The clinical symptoms that varicocele may cause are mainly as follows:
1, scrotal dampness, scrotal swelling or painful sensation, which may radiate to the lower abdomen or groin;
2.Decreased libido, premature ejaculation, decreased sexual function;
3, abnormal semen, reduced sperm count, reduced sperm motility, semen is not liquefied;
4, Infertility after marriage;
5, testicular swelling and pain;
6, testicular shrinkage, the more obvious the varicocele, the smaller the testicle, the texture of the testicle is slightly soft;
7, the surface of the scrotum can be seen varicose veins;
8, all clinical manifestations of prostatitis can appear. About the grading of varicocele
Indications for varicocele surgery.
I. The indications for surgery in adult clinical type patients are recommended as follows.
1. The following 3 conditions are present at the same time: Presence of infertility. Decreased spermatogenic function of the testes. The female partner has normal fertility, or has infertility but may be cured.
2.Those who have no requirement for fertility for the time being, but the examination reveals abnormal semen quality.
3.The symptoms associated with varicocele (such as swelling and pain in the perineum or testicles) are serious and obviously affect the quality of life, and if the improvement is not obvious through conservative treatment, surgery can be considered.
4. Those with degree II or III varicocele and significantly decreased blood testosterone levels, excluding those caused by other diseases.
For patients with subclinical varicocele, surgery is generally not recommended; however, for patients with clinical varicocele on one side and subclinical varicocele on the other side, bilateral surgery is recommended when surgery is indicated.
Indications for surgery for adolescent varicocele.
1.Seminomatous varicocele causes significant reduction of testicular volume on the affected side (see the section on testicular function evaluation).
2.Second degree or third degree varicocele.
3.Decreased spermatogenic function of the testis.
4.The more severe symptoms associated with varicocele.
The degree of varicocele is not positively correlated with the clinical symptoms, the effect on fertility, and the effect on sexual function, not that the more obvious the degree of varicocele is, the more obvious the clinical symptoms are, and the greater the effect on fertility and sexual function.
In clinical practice 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 easy to palpate during palpation, with a diameter of 2 mm, but cannot be seen.
Grade I: not obvious on palpation, but the varicose veins of different degrees can be detected by Valsalva test (the examinee is placed in standing position, the examiner presses the abdomen of the examinee with his hand to increase the abdominal pressure, and asks the patient to hold his breath to increase the abdominal pressure, and then observes and touches the spermatic veins in the scrotum).
Grade 0 (normal): no varicocele symptoms and Valsalva test is not available.
Since patients are hospitalized for a short period of time, 3-4 days on average, some of them are operated on the same day of hospitalization, and the precautions after going home may not be explained in detail enough, or the bedside doctor may have given them, but the patient soon forgets them again. Therefore, through my website, I would like to provide the following additional information to all patients.
1.No sexual life, especially strenuous sexual activity, within three weeks after surgery;
2, within one month after surgery should not engage in hiking, running, long-distance cycling motorcycle, playing ball and other strenuous sports;
3, if economic conditions allow, male patients with infertility is best to take some vitamins, Chinese medicine, etc., can further improve the chances of natural conception;
4, some patients, during the male side of the medication pregnant deeply concerned about the safety of the next generation, it is not necessary, but the female side of the medication to pay special attention;
5, many patients with varicocele have a lot of pressure on their minds (this is a very deep experience!) The only way to get what you want is to be relaxed, have a happy and regular life, and encourage each other rather than blame each other;
6, as for the time of review after surgery, 2 weeks after surgery can be ultrasound review varicocele, semen often rules need to have 2-3 times regular sexual life after the review to be accurate.
How are varicocele caused?
Varicocele (VC) is a pathology in which the varicocele plexus of the spermatoid vein is damaged due to poor reflux or damage to the venous valves, resulting in dilatation, tortuosity and elongation of the local veins. The causes of varicocele are currently considered to be related to the following factors.
1, the human body usually take more upright posture: so that the spermatic vein blood must overcome gravity from the bottom upward reflux.
2, the spermatic vein valve abnormal or lack of: because the renal vein pressure is higher than the spermatic vein pressure, the spermatic vein valve plays the role of stopping the blood reflux. If the venous valve is lacking or incomplete, it leads to blood reflux.
3, The connective tissue around the internal spermatic vein is weak or the levator muscle is underdeveloped: it weakens the relying role around the internal spermatic vein.
4.The left internal spermatic vein is injected into the left renal vein at a right angle: the left internal spermatic vein is injected into the left renal vein at a right angle unlike the right one. Due to the high pressure of the left renal vein, the upright position of the body makes this reflux more difficult.
5.The left internal spermatic vein is longer: the left internal spermatic vein is about 8-10cm longer than the right one, which increases the resistance to reflux hemodynamically compared to the right one.
6.The sigmoid colon compresses the left internal spermatic vein, so that the blood reflux is obstructed.
7.Proximal clamping phenomenon: the superior mesenteric artery and abdominal aorta form an angle or the left renal vein after the abdominal aorta is congenitally malformed, which compresses the left renal vein, thus causing the normal blood return to the left internal spermatic vein to be obstructed to form the proximal clamping phenomenon.
8, distal clamping phenomenon: the left common iliac vein is compressed by the right common iliac artery, so that the blood return of the left vas deferens is obstructed to form the so-called distal clamping phenomenon.
9, synergistic contraction mechanism destruction: the wall of the large spermatic vein within the tracheal vein has the outer membrane longitudinal smooth muscle structure, from the outer membrane longitudinal smooth muscle sends out oblique muscle fibers to stop at the middle membrane circular smooth muscle, this morphological connection between the two can produce synergistic contraction, thus promoting the blood return within the tracheal vein. When degenerative lesions occur in the vessel wall, such as degeneration or absence of longitudinal smooth muscle of the outer membrane, the synergistic contraction mechanism is destroyed, thus making the venous return obstructed.
10, abnormal blood flow theory: testicular arterial blood flow increased, more than the venous volume, which leads to venous dilatation and tortuous, become another cause of the disease.
11, height, weight, body mass index (BMI) influence: research shows that height, weight, body mass index (BMI) affect the occurrence of varicocele. The height and weight of the affected population were higher than normal controls, while their BMI was lower than normal controls.
12, Kidney cancer, intra-abdominal or retroperitoneal tumor compression,renal cancer renal vein or inferior vena cava cancer thrombosis.