According to my long-term practical experience in surgical treatment and combined Chinese and Western medicine therapy for varicocele, I shall talk about varicocele as follows.
Varicocele is the most common cause of male infertility patients.
Research on the harm of varicose spermatozoa to the body has found that the following factors are related to.
1, blood stagnation in varicose veins, resulting in increased local temperature of the testes and affecting sperm production.
2. Blood retention affects the blood circulation in the testes, causing the testes to lack the necessary nutrient supply and oxygenation, which affects sperm production.
3, The above factors can also affect the endocrine function of the testicular mesenchyme and interfere with sperm production.
4.The varicocele on the left side can also affect the function of the right testicle. There is a rich anastomosis of the testicular veins on both sides, and the toxins in the blood on the left side can go to the right side and affect the sperm production of the right testicle.
5, the reverse flow of blood in the left spermatic vein will bring the metabolites secreted by the adrenal glands and kidneys such as steroids, catecholamines and 5-hydroxytryptamine to the testes, steroids can inhibit spermatogenesis, catecholamines can make the testes chronically toxic, 5-hydroxytryptamine can cause vasoconstriction, cause premature shedding of immature sperm and cause male infertility.
If varicocele is not effectively treated for a long time, it will have a great impact on male fertility. At present, the main treatment is through surgery, and the better surgical method is minimally invasive surgery varicocele ligation.
Spermatic vein ligation can improve semen quality in 60% to 80% of patients, with a postoperative conception rate of 20% to 60%, and can also improve serum testosterone levels in patients with infertility with decreased serum testosterone (Su etal, 1995). A randomized study showed that in both groups of patients with varicocele, the conception rate after one year was 44% in the operated group; compared to 10% in the non-operated group (Madgar etal, 1995). The outcome of surgery is related to the degree of varicocele. The semen quality improved significantly after surgery for severe varicocele, but the conception rate was not significantly different from that after surgery for mild varicocele. This is presumably related to the fact that severe varicocele affects semen quality more significantly before surgery. Some data suggest that the earlier the surgery is performed, the better the results are and that further damage to testicular function from varicocele can be reduced. Complications such as recurrence of varicocele, testicular artery damage, and postoperative edema can all affect the outcome of the procedure.
Varicocele does not always affect fertility. Microscopic surgery for varicocele is mainly used to treat patients with infertility. The effect of varicocele on fertility is related to the course of the disease, so early surgery is advocated to minimize the effect of varicocele on fertility, especially in asymptomatic varicocele, which rarely attracts the patient’s attention and may require treatment only because of infertility. There is no unified standard for the indications for surgical treatment of varicocele, but in principle there are the following.
1, varicocele with infertility;
2.Patients with severe varicocele;
3.Patients with bilateral varicocele;
4.Mild or moderate varicocele with abnormal semen quality or obvious symptoms (such as swelling and pain) or testicular shrinkage and softening texture.
5.Adolescent patients are limited to those with severe varicocele, obvious symptoms (continuous pain) and ipsilateral testicular growth retardation and volume reduction.
Surgical method: Spermatic vein microscopic surgery
Microscopic surgery for varicocele is the safest surgery for varicocele. 10x microscope can clearly see arteries, veins, lymphatic arteries, vas deferens, etc.
Surgical incision under the external ring.
1.In supine position, take an oblique incision under the external ring, about 1 to 3 cm long, and free the spermatic cord.
2.Ligation of the levator muscle vein, internal and external spermatic veins and vas deferens veins larger than 3mm, paying attention to protect the vas deferens, testicular artery and lymphatic vessels from damage.
3.After making sure that there is no vein leakage, the spermatic cord is returned and the skin is sutured.