Reproducing male virility in varicocele patients
If you turn on the radio in your home, almost every radio station has a few “experts” who introduce infertility and the drugs they highly recommend, and for various reasons almost all young people learn about infertility from these small broadcasts and leaflets. The “knowledge” about infertility, of course, also includes the fabulous varicocele and its related ligation surgery promoted by the “expert professors” of some private hospitals.
Because of this unscientific and profit-oriented propaganda, the Chinese people are scared of “varicocele”, and they have the fear of not knowing how to diagnose and treat the disease, but they also have the fear of being deceived by the unscientific propaganda of small advertisements. The reason for this is that on the one hand, men are ashamed to talk about their privacy, and on the other hand, they do not have a scientific, professional and systematic understanding of it, which has led to many people being unwilling and afraid to go to the regular hospital’s male clinics to receive regular and systematic treatment, thus delaying the condition and leading to infertility.
What kind of disease is varicocele? What kind of harm is there?
A hundred million years ago with the transformation of humans from crawling to walking upright, our ancestors not only completed the magnificent transformation from ape to man, but also produced diseases that only humans have such as varicose veins in the lower extremities, hemorrhoids and varicose veins in men, and the most important factor triggering these disorders is the increase in venous pressure after uprightness, which in turn causes venous valve lesions. As young men are more active and have a richer blood supply in the scrotum, they are the main group of people with varicose veins.
Under normal circumstances, the occurrence and growth of human sperm need a temperature lower than 37℃, and the spermatic vein is like a small furnace that provides warmth to the testes, and the temperature and nutrition it produces can meet the nutrition and temperature needs of the testicular tissue, but when varicocele occurs, the testicular temperature can rise about 0.6℃ on average, and the excessive testicular temperature will lead to a decrease in the synthesis of androgens by the testicular interstitial cells. This can even lead to spermatogenic disorders.
At the same time, when varicocele occurs, it will cause the spermatic vein pressure to rise, leading to testicular tissue stasis and hypoxia. It can also cause the retrograde flow of adrenal metabolites along the spermatic vein, affecting testicular blood flow, increasing reproductive toxins, affecting testicular metabolism, and inducing germ cell apoptosis. Examination can reveal a decrease in testicular volume as well as semen abnormalities caused by testicular spermatogenic dysfunction.
Patients with varicoceles often present with scrotal discomfort or painful downward swelling, which is relieved by lying down. If the varicoceles are severe, worm-like varicose vein masses can be seen in the scrotum when standing, and mild or occult varicoceles can be seen or felt when taking a deep breath and holding it, due to increased abdominal pressure.
As venous stasis affects the metabolism of the testes and causes local hypoxia, many patients experience reduced sperm count, low motility and increased malformed sperm, which can lead to infertility. If treatment is not taken in time, it will not only affect sexual life and fertility, but also induce serious lesions such as kidney tumors and hydronephrosis, which can directly endanger life.
Do varicocele patients need to be treated? What kind of treatment is more appropriate?
Whether primary varicocele needs to be treated and what kind of treatment should be taken should be treated differently according to whether the patient has infertility or abnormal semen quality, whether there are clinical symptoms, the degree of varicose veins and whether there are other complications. At present, the common treatment methods include surgery, psychological intervention, scrotal support, cooling therapy, medication, diet and so on, but at present, surgery is the main method.
Therefore, for adolescent varicocele, since it often leads to testicular disease, it is currently advocated that adolescent varicocele with testicular volume reduction should be treated with surgery as early as possible to help prevent infertility in adulthood. As far as patients with varicocele-induced infertility are concerned, when there is abnormal semen examination and no other diseases affecting fertility are found, and the endocrine examination is normal, while the female partner’s fertility examination is normal, regardless of the severity of the varicocele, surgery should be performed as soon as the diagnosis of varicocele is established.
For patients with mild varicocele, if the semen analysis is normal, the patient should be followed up regularly, and whenever there is abnormal semen analysis, testicular shrinkage and softening of texture surgery should be taken in time. For patients with severe varicocele, they may feel painful scrotal swelling after standing for a long time, and the testicles may shrink significantly during physical examination, so surgery can be considered even if they have already given birth.
Currently, microligation has become the procedure of choice for varicocele treatment in the United States. In China, due to the constraints of concept, technical level and equipment, it is only carried out in a small number of large hospitals and is far from popular, but there is a springing trend. At present, our center has carried out this operation since 2012, and now we have performed microscopic ligation of the spermatic vein via small hidden incision under the external ring according to the international standard procedure, and the treatment effect is very satisfactory.
With microscopic spermatic vein ligation, we can maintain the integrity of the vas deferens and its vascular system because the testicular arteries, lymphatic vessels and smaller veins are magnified 10 times under microscopic static, and at the same time we can clearly free and ligate all the internal veins of the spermatic cord, and at this time we can also ligate the branches of the external veins of the spermatic cord because of the trans-inguinal incision. Therefore, the postoperative complication rate and the overall assessment of the improvement of semen parameters and conception rate of microscopic technique spermatic vein ligation are significantly better than other methods.
A real case: a 4-hour operation gave them a love child
In March this year, a patient from Datong, Shanxi, Zhao Changjiang (Ming) came to our center because of varicocele and told us about his encounters in the process of seeking medical treatment for this disease. Zhao Changjiang and his lover Chunmei (Ming) have been married for three years, and usually feel that their sex life is quite normal, but they just can’t conceive their own babies.
During this period, both sides have been looking for reasons in the Chunmei, visited the obstetrics and gynecology departments of major hospitals in the province, Chunmei is normal, then is it the male side of the problem, the family began to wonder up. Without the knowledge of his lover, Zhao Changjiang took a leave of absence to come to a private hospital in the provincial capital.
The two sides came to the Provincial Maternal and Child Reproductive Medicine Center after much inquiring. When Zhao Changjiang’s semen was examined, the patient had already entered the stage of severe oligomenorrhea. After palpation, it was found that the patient’s varicocele was at degree III at this time, and then the hemodynamic information of the spermatic veins was analyzed through color ultrasound, and a clear diagnosis was made.
After 4 hours of surgery and 3 days of hospitalization, the couple’s joyful smile and love crystallized half a year later when they pushed open the door of the male clinic and Dasheng shouted, “I got pregnant, doctor got pregnant! . At this time, we were joyful and happy together, but at the same time we also sighed that how many young couples in China are not treated by regular hospitals in time because of varicocele, resulting in the delay of the disease and causing infertility.
So we further emphasize here that varicocele is one of the main causes of male infertility, and its mechanism is likely to be the result of a combination of factors, and the effect of surgical treatment is sure and safe, so once it is clear that it is the cause of male infertility, surgical treatment should be preferred in order to achieve natural conception. Varicocele can also cause sexual dysfunction in men, causing great harm to male health. We should pay high attention to this disease and choose surgical treatment correctly and positively so that patients with infertility caused by varicocele can reappear as male children and conceive the crystallization of love.