Some male patients may find earthworm-like masses in the scrotum when they take a shower, and they may be overwhelmed for a while, but there is no need to be nervous. In severe cases, the varicose veins are visible to the naked eye, resembling earthworms.
Varicocele is divided into 3 main types.
1. Primary varicocele: it is related to dysplasia and anatomical factors, and it is the most common type in our clinic.
2, subclinical varicocele: asymptomatic, ultrasound suggests that the diameter of the vein exceeds 2mm can establish the diagnosis.
3.Secondary varicocele: It is caused by tumor, hydronephrosis or ectopic blood vessels compressing the upstream spermatic veins.
The incidence of varicocele accounts for about 10%-15% of the male population and occurs less frequently in men before puberty, while its incidence gradually increases with age after puberty, probably related to physical growth, increased testicular volume and increased testicular blood supply. It is now well established that palpable varicocele can affect fertility and is one of the leading causes of male infertility.
Clinically, varicocele is classified into four grades.
Grade 0: No symptomatic manifestation of varicocele and Valsalva test cannot be present.
Grade I: not obvious on palpation, but can be present on Valsalva test.
Grade II: dilated veins are extremely palpable on palpation, but cannot be seen.
Grade III: dilated veins can be seen protruding from the scrotal skin when the patient is standing, like a mass of earthworms, and can be easily palpated.
We often use some tests to help us diagnose and treat, which include
1.Imaging tests: ultrasound, infrared scrotal thermometry, spermatic venography.
2.Laboratory tests
(1) Semen analysis: Patients with varicocele need to have at least 2 semen analyses.
(2) Sperm antibody test: Patients with infertility should be checked for serum or semen sperm antibody.
(3) Measurement of testicular volume: In order to understand whether the testicles are damaged and whether they have indications for surgery, the size of the testicles should be measured, with the most accurate method being color ultrasound, in addition to ruler measurement and mold.
Treatment is mainly based on surgical treatment, partly with (or combined with) the application of drug therapy.
1, varicocele infertility, the presence of abnormal semen examination, medical history and physical examination did not find other diseases affecting fertility, normal endocrine examination, female fertility examination without abnormal findings, regardless of the severity of varicocele, as long as the diagnosis of varicocele once established, should be promptly operated.
2.Severe varicocele with obvious symptoms, physical examination found that the testicles are obviously shrunken, even if there is fertility, the patient has the desire for treatment can also be considered for surgery.
3, clinical observation found that the incidence of prostatitis, seminal vesiculitis in patients with varicocele is significantly increased, twice as much as normal people, so if the above two diseases exist at the same time, and prostatitis is not cured for a long time, you can choose to perform varicocele surgery.
4, for adolescent varicocele, because it often leads to pathological and progressive changes in the testicles, it is currently advocated that adolescent varicocele with testicular volume reduction should be treated with surgery as early as possible, which can help prevent infertility in adulthood.
5.For patients with mild varicocele, if the semen analysis is normal, they should be followed up regularly (every 1-2 years), and once the semen analysis is abnormal, the testicles shrink and become soft in texture, they should be operated in time.
6.For patients with varicocele accompanied by oligospermia due to non-obstructive factors, it is recommended to perform testicular biopsy and varicocele surgery at the same time to help perform assisted reproduction.
Currently, the main surgical options include open surgery: transinguinal canal internal spermatic vein high ligation, and retroperitoneal high ligation. Laparoscopic surgery is currently the most commonly used treatment modality, which is characterized by less trauma and faster recovery, and is indicated for bilateral transcatheter high ligation, obesity, history of inguinal surgery and recurrence after open surgery.