The surgeon is time-consuming and laborious. This surgical procedure is also the last choice for recurrence after other surgical procedures.
5.Laparoscopic spermatic vein high ligation, small trauma (umbilical incision 1cm, double lower abdominal incision 0.5cm), short operation time, can be completed in about 10 minutes, the operation field is enlarged, easy to distinguish the arteries and veins, but for the very small veins still can not distinguish, many doctors in China still choose the way to ligate all the spermatic vessels (including arteries and veins).
Effect of surgical treatment
Patients often ask if pregnancy can be guaranteed after surgery. Generally speaking, for patients with moderate varicocele, 80% of those with about 20% forward motion spermatozoa in preoperative semen examination can recover their fertility after surgery, but for patients with severe varicocele, or even those who are already azoospermic, it is much more difficult to recover, but sexual function will slowly improve. I often give this example: the sewage has seriously polluted the land where crops are grown, although the source of the sewage is blocked, the soil has not been improved, some can be improved by medication, but some damage is serious, it is not easy to improve. Of course, it does not exclude that there are other diseases as influencing factors, but also need to do different treatment for different causes.
Therefore, can I have children after varicocele surgery? The results of the surgery and the recovery status and the impact of other diseases, regular re-examination of semen, the development of countermeasures, do not have to worry too much, as long as actively identify the cause of symptomatic treatment, natural fertility will be restored.
Eleven, warm tips
Life should pay attention to: diet, work and rest, exercise.
1.Improve the nutritional status and improve the physical quality.
2, pay attention to adjust the diet structure, improve the quality of the diet to ensure that the production of sperm with sufficient “raw materials”: (1) protein.
(1) protein. The main component of sperm is protein, so to create quality sperm we must use high-quality protein, such as a variety of lean meat, fish and shrimp, eggs and other foods rich in arginine, such foods are beneficial to the generation of sperm. Arginine is a necessary component of sperm formation, from food to supplement arginine is conducive to sperm production.
(2) Vitamins. Vitamin A, vitamin B, vitamin C, vitamin D and vitamin E are the raw materials for the production of sperm and semen, which can promote sperm production, regulate gonadal function, enhance sperm vitality, protect the anti-infection ability of the secondary gonads and maintain the entire metabolic process of sperm. These vitamins are widely found in animal liver, vegetable oils, green leafy vegetables and fresh fruits. If necessary, vitamin pills can be supplemented directly.
(3) Trace elements. Various minerals and trace elements are also beneficial to sperm production, especially zinc and selenium supplements in due course.
(4) Nuts, animal offal such as pork loin, chicken liver and eggs are rich in sex hormones and cholesterol and lecithin needed for hormone synthesis, which can promote spermatogenic cell division and sperm maturation.
(5) Chicken, duck meat, milk and soy products contain more estrogen; celery and parsley can lower cholesterol and eventually reduce androgen synthesis. Long-term consumption can make sperm production disorders, occasional consumption does not affect sperm quality.
3, appropriate exercise: can swim, should not be strenuous activity.
4, work and rest: do not stay up late, life as regular as possible.
Second, avoid pollution, radiation, high temperature and other harmful factors
1, not addicted to alcohol and tobacco.
2, avoid the impact of various pollution and radiation harmful substances: home decoration, atmospheric pollution, water pollution, food pollution, harmful chemicals (including pesticides, fertilizers, detergents, paints, etc.), a variety of radiation (cell phones, computers, microwave ovens, induction cookers, nuclear radiation: hospital radiology staff, chest X-ray, chest X-ray, CT examinations, etc.) and other effects of qualitative changes. Therefore, men in their reproductive years should try to avoid long-term exposure to a large number of such harmful substances.
3, sauna, bathing, hot springs, wearing tight pants (such as jeans), long-distance cycling and sitting on the seat for a long time can cause testicular temperature to rise, which can cause testicular spermatogenic dysfunction.
Third, sexual life: for patients with varicocele, those who have fertility requirements, we advocate: general age 20-30 years old, two or three times a week sex; 30-40 years old, two times a week or 5 days once; 40 years old and above, two times a week to once a week; female ovulation 2-3 days a sex. Try not to exceed 10 minutes per sexual life, so that one is easy to get pregnant, the second is the metabolism is conducive to the production and improvement of sperm.
For those male infertility patients with low sperm count and normal vitality, the sexual interval should be extended appropriately, frequent intercourse, will only make the sperm density lower, the desire for speed is not achieved; for low sperm vitality, normal density, the sexual interval should be shortened appropriately, the newborn sperm vitality is strong. The sperm will not be discharged for a long time, the sperm aging, vitality decline, become “old and weak” weak sperm disease. For patients with varicocele, frequent sexual life can aggravate the condition.
Twelve, disease problems
Why does it occur more on the left side?
1. The left spermatic vein is long and enters the renal vein at a right angle, and the blood flow is subject to certain resistance. In the left kidney vein near the left spermatic cord are veins without valves, thus leading to easy backflow of blood.
2.The left internal spermatic vein is located after the sigmoid colon, which is easily compressed by the feces in the intestine and affects the blood reflux.
The left internal spermatic vein is anastomosed with the left renal vein at a right angle, while the right internal spermatic vein is anastomosed with the inferior vena cava obliquely, and the blood flow is relatively smooth.