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Abstract: Varicocele occurs in men between 20 and 30 years of age and is mainly manifested as a worm-like mass of varicose veins in the scrotum, which is often insidious and not easily detectable. A 21-year-old male was diagnosed with this disease after a routine physical examination. After 3 months of treatment with laparoscopic high ligation of the left spermatic vein and right heptaosaponin sodium tablets and diosmin tablets, the patient’s condition was stabilized and he was discharged from the hospital after 1 week.
[Basic information] Male, 21 years old
Type of disease】Bilateral varicocele
Hospital】Xiang Ya Hospital of Central South University
Date of consultation】February 2022
Treatment plan】Surgical treatment (laparoscopic high spermatic vein ligation) + medication (indomethacin enteric soluble tablets, ibuprofen extended-release capsules, heptaosaponin sodium tablets, diosmin tablets)
Treatment cycle] 1 week of hospitalization, 3 months of medication after discharge, and follow-up in the 3rd month
Treatment effect】The symptoms of varicocele improved and the condition was stable
I. Initial consultation
The patient complained that he was found to have varicocele on the left side of the spermatic cord 4 months ago, but he did not pay attention to it because there were no obvious symptoms at that time. 3 months ago, he experienced bilateral swelling and discomfort after prolonged standing and strenuous exercise, no fever and chills, no pain in the lumbar abdomen, no urinary frequency, urinary urgency, urinary pain and effort to urinate, and light yellow urine. A week ago, he came to our outpatient clinic, and the ultrasound showed that the left testicle was 44x19x28mm and the right testicle was 43x19x28mm; the testicles were regular in shape, with medium parenchymal echogenicity, fine light points and uniform distribution. The epididymis was not large; CDFI showed normal blood flow distribution in both testes and epididymis; bilateral spermatic veins were tortuous and dilated, and the wider internal diameter was 4.6mm (left) and 2.9mm (right), respectively, which was initially diagnosed as bilateral varicocele and admitted to our department for treatment.
II. Treatment history
The patient was admitted to the hospital, and the specialist examination showed that the development of the penis was normal, the left spermatic vein was severely varicose, a worm-like mass was visible when standing, which did not disappear when lying on the back, the left scrotum was smaller than the right, and the testicular epididymis did not show any obvious abnormality; the right spermatic vein was moderately varicose, and the right scrotum and right testicular epididymis did not show any obvious abnormality. Combined with the ultrasound findings, it was considered appropriate to perform surgical treatment on the left side, and the best plan was to give medication on the right side, which was performed after communication with the patient. On the left side, laparoscopic ligation of the spermatic vein was performed, and postoperative anti-inflammatory treatment with indomethacin enteric-coated tablets and ibuprofen extended-release capsules was administered. For the right spermatic varicocele, heptaosaponin sodium tablets and diosmin tablets were given to improve circulation. The patient’s condition was stable and he was discharged from the hospital for convalescence after 1 week.
III. Treatment effect
1 week after the left spermatic vein high ligation, the patient’s wound basically healed, during which there were no complications such as infection and edema, and a specialist examination showed that the earthworm-shaped mass disappeared when standing, and he recovered well. For the moderate varicocele of the right spermatic vein, the effect of drug treatment was slow and long-term medication was needed. After discharge, the patient returned to the hospital for a follow-up examination 3 months later, and if there was any discomfort during the period, he was rechecked promptly. If the testicular epididymal spermatic vein disappears by ultrasound, the medication can be stopped.
IV. Precautions
After the patient’s condition improved, I also felt happy for the patient, while not forgetting to emphasize to the patient that the following points should be noted in life.
1, about 1 month after the operation can be basically recovered, does not affect the work and life. However, sexual life should be avoided for 2 months after surgery so as not to affect recovery.
2.Strengthen personal hygiene management, change intimate clothing regularly and keep the perineum clean and hygienic. In the early postoperative period, it is recommended to choose triangular underwear, which helps to hold up the scrotum and avoid scrotal edema.
3. Combine work and rest after discharge, ensure sufficient sleep and appropriate low-intensity physical exercise, and do not overwork or stay up late for a long time.
V. Personal insight
Patients with varicocele in this part have no clinical symptoms, and if not found during physical examination, with further development of the disease, they may develop a feeling of swelling and vague pain in the scrotum, radiating to the lower abdomen and waist, and in serious cases, male infertility and testicular atrophy may occur, affecting the patient’s reproductive life. The disease is usually caused by excessive standing and overexertion. Therefore, men who have the above risk factors due to work or life needs should have regular physical examinations to prevent the occurrence of such diseases.