Varicocele (VC) is one of the common genitourinary disorders in men and is a common cause of male infertility, which must be seen in a timely manner. However, patients often do not receive timely diagnosis and treatment due to lack of self-perceived symptoms, leading to infertility. How can we prevent or detect it in our daily life?
What is varicocele?
Every human life is inextricably linked to a small “tadpole”. However, some diseases may cause these “tadpoles” to lose their vitality or even die, and varicocele is one of them. So, what exactly is varicocele? And what causes it?
What is varicocele? What are the causes?
Varicocele is an abnormal dilatation, elongation and tortuosity of the trapezius artery plexus in the spermatic cord. It is a common condition in men. Varicocele can be caused by increased local pressure in the perineal veins, which can be aggravated in some patients by strenuous exercise or prolonged exercise. In addition, the incidence of varicose veins on the left side is significantly higher than that on the right side, which is mainly related to the anatomical characteristics of the left spermatic veins and their proximity.
Why do varicose veins cause infertility?
Varicose veins are veins of the testes, and varicose veins can cause changes in the environment of the testes, including changes in testicular temperature, PH value and blood flow factors, which can affect the environment of spermatogenesis in the testes and reduce the quality of spermatogenesis and affect fertility.
What is the prevalence of varicocele?
Overall, the prevalence in the general male population is about 10 to 20%. In infertile men, the prevalence is about 40 to 50 percent.
Is varicocele hereditary?
There is no evidence that varicocele is hereditary, but there are some epidemiological studies that suggest a higher incidence in families with varicocele than in the general population, but these are only partial national findings and there is no definitive evidence.
What are the symptoms of varicocele?
Many people may be unfamiliar with the term spermatic vein and do not know what it is, but he has a great impact on our fertility. What are the symptoms of varicocele? How should it be diagnosed?
What are the common symptoms of varicose spermatocele?
Varicocele usually causes discomfort in the perineum, such as testicular swelling and pain in the perineum.
How is varicocele diagnosed?
Varicocele can be diagnosed first by referring to clinical symptoms, but many times the clinical symptoms are not specific. The symptoms of testicular swelling and perineal pain are also known to be present in patients with prostatitis or chronic pelvic pain syndrome. Symptoms can indicate the presence of the disease, but not necessarily. Physical examination is an important tool to determine whether varicocele is present, and perineal examination can reveal whether varicocele is present. Varicocele can be clinically classified into three degrees. In more severe varicose veins (third degree), physical examination can directly reveal the presence of tortuous trabecular vessels in the perineum and scrotum. This can be seen directly with the naked eye. It is not very obvious when you look at it, but when you touch it with your hand, you can clearly feel the thickening of the veins, which belongs to the second degree. In milder cases, the thickening of the veins is not obvious when touched, but when the test of increasing abdominal pressure (Vasava test) is performed, the thickening of the veins is clearly detected when the pressure increases, which is the first degree. The examination will basically determine whether the patient has varicocele and what degree it is. In addition, an ultrasound of the scrotum can be done to check whether the veins of the spermatic cord inside the scrotum are thickened and to what degree, and this can be measured. In addition to thickening, it is also possible to check for reflux. Varicose veins can cause blood reflux, which may lead to an impact on the microenvironment of the testes and the ability to produce sperm, and the ultrasound can further clarify whether the varicose veins are present and the degree of varicose.
What treatment is required for varicocele?
Since varicocele is a concern for future generations, it should not be taken lightly. So, what treatment is needed for this disease?
What treatment is required when varicose veins are found? Can mild cases heal themselves?
The incidence of spermatic veins is quite high, but a significant number of patients do not need to receive treatment. There are two general categories of conditions that require treatment, one being changes in the microenvironment caused by varicose veins that affect sperm production. If the patient has varicose veins with decreased spermatogenic function, further treatment is needed to change the semen level through treatment, especially if it is accompanied by infertility conditions. The second category is symptomatic varicocele, where some patients with varicocele have symptoms that seriously affect their daily life and cause greater distress to the patient, and further treatment can be done.
How do patients undergoing treatment need to be treated? Does it have to be surgery?
Surgery is one of the main treatment options, but medications are also available. Some medications can improve the symptoms or improve the quality of the semen. These are the two main methods of treatment. There are also some adjunctive treatments such as scrotal braces and lifestyle modification that can be used as adjunctive treatments.
Can varicose veins recur after treatment? How often do I need to be rechecked?
Varicocele may recur after treatment. You will need to follow up with your primary care physician 2 weeks after surgery. This exam is to look for any recent post-operative complications such as edema. The second follow-up visit is usually 3 months after surgery. The main assessment is the semen level, or if the symptoms have decreased. If the procedure is performed for infertility, it is recommended to follow up every 3 months for at least one year. The follow-up includes medical history, physical examination, ultrasound and semen examination.
