Varicocele is the elongation, dilatation and tortuosity of the trapezius plexus of the spermatic cord, which is caused by some causes of venous valve malfunction, obstruction of spermatic venous reflux and blood reflux. The prevalence of varicocele is 10-15% of the male population and 35% of the male infertility population, making it an important cause of male infertility.
Etiology
1, envelope factors.
Under normal conditions, the muscle fiber tissue in the spermatic cord envelope can produce the role of the pump to promote venous reflux. When the above-mentioned muscle fiber tissue is atrophied or relaxed, it is not conducive to venous reflux and causes varicose veins in the spermatic cord.
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.
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, kidney tumor, hydronephrosis, etc. compressing spermatic veins can cause symptomatic or secondary varicocele.
Varicocele grading.
①Mild: palpation is not obvious, and varicose veins can be palpated in the spermatic cord above the scrotum after the patient inhales and holds his breath and increases abdominal pressure (Valsalva method).
(ii) Moderate: varicose veins can be palpated, but the scrotum has a normal appearance.
(iii) Severe: varicose veins can be seen in the scrotum like a mass of earthworms, which are more obvious on palpation.
Clinical manifestations
The symptoms are aggravated after exercise, standing for a long time or exertion, and alleviated after lying down or resting, and some patients have symptoms of neurasthenia and hypogonadism.
Hazards
I. Local discomfort: It is manifested as swelling and pulling pain at the scrotum, which is significant when standing and moving, and can be alleviated when lying down. It can also be accompanied by nervous weakness due to the patient’s worry and anxiety, causing emotional perversion, weakness, insomnia, etc.
Secondly, due to the stagnation of venous blood, the temperature of the testicles rises, which affects testicular metabolism and sperm production. The occurrence and growth of human sperm require a temperature lower than 37°C, which is the reason why human testicles grow outside the body cavity. Varicocele can raise the testicular temperature by an average of about 0.6°C, thus interfering with spermatogenesis. It causes local hypoxia and the accumulation of metabolic waste, which poisons the spermatogenic cells and sperm of the testes, as well as inhibits the production of the androgen testosterone.
Relationship between varicocele and fertility.
Causes of infertility
1, nutritional disorders: because of venous blood flow stagnation, the blood circulation of the testes and epididymis is affected, and the lack of nutrients and oxygen it needs will affect sperm production.
2, scrotal temperature rise: varicocele, because of the spermatic vein in the blood flow depression, will make the scrotal temperature gradually rise, an average of 0, 6 ℃ higher than normal, thus affecting sperm production.
3, testicular endocrine dysfunction: because of the increased local temperature in the scrotum, 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 spermatic vascular valve insufficiency is the main cause of varicocele, but also can cause spermatic vein blood stagnation, affecting the blood circulation of testes and balls, so that testes and balls tissue ischemia and lack of oxygen and essential nutrients supply obstacles, thus affecting the spermatogenic function.
6, blood stagnation, damage to testes: testes and epididymis blood flow stagnation, small blood vessel embolism, so that the tissue lack of oxygen and carbon dioxide accumulation, damage to testicular spermatogenic epithelium, the number and quality of sperm birth 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, toxin effect: because there is rich side branch circulation between spermatic vein and testicular vein, when varicocele occurs, it leads to blood countercurrent, which can carry high concentration of toxic metabolites in the blood of left adrenal gland and left renal vein, which can flow into bilateral testes before detoxification, resulting in interference with sperm production, forming different degrees of sperm hypospermia, morphological abnormalities and motility disorders, etc.
Treatment
(A) General treatment
For mild varicocele without obvious clinical symptoms or married and fertile people can be left untreated. If there are mild symptoms, scrotal brace or tight pants can be used to promote blood reflux and reduce clinical symptoms.
(B) Surgery
1.Surgical indications
It is used for those who have severe symptoms, obvious varicocele or clinical symptoms or whose symptoms are not relieved by non-surgical treatment, as well as those who have mild varicocele but have abnormal semen related indexes (including reduced sperm count, reduced vitality and abnormal morphology) or to prevent testicular atrophy and spermatogenic disorders.
Prevention methods
1, wear underwear, should be made of cotton material with high elasticity, should not wear tight underwear, in order to facilitate heat dissipation and sweat absorption, reduce the local temperature of the scrotum and reduce the effect of gravity.
2. If there is any discomfort of scrotal swelling and obvious abnormality, you should go to the hospital in time for consultation and treatment. Regarding the treatment of varicocele, asymptomatic or less symptomatic people can wear elastic underwear or use scrotal brace.
3, male friends must usually pay attention to local hygiene, to change underwear and underwear diligently, to keep the local dry and hygienic, some diseases can lead to the occurrence of varicocele, so men should pay more attention to their own health, timely treatment of genitourinary system infections such as prostatitis, urethritis, etc., to reduce the chance of inflammation.
4, a reasonable schedule of training, so that the combination of work and rest, avoid too long weight standing.
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Diet attention
Varicocele diet should pay attention to the intake of food rich in vitamin E. The best source of vitamin E is vegetable oil.
Vitamin E rich foods are sesame, walnuts, lean meat, dairy, peanut rice, eggs and lettuce, in addition to soybeans, peanuts, walnuts, melon seeds, animal liver, egg yolk, cream and corn, yellow green vegetables, are rich in vitamin E.