I. Definition and classification of varicocele
Definition: Varicocele refers to the dilatation, tortuosity and elongation of the vasculature of the trapezius plexus (venous plexus) of the spermatic cord due to stagnation of blood flow in the spermatic cord.
Classification.
1, Primary varicocele: varicocele caused by anatomical factors and dysplasia.
2, Secondary varicocele: It is caused by compression of the spermatic vein on the way back to the spermatic cord, common compression lesions are: renal tumor, ureteral tumor, retroperitoneal tumor, hydronephrosis, iliac vein obstruction, etc.
3, Subclinical varicocele: a minor varicocele that cannot be detected on physical examination but can be detected by ultrasound, nuclear scan or Doppler ultrasound. It is generally believed that a venous diameter of more than 2 mm can establish the diagnosis.
II. Etiology of varicocele
(A) Anatomical factors.
1. The left internal spermatic vein is long and enters the renal vein at a right angle, and the blood flow is subject to certain resistance. The left internal spermatic vein near the left renal vein has no valve, so the blood is easy to backflow.
2, the left internal spermatic vein is located after the sigmoid colon, which is easily compressed by feces in the intestine and affects the blood reflux.
(B) Physiological factors: The sexual function of young adults is more vigorous, and the blood supply of scrotal contents is strong. In addition, long standing, increased abdominal pressure is also the pathogenesis of trapped factors.
(C) Other factors: retroperitoneal tumor, renal tumor, hydronephrosis, etc. can cause symptomatic or secondary varicose veins in the spermatic cord by compressing the veins. The primary ones disappear quickly when lying down, while the secondary ones often do not disappear or disappear very slowly.
Third, the harm of varicocele
At present, it is recognized that varicocele can affect fertility and is one of the main causes of male infertility. The reasons for this include the following.
1., blood stagnation in the spermatic vein, resulting in increased local temperature in the testes and degeneration of spermatogenic tubules affecting spermatogenesis.
2. Blood retention affects testicular blood circulation and carbon dioxide accumulation in testicular tissues affects spermatogenesis.
3, Left spermatic vein reflux of renal vein blood contains such as steroids, catecholamines can cause vasoconstriction, resulting in premature sperm shedding.
4. Because there are abundant traffic branches in the bilateral intertesticular veins, the toxins in the blood of the left spermatic vein can affect the spermatogenesis of the right testis.
Diagnosis of varicocele
(A) Clinical manifestation: Asymptomatic people are mostly detected by physical examination or due to infertility. Those who have symptoms mostly show discomfort or pain in the affected scrotum, and the pain radiates to the groin area and lower abdomen, which is aggravated when standing or after walking and alleviated after lying down and resting.
(II) Grading.
Grade 0: no symptomatic manifestation of varicocele, Valsalva test does not appear.
Grade Ⅰ: not obvious on palpation, but Valsalva test may appear.
Grade II: dilated veins are easily palpable on palpation, but cannot be seen.
Grade III: When standing, both tortuous vein masses can be seen in the scrotal skin, like earthworms, which can be easily palpated.
Auxiliary examination
(A) Imaging examination
Ultrasound and color Doppler ultrasonography (recommended May be preferred)
Infrared scrotal thermometry (higher false positive)
Internal spermatic venography (invasive test Optional)
(II) Laboratory tests
Semen analysis
Anti-sperm antibody test
(iii) Measurement of testicular volume: ultrasound is the best detection method
V. Treatment of varicocele
(A) Drug treatment
Compound carnitine
Clomiphene
Tongjin
Other herbal treatments
Non-surgical methods such as scrotal support, local cold compresses and reduction of sexual stimulation can be adopted for mild asymptomatic cases.
(II) Surgical treatment
Indications for surgery.
Infertility of varicocele, presence of abnormal semen examination, physical examination and medical history do not reveal other diseases affecting fertility.
Severe varicocele with obvious symptoms, patients who have a desire for treatment can choose surgery.
Clinical findings of combined prostatitis and vesiculitis.
In adolescent patients with varicocele, the testicular pathological changes are progressive, so adolescent varicocele with testicular volume reduction should be treated with surgery as soon as possible.
Open surgical treatment
1, transinguinal canal spermatic cord ligation: commonly used, because there are more arteriovenous branches in this area, lymphatic vessels are richer, and arteries and veins are closely related, so there is a possibility of testicular atrophy after injury. The recurrence rate after surgery is about 25%.
2.Transepithelial high ligation: the recurrence rate is lower, but the testicular sphingomyelia, scrotal edema and aseptic epididymitis are likely to occur after surgery.
Laparoscopic surgical treatment: Applicable to bilateral transperitoneal high ligation, obesity, history of groin surgery and postoperative complications of open surgery.
Other treatments: including microscopic high ligation of spermatic veins and spermatic vein interventional embolization.
VI. Complications of surgery
Scrotal effusion or testicular syringomyelia: mostly related to lymphatic vessel injury.
Testicular atrophy
Nerve injury: symptoms manifest as temporary numbness in the anterior medial thigh and anterolateral side of the surgical incision, usually appearing within 10 days after surgery, with symptoms maintained for an average of about 10 months. Mostly due to injury to the ilioinguinal nerve and genitofemoral nerve
Vas deferens injury
Acute epididymitis
Omental emphysema and scrotal emphysema