What can I do to avoid varicocele in my life?
To prevent varicocele, it is important to have a regular lifestyle, regular rest and exercise, but not excessively. Excessive exercise can lead to excessive venous pressure affecting the spermatic veins. Smoking and alcohol abuse also have an effect on the disease.
What are the common misconceptions?
The disease is not afraid of treatment, but it is afraid of not being able to treat the right symptoms. So, what are the misconceptions when it comes to the treatment of varicocele? What are the “misconceptions” about varicocele in life?
Does masturbation cause varicocele?
Masturbation and failed intercourse are not directly related to varicocele.
Are frequent cyclists prone to varicocele?
If you ride a bicycle often, if you sit in an improper position, the pressure on the perineum will be more obvious and will lead to or aggravate the disease over time. If you are a cyclist, you need to adjust the cushion to a comfortable position to avoid compressing the perineum. Avoid prolonged cycling, as compression of the perineum has a certain effect on blood return.
Are varicose veins related to the condition of semen?
It has been studied that varicocele may have an effect on spermatogenesis, but it is not 100% possible for a specific patient, and some patients can have a decrease in spermatogenic function. However, there are many patients whose semen tests are normal. There is a link between varicocele and semen quality, but it is not absolute and should be evaluated after a specific examination.
Is treatment not necessary for severe varicocele but fertile?
Severe varicocele, but fertile and without serious clinical symptoms, may not require special treatment.
Can varicocele affect erectile function?
There is no direct relationship between varicocele and erectile function. However, theoretically, there may be an indirect effect. Some studies have shown that testosterone levels are lower in patients with varicocele than in normal people. Testosterone is the main androgen, and there is a link between androgens and a person’s libido and sexual performance, including erectile function. Androgen levels can link these two disorders together. Secondly, some patients with varicocele clinically present with pain in the perineum and a feeling of testicular swelling, symptoms that themselves have an impact on sexual life. There is no direct link between varicocele and erectile function, but indirect effects are present.
Will the varicocele be significantly enlarged or painful during erection in varicocele patients?
Patients with varicocele, who have clinical symptoms themselves, may have symptoms that worsen during sexual intercourse, but there are patients who do not have an effect. Erectile function depends mainly on the corpus cavernosum of the penis. The spermatic veins are part of the testicular vasculature and will be involved in erectile function, but erection is still primarily dependent on the corpus cavernosum and the spermatic veins are not the most directly connected.
What form of spermatic vein surgery is performed?
There are several common surgical approaches. The first is open surgery, one through the inguinal route and one through the retroperitoneal route. The purpose of both procedures is to find the diseased vessel and then ligate it. The varicose and diseased vessels can affect the sperm production environment of the testes, and ligation can avoid the effect of harmful substances on the semen of the testes. The second type of surgery is microsurgery, which has two routes via the inguinal region and under the external ring. Microsurgery is a smaller incision than open surgery, where the varicose veins are separated out under a microscope and then ligated. This procedure requires more specialized skills and a longer operative time, but certain patients have better results. A third type of treatment can be performed laparoscopically. The diseased vessel is ligated laparoscopically. Regardless of the surgical procedure, the goal is to ligate the diseased vessel.
Do all patients with varicocele need surgery?
No. Patients with varicocele do not always need surgery. Some patients do not require surgery, but follow-up is recommended. Follow-up is recommended for patients with varicocele whose semen test results are normal but who are not married or do not want to have children at this time. Although the semen is normal now, it is possible that the quality of semen will decline with the passage of time. You may find that you are already suffering from infertility when you want to have children. Therefore, it is recommended that this type of patient should have a follow-up examination every one to two years. If the quality of semen decreases, it should be treated promptly. In addition, adolescents with varicocele, where semen cannot be evaluated, need to be followed up, annually. In addition to physical examination and ultrasound, special attention should be paid to testicular size. If the testicle on the side of the varicocele is found to be shrinking, it should be treated promptly. If semen can be retrieved by late adolescence, semen evaluation should also be performed, and if spermatogenic function decreases, treatment should also be performed.
Is it better to perform surgery early or late for varicocele patients?
It is important to combine the patient’s wishes and to communicate with the patient whether to operate for the disease or not. If the varicose veins are severe but do not affect fertility, surgery is generally not recommended. However, if the varicocele is severe and the patient already has children and the semen is normal, but if the patient still wants to have children in a few years, he or she should be followed up and if the semen quality is found to be declining, surgery should be performed. In children with varicocele, evaluation is also performed to exclude some primary diseases (e.g. Nutcracker syndrome) causing secondary varicocele, and if necessary, the primary disease needs to be treated. In addition, tumors growing in the peritoneum, may also cause varicocele. In adolescents with varicocele, in addition to the common causes, it is important to look for other primary diseases.