Varicocele is a common disease in men. The prevalence is about 15% in the normal population and 35% in the infertility population. The actual animal and clinical studies show that varicocele can cause the decline of testicular function and secondary infertility in 75%-85% of patients, and timely and reasonable surgery can improve the quality of semen in 60%-80% of patients and increase the conception rate to 20%-60% after surgery, and also improve the level of testosterone in blood. For this reason, I would like to discuss the problems related to varicocele for your participation in politics.
Causes of morbidity.
It is divided into primary spermatic varicose veins and secondary spermatic varicose veins, which should be treated and dealt with separately for primary spermatic varicose veins pathogenesis.
1, anatomical features: left and right spermatic veins can be varicose, but mostly seen on the left side, because the left spermatic vein comes directly from the renal vein in a ding-shaped length 8~10cm longer than the right side, and enters the renal vein at a right angle so that the venous pressure increases, the vein is compressed by the colon in the posterior abdomen, and also by the left common iliac vein, so that the reflux of the left spermatic vein is obstructed, forming a distal clamp phenomenon, so that the left spermatic vein The return pressure is obstructed, forming varicose veins in the scrotum.
2, stasis e blood due to the higher temperature, directly affect the development of the testes and sperm production, so that the testes undergo pathological changes, resulting in reduced sperm motility, sperm cell dysplasia malformation rate increased.
3, blood retention affects the blood circulation of the testes, making the testes lack the necessary nutrient supply and oxygen supply and affecting spermatogenesis.
4.The blood reflux of the left internal spermatic vein brings the metabolites of the adrenal glands and kidneys such as steroids, catecholamines, 5-hydroxytryptamine and other such products to the testes. Solid alcohols can inhibit spermatogenesis, catecholamines can cause chronic testicular toxicity, 5-hydroxytryptamine can cause vasoconstriction causing premature shedding of immature sperm, resulting in male infertility, and can affect the testicular interstitium, endocrine function interferes with spermatogenesis. At the same time there is a rich anastomosis between the blood vessels of the two testes, so it can also affect the right testicle.
Clinical manifestations.
The disease occurs 95% on the left side, which is related to the direct right-angle form of the left spermatic vein into the renal vein The disease is mild and usually asymptomatic. Many are detected on physical examination. The common symptoms are scrotal prolapse and lower abdomen, pulling discomfort, aggravated when standing for a long time, walking for a long time or overexertion, even causing pain, and the symptoms are significantly reduced at night when sleeping, which can cause infertility and decreased sexual function in severe cases.
Examination: When the patient is standing, the scrotum can be seen to droop significantly. Sometimes varicose veins are visible on the surface of the scrotal skin, and the veins in the scrotum are coiled in a mass. On palpation, curved and thickened veins may be found in the spermatic cord and the same varicose veins may be palpated behind the epididymis. If the varicose vein does not disappear after lying down, it should be considered secondary and further examination is needed.
According to the degree of varicose, it can be divided into mild, moderate and severe. In mild degree, the varicose vein is not visible locally and is not obvious on palpation, but it is slightly thicker than normal, which can be considered when combined with ultrasound showing vessel diameter >2.5mm; in moderate degree, the appearance is not obvious when standing, but when touched by hand, the varicose vein can be touched with moderate varicose feeling and disappears when lying down, and in severe degree, the appearance can be seen in the spermatic cord area and scrotum. In severe cases, the varicose veins can be seen in the area of the spermatic cord and the posterior wall of the scrotum in the form of earthworm-like masses of varicose veins, which can disappear when lying down. In recent years, due to the gradual increase in the number of infertility cases, the number of patients with asymptomatic varicocele has increased due to the finding of spermatic veins with a diameter of more than 2.5 mm during ultrasound examination in asymptomatic patients, which then gradually attracted attention.
Treatment.
It is divided into conservative treatment and surgical treatment.
1. Mild or asymptomatic varicocele may not be treated, but personal hygiene and prevention of genitourinary system infection should be carried out. Such as prostatitis, urethritis, etc., reduce masturbation, appropriate sex life, wear tight underwear and do not do strenuous exercise and discard gas exercise, such as weight lifting, etc.
If the person is Ⅰ or Ⅱ degree with symptoms can consider using Chinese medicine treatment.
If the symptoms are obvious and the sperm quality is basically normal, you can consider using Chinese medicine for dialectical treatment.
2, generally divided into liver qi stagnation type, qi deficiency blood stagnation type, stasis blocking pulse type, yin deficiency fire type, kidney deficiency less sperm type, these dialectical classification, must be through the formal Chinese medicine dialectical treatment, do not be smart, haphazard use of drugs.
