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Abstract: A 42-year-old male patient presented with scrotal enlargement in the past 1 year and a feeling of scrotal swelling and vague pain worsened 1 week ago, so he came to our hospital and was diagnosed with varicocele by ultrasound examination. He underwent laparoscopic spermatic vein ligation in our hospital, and the varicocele disappeared after 1 week of treatment with cefadroxil capsules and diclofenac sodium extended-release tablets.
Basic information】Male, 42 years old
Type of disease】Venous varicosities of the spermatic cord (left side)
Hospital】Xiang Ya Hospital of Central South University
Date of consultation】March 2022
Treatment plan】Surgical treatment (laparoscopic spermatic vein ligation) + medication (cephalexin capsules, diclofenac sodium extended-release tablets)
Treatment period】Inpatient treatment for 1 week, follow up after 3 months
Treatment effect]: Scrotal swelling and other symptoms improved, left spermatic varicose vein disappeared.
I. Initial interview
The patient complained of a right inguinal mass with an enlarged right scrotum found after heavy work in 2019, which was obvious when standing and moving, with soreness and swelling, and shrank when lying down and resting, without other special discomfort such as pain, hematuria, difficulty in urination, etc. For treatment, he was admitted to a local hospital for surgery (details not available), and complained that the mass shrank significantly after surgery. One year after surgery, the scrotum enlarged again after activity, but no attention was paid and no treatment was given. After that, the symptoms continued without relief, and a feeling of swelling and vague pain appeared. The initial diagnosis was: left spermatic varicocele, and the patient was admitted to our department for surgery. Since the onset of the disease, the patient’s general condition was acceptable, and his mental health, sleep, and appetite were acceptable, his urine and stool were normal, and his weight did not change significantly.
II. Treatment history
After the patient was admitted to the hospital, he considered laparoscopic spermatic vein ligation as the best treatment option, and after communicating with the patient about the importance and risks of the surgery, he agreed to undergo the surgery on the second day of admission. On the second day of admission, a small incision was made under the umbilicus to insert the laparoscopic device, and the spermatic cord vessels in the left scrotum were ligated. After the operation, the patient was returned to the ward for convalescence, and cefadroxil capsules were administered to prevent postoperative infection. After the anesthesia wore off, the patient complained of pain and discomfort, and was instructed to take diclofenac sodium extended-release tablets for pain relief. Because of the small size of the right epididymal head cyst, no special treatment was carried out for the time being, and the patient was followed up and observed.
III. Treatment effect
One week after the laparoscopic spermatic vein ligation, the patient’s wound healed well, and the patient complained of significant relief of scrotal swelling and hidden pain. Physical examination showed that the left scrotum was smaller than before. Ultrasound of the testes and epididymis showed that the testes were normal in size and the spermatic veins were not significantly varicose. The patient’s condition was stabilized and he was discharged from the hospital for convalescence. He returned to the hospital for review in the third month.
IV. Precautions
After the patient’s condition was stabilized, I, as a physician, was deeply relieved, and on the occasion of discharge, I did not forget to emphasize to the patient that the following points should be noted in life.
1. Patients should limit heavy physical activities after surgery to prevent disease recurrence. It is recommended to avoid strenuous exercise and overexertion for 3 months.
2. Patients should wear soft cotton clothing, change clothes regularly and pay attention to personal hygiene.
3, the diet should be light and easy to digest, rich in vitamins, proteins and other nutrients, quit smoking and limit alcohol, avoid the intake of spicy and stimulating food.
4.Strengthen self-observation after surgery, if there are changes in scrotal size, skin color, etc., you should seek medical advice in time and follow the doctor’s instructions for review after surgery.
V. Personal insight
A variety of factors can cause the occurrence of this disease, such as the patient in this case, who developed related symptoms after heavy physical activities, in addition to physiological factors such as sedentary, standing and overworking can also induce the disease, so the patient should strengthen life management after discharge to reduce the presence of the above risk factors. Also, avoiding exercises that increase abdominal pressure, such as dumbbell lifting, sit-ups, pull-ups, etc., can help to oxidize the spermatic veins. Patients are encouraged to undergo scrotal ultrasound once every 1 year after stabilization is recommended.