Varicocele: is an abnormal elongation, dilatation and tortuosity of the trabecular plexus of the intra-seminomatous veins.
1.Primary varicose spermatic veins Varicose spermatic veins due to anatomical factors and dysplasia.
2.Subclinical varicocele refers to minor varicocele that cannot be detected on physical examination but can be detected by ultrasound, nuclear scan or color Doppler examination. It is generally considered that a vein diameter of more than 2mm can establish the diagnosis.
3.Secondary varicocele Intra-abdominal or retroperitoneal tumor, hydronephrosis or ectopic vascular compression of upstream spermatic veins may also lead to unilateral or bilateral varicocele.
I. Clinical manifestations
Most of the patients are found during physical examination without conscious discomfort, or are detected during infertility consultation. The pain may radiate to the inguinal region and lower abdomen, and it is aggravated when standing and walking, and reduced after lying down and resting.
Second, the diagnostic criteria
Clinically, varicocele is classified into four grades.
Grade III: dilated veins can be seen protruding from the scrotal skin when the patient is standing, like a mass of earthworms, which can be easily felt.
Grade II: The dilated veins are very easily palpable during palpation, but cannot be seen.
Grade I: not obvious on palpation, but can be present on Valsalva test.
Grade 0: No symptoms of varicocele and Valsalva test cannot be seen.
Auxiliary examination
1.Ultrasound and color Doppler ultrasonography, non-invasive examination, with convenient, good repeatability, high resolution and accurate diagnosis, can be the preferred detection method.
2.Infrared scrotal thermometry.
3.Seminogram.
IV. Treatment of varicocele
(A) Drug treatment
1.Carnitine compound
2.Clomiphene
3.Stretching varicose veins to help fertility soup: with the main drugs of made aromatic herb, lychee nucleus, angelica, white peony, red peony, citrus aurantium, green peel, Chen Pi, roasted licorice, etc. It has the effect of draining liver and regulating qi, regulating qi and relieving pain, etc. Combined with high ligation of internal spermatic veins can significantly improve the sperm quality of patients with varicose veins with infertility.
4.Tong wizard
Chai Hu, Safflower, Radix Angelicae Sinensis, Wu Jia Pi, Fructus Lycii, Radix Rehmanniae, Huai Shan Yao, Raspberry, Calcined Dragon Bone, Salviae Sinensis, Wu Wei Zi, Radix Astragali and Chuan Niu Kne. It can promote blood circulation to the testes, promote testicular sperm production and improve semen quality.
(II) Surgical treatment
1. Indications and contraindications for surgery
(i) Indications
(1) Infertility of varicocele, the presence of abnormal semen examination, normal endocrine examination and no abnormal findings in female fertility examination, regardless of the severity of varicocele, as long as the diagnosis of varicocele is established, surgery should be performed in time.
(2) Those who have severe varicocele with obvious symptoms.
(3) Clinical observation shows that the incidence of prostatitis and seminal vesiculitis is significantly increased in patients with varicocele, which is twice as high as normal people. Therefore, if the above two diseases exist at the same time, and if prostatitis is not cured for a long time, varicocele surgery can be chosen.
(4) For varicocele in adolescence, since it often leads to pathological and progressive changes in the testes, it is now advocated that varicocele in adolescence with testicular volume reduction should be treated by surgery as early as possible to help prevent infertility in adulthood.
(5) For patients with mild varicocele, if the semen analysis is normal, they should be followed up regularly (every 1 to 2 years), and once there is abnormal semen analysis, testicular shrinkage and softening of texture, surgery should be performed promptly.
(6) For patients with varicocele accompanied by oligospermia due to non-obstructive factors, simultaneous testicular biopsy and varicocele surgery is recommended to help perform assisted reproduction.
(ii) Contraindications
A history of abdominal infection and open pelvic surgery with extensive adhesions is contraindicated for high level ligation of the internal spermatic vein.
2.Open surgical treatment
(1) Transinguinal canal high ligation of the internal spermatic vein
This procedure has a high recurrence rate and is less commonly used.
(2) Transperitoneal high ligation
This procedure has a low recurrence rate and is the treatment of choice for unilateral varicocele.
3.Laparoscopic surgery treatment
Compared with traditional open surgery, laparoscopic high ligation of spermatic vein has the advantages of reliable effect, less damage, less complications, simultaneous bilateral surgery, quick recovery and short hospital stay, which is accepted by many patients and doctors.