1. What is the incidence of varicocele?
The prevalence of varicocele in the general population is 4.4%-22.6%, with an average of about 15%, mostly in adult men, and relatively less in adolescents, with the relevant domestic data showing 8.5%-19.82%, and there is a clear correlation with age, gradually increasing with the age group (5172 adolescents surveyed by Liang Chaozhao in China, with a total prevalence of 19.82% , 2.44% at the age of 7-10 years, 16.53% at the age of 11-14 years, and 20.61% at the age of 15-18 years). About 35% of primary male infertility patients have varicocele, while in secondary infertility this percentage can be as high as 70%-81% (foreign data). Mao Xiangming, Department of Urology, Peking University Shenzhen Hospital
2. Is there an increase in the number of clinical visits?
At present, the number of patients with varicocele diagnosed in our urology clinic has increased compared with the previous trend, but there is no big fluctuation in the number of patients with varicocele treated by surgery in our hospital every year. 131 patients were treated by surgery in 2008, 128 in 2009 and 130 in 2010.
Is varicocele an important cause of male fertility?
Varicocele has been suggested as early as the 19th century as a possible cause of male infertility. We have mentioned above that about 35% of patients with primary male infertility have varicocele, while in patients with secondary infertility this percentage can be as high as 70% to 81%, so there is a close relationship between varicocele and male infertility. The mechanism of male infertility caused by varicocele is not completely clear. A large number of animal experimental studies have shown that the combined pathophysiological changes such as elevated testicular temperature, testicular blood backflow stagnation, toxin and metabolite poisoning, and endocrine hormone level changes may eventually lead to germ cell apoptosis, testicular spermatogenic cell reduction, testicular growth stagnation, and atrophy resulting in infertility.
4. What is the etiology of varicocele? Some information says that it is related to excessive sexual desire and frequency of sex.
There are two main causes of varicocele: congenital anatomical factors and acquired factors.
Congenital anatomical factors: The left internal spermatic vein injects into the left renal vein at a right angle and is compressed by the sigmoid colon in front, and the left renal vein passes between the aorta and the superior mesenteric artery. When standing or connective tissue relaxation, the superior mesenteric artery makes the left renal vein collect and squeeze, forming the proximal clamp phenomenon (also called nutcracker syndrome or left renal vein compression syndrome, mostly seen in the age of 13-16 years old, mainly because of faster pubertal development, rapid height growth, spinal hyperextension, rapid change in body shape or renal prolapse, etc., the angle between the superior mesenteric artery and the aorta becomes smaller, compressing the renal vein (caused by). The right common iliac artery sometimes also compresses the left common iliac vein, forming a distal clamping phenomenon. Normal left internal spermatic vein has a valve at the entrance into the left renal vein to prevent reflux, if the venous valve enters the left renal vein has a valve to prevent reflux, if the venous valve is underdeveloped or the smooth muscle or elastic fibers of the vein wall are weak, it can also lead to varicose spermatic vein, this varicose due to anatomical factors becomes primary varicose spermatic vein.
Acquired factors: mainly retroperitoneal tumor, renal tumor, hydronephrosis or vagus vessels compressing the inner spermatic vein, cancer embolism or other reasons causing obstruction of renal vein or inferior vena cava, so that the return flow of blood to the inner spermatic vein is obstructed, which can cause secondary varicocele.
As to whether excessive sexual desire and frequency of sex are related to varicocele, there is no data to prove the correlation; however, some data show that high-intensity sports (basketball, soccer, etc.) may accelerate the progression of varicocele, but do not increase the risk of varicocele.
5. What is the difference in the incidence of primary and secondary varicocele?
The majority of our patients with varicocele are primary varicocele, which is much more common than secondary varicocele. However, there are no specific data.
6. What are the symptoms of varicocele? What are the most important reasons for patients with varicocele to seek medical attention? Pain or infertility?
Primary varicocele is asymptomatic if the lesion is mild and is detected during a physical examination or during a visit for infertility. If the symptoms are severe, there may be a feeling of swelling and hidden pain in the affected scrotum, mostly aggravated after exertion or prolonged standing, and the symptoms may be relieved or disappear after lying down and resting. If the varicose veins are not relieved in the recumbent position, they may be secondary. In general, there are quite a lot of people who come to the clinic for the above reasons, and slightly more for infertility.
7. How is varicocele diagnosed? What tests are needed?
The diagnosis of varicocele is mainly based on physical examination and ultrasound. On physical examination, varicose veins can be classified into three degrees (degree I, II and III) according to the degree of varicose veins: degree I, varicose veins cannot be palpated locally in standing position, but varicose veins can be palpated by Valsalva test; degree II, varicose veins can be palpated in scrotum in standing position, but varicose vessels cannot be seen on the surface; degree III, varicose veins can be seen in the scrotum in the shape of earthworms or clusters. The diagnosis can sometimes be missed or misdiagnosed by physical examination alone, so ultrasound examination should be performed to further clarify the diagnosis. The combination of the two can basically make the diagnosis. In addition, patients with varicocele should routinely undergo semen examination. Most patients have abnormal sperm count, motility, morphology, or in severe cases, no sperm.
There are rumors that some patients with varicocele will get better after marriage?
According to clinical experience, varicocele will gradually aggravate, and the longer the time, the worse the symptoms.
9. Which cases require surgery? Surgery before marriage or after marriage?
Surgery should be performed for those with infertility or semen abnormalities, regardless of whether they are symptomatic or not. The treatment of asymptomatic varicocele, especially if it occurs during adolescence, is controversial. In recent years, a growing number of studies have shown that testicular damage from varicocele can occur early in the disease and that this damage is progressive. Timely and effective treatment may reverse the testicular damage caused by varicocele and reduce the chances of infertility in adulthood. Current indications for surgery for adolescent varicocele recognized by many scholars are: (1) significant reduction in testicular volume (more than 2 ml difference in ultrasound measurements); (2) patients with bilateral varicocele; (3) adolescent patients with significant symptoms; (4) patients with grade III varicocele; and (5) those with abnormal semen analysis. Therefore, on the issue of whether to operate before or after marriage, for patients who need surgery, it is better to operate before marriage than after marriage. The earlier the surgery, the less damage the varicocele does to the testicles and the greater the chance of recovering the testicular function; if the surgery is too late, the testicular damage is too heavy, and even after the surgery, the treatment effect may not be achieved.