Definition: Varicocele refers to the poor reflux of the trabecular plexus of the spermatic cord due to various reasons or venous reflux due to venous valve insufficiency, resulting in abnormal expansion, elongation and tortuosity of the local veins and the formation of vascular masses in the scrotum. Varicocele can lead to male infertility, and in serious cases, it can lead to scrotal swelling and discomfort that affects work and life, so it needs to be treated. Ultrasound diagnostic criteria of varicocele: varicocele can be diagnosed as varicocele if the following two items are met at the same time. 1. The maximum internal diameter of spermatic vein (DR) ≥1.8mm during calm breathing, and DR ≥2.0mm during Valsava test (the patient stands and holds his breath to increase the abdominal pressure, at which time the spermatic vein in the scrotum is examined as Valsava test); 2. Positive Valsava test, that is, color and spectral Doppler detects reflux signal during Valsava test and the duration of reflux TR≥1s. According to the clinical and ultrasound diagnosis, varicocele is divided into 4 grades, which are subclinical varicocele, clinical varicocele grade I, grade II and grade III. 1. subclinical varicocele: negative clinical palpation and reflux in the spermatic vein on ultrasound, DR: 1.8-2.1mm, TR: 0.8-2s; 2. clinical varicocele grade I: positive clinical palpation and DR on ultrasound: 2.2-2.7mm, TR: 2-4s; 3. clinical varicocele grade II: positive clinical palpation and DR on ultrasound: 2.8-3.1mm. 2.8-3.1mm, TR: 4-6s; 4. Clinical varicocele grade III: positive clinical palpation and ultrasound DR ≥3.1mm, TR ≥6s. IV. Treatment of varicocele 1. Conservative treatment: Patients with no symptoms or mild symptoms and no fertility requirements can try non-surgical treatment, including scrotal brace, local cold compresses, oral Chinese and Western medicines, etc.; 2. Surgical treatment: It is the most effective method at present, with open surgery, laparoscopic surgery and microscopic surgery. It is suitable for patients with varicocele with male infertility, those who have serious symptoms or those whose symptoms are not significantly relieved by non-surgical treatment. Because the incidence of varicocele is close to that of adults in late adolescence, the older the age and the longer the course of the disease, the more severe the damage to testicular function and the less likely it is that fertility will be restored; therefore, surgery should be performed as early as possible in adolescence. Surgery is advocated for grade III varicocele in childhood to avoid affecting reproductive function.
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