I. Symptoms.
Varicocele is an abnormal dilatation, elongation and tortuosity of the trabecular plexus in the spermatic cord. The incidence of the disease is about 20% in the general male population and about 40% in infertile males. The disease is mostly seen in young adult males and is relatively rare in adolescents, with an overall prevalence of 10.76% in adolescents aged 6-19 years, but the degree of varicocele is more severe, mostly grade III. Varicocele is the first cause of male infertility, accounting for 35% of patients with primary infertility and 50%-80% of patients with secondary infertility.
Varicocele is usually asymptomatic and is found during routine physical examinations, or painless earthworm-like masses in the scrotum are found during self-examinations, or during visits to the doctor for infertility. Some patients may have symptoms such as swelling, vague pain and discomfort, which can be aggravated after prolonged standing or walking and can be relieved or disappear after lying down.
Second, the degree: clinically, varicocele is divided into three degrees.
Degree 1 (mild): When standing, we can’t see the varicose veins protruding from the scrotal skin, but we can feel the varicose veins in the scrotum, and the varicose veins disappear soon when lying down.
Degree 2 (moderate): dilated veins can be seen on the scrotum when standing, 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.
Treatment: The effect of conservative treatment of varicocele is limited, so it is mainly treated by surgery.
Surgical indications.
1.Adult type varicocele.
(1) Three conditions are met at the same time: 1) infertility exists; 2) testicular spermatogenic function decreases; 3) the female partner has normal fertility, or infertility is possible to be cured despite the infertility condition.
(2) Those who have no requirement for fertility for the time being, but the examination reveals abnormal semen quality.
(3) If the symptoms associated with varicocele (such as swelling and pain in the perineum or testicles) are serious and obviously affect the quality of life, and the improvement is not obvious by conservative treatment, surgery can be considered.
(4) Those with grade II or grade III varicocele and significantly decreased blood testosterone level, excluding other diseases.
(5) With non-obstructive oligospermia, testicular puncture biopsy can be performed at the same time to help assist reproduction.
2.Adolescent type varicocele.
(1) Varicocele causes significant reduction in the size of the affected testis.
(2) Grade II or III varicocele.
(3) Decreased spermatogenic function of the testis.
(4) those with more serious related symptoms caused by varicocele.
IV. Surgical modalities.
1.Transinguinal route and subinguinal route.
2.Transcatheter retroperitoneal route.
3.Laparoscopic internal spermatic vein ligation
4.Transcutaneous embolization technique.