Commonly used Chinese medicine according to different types and use of different Chinese medicine for the Senate
Liver qi stagnation type: available prolotherapy, Mu Xiang Shun Qi Wan 6 grams 3/day
Qi deficiency and blood stasis type: Tonic Zhong Yi Qi Wan 6g 3/day
Blood stasis and stagnant veins: Blood Mansions and Stasis Capsules, 3 capsules, 3/day
Yin deficiency and fire: Zhi Bai Di Huang Wan 6g 3/day
Kidney deficiency and less sperm type: Kirin Pill 6g 3/day
Food therapy: corn oil, sesame oil, lettuce leaves, mustard, tomatoes, sesame seeds, walnut meat, peanuts, corn, yellow and green vegetables.
Prohibit smoking, alcohol, and stimulating food.
3.Surgical treatment
Surgical treatment should be careful to be sure to follow the contraindications of the indications for surgery, so that they do not suffer physical and mental injuries again.
Indications
(1) Varicocele with semen abnormalities causing infertility (but must exclude other causes of infertility, such as endocrine examination for urinary tract infection, prostatitis, genetic factors of anti-sperm factor in semen, immune diseases, female fertility examination without abnormal findings) regardless of the severity of varicocele, once the diagnosis is established, surgery should be performed promptly.
(2) For those who have severe varicocele with obvious symptoms, surgery can be considered even if there is fertility, if it is accompanied by testicular shrinkage during physical examination.
(3) For adolescent varicocele, it is often accompanied by testicular lesions that cause progressive changes in the testes and affect the development of spermatozoa. If varicocele is found to be accompanied by testicular volume reduction, such as in older individuals, a sperm analysis can be performed by masturbation. If there is any abnormality, early surgical treatment should be performed to prevent adult infertility.
(4) For mild varicocele, regular follow-up should be performed if the sperm analysis is normal, and timely surgery should be performed if abnormal sperm analysis or testicular volume reduction is found.
Contraindication: secondary varicocele, i.e. varicose veins do not disappear after lying down.
Surgical modalities.
1.Traditionally, through the inguinal route, the spermatic cord is freed and the levator muscle is cut open, the spermatic cord plexus is freed, the varicose veins are cut and ligated, only the testicular artery is retained, and the upper and lower varicose veins are overlapped and ligated to complete the surgery.
The advantages of this method are simple, but there is a certain recurrence rate after surgery, and a few patients sometimes have syringomyelia, and because the testicular artery is thin, there is some experience in identifying this artery, therefore, some patients are mistakenly ligated. In recent years, the use of microsurgery to open the spermatic vein has greatly reduced the rate of miscarriage, and the recurrence rate has also been significantly reduced.
2, the pathway iliac fossa route to the internal spermatic vein, in the iliac fossa department of extraperitoneal find spermatic vessels generally for the arteriovenous companion, under the intuitive ligation of the internal spermatic vein, the early postoperative need to support the scrotum, the method is mainly limited to the left spermatic varicocele, the advantages of less chance of injury to the artery, the disadvantage is relatively slow recovery, at present, some hospitals are using laparoscopic ligation of the internal spermatic vein, less damage, postoperative The results are evaluated.
(1) After ligation, semen quality can be improved in 60~80% of patients, and the postoperative conception rate is 20~60% and can improve the level of blood testosterone.
(2) The effect after surgery is related to the severity of the spermatic vein, and the effect of surgery is relatively poor in heavy patients.
(3) The earlier the surgery is performed, the better the results will be.
My suggestions
1.For adolescent male, parents should pay attention to whether there are aura symptoms of varicocele, if there is doubt, go to urology clinic immediately, if necessary, make ultrasound examination in time, if there is problem and testicular volume is small, it is possible to make a semen analysis again, once all three examinations are found to be abnormal, surgery should be performed in time to prevent the occurrence of fertility and poor sexual function in the future.
2.For those who have symptoms of severe varicocele, surgery should be performed in a timely manner regardless of whether they are fertile or not.
3, for adult infertility, if other factors have been ruled out infertility should be operated regardless of light, medium or heavy.
4, usually in the sex side should be clean, reduce masturbation (some reported masturbation can aggravate varicocele), regular life, appropriate sex life, pay attention to hygiene.
5, my view on Chinese medicine treatment.
(1) First of all, for those who have severe varicocele with symptoms and abnormal sperm analysis, it is recommended that no herbal treatment should be used and surgery should be performed in time.
(2) For those who have moderate varicocele with mild symptoms and abnormal sperm composition, we can consider the use of Chinese herbal medicine in combination with traditional Chinese medicine for a period of six months for observation. Because Chinese medicine has a certain role in improving sperm vitality, sperm density, viability and liquefaction time, some patients have a certain percentage of wife conception through Chinese medicine treatment.
(3) Necrospermia is a contraindication to traditional Chinese medicine, and it is advisable to find out whether the cause is primary, testicular spermatogenic cell disorder or obstruction of the output pathway, and to find the cause in time for timely treatment.