Varicocele is a blockage of venous return to the spermatic cord that causes stagnation of blood, resulting in elongation, dilation and tortuosity of the trabecular plexus. The prevalence of varicocele in adolescents can be as high as 19%-26%, mostly on the left side. Forty percent of men seen for infertility have varicocele. They are detected clinically at the age of 10C15 years and once present, do not disappear on their own. If there are no varicoceles in adolescence, they usually do not develop in adulthood. Approximately 85% of adults with varicocele are fertile, but if one waits until adulthood to deal with varicocele due to infertility, the patient appears to remain infertile.
[Etiology and pathogenesis
About 95% occur on the left side. The main cause is the lack of valves in the spermatic vein and the long left internal spermatic vein, which enters the renal vein at almost right angles.
Diagnosis
(A) Symptoms
Most of them are asymptomatic and are often detected by physical examination. In severe cases, the symptoms may be manifested as a sensation of falling scrotum on the affected side, which is aggravated by exercise and prolonged standing.
(B) Physical signs
The scrotum is asymmetrical bilaterally, with the affected side lower than the healthy side. It is clinically classified into three levels.
(1) 1st degree: palpation is not obvious, and the varicose veins can be palpated only when the patient holds his breath and increases abdominal pressure.
(2) 2nd degree: varicose veins are palpable on palpation but have a normal appearance.
(3) Grade 3: varicose veins are visible on visual and palpation as a mass of earthworms.
(3) Laboratory tests
Color Doppler ultrasound auscultation technique can determine blood stagnation and reflux in the internal spermatic veins, increased vascularity and thickened internal diameter.
(D) Differential diagnosis
Secondary varicocele: due to abdominal diseases such as retroperitoneal tumor, renal tumor, giant hydronephrosis, ectopic vascular compression, etc. that increase intra-abdominal pressure. If suspected, ultrasound and other examinations should be done to differentiate.
Treatment
In 1st degree juvenile varicocele, testicular volume is normal and no treatment is needed.
If the testicular volume is normal, we can follow up and observe the testicular changes.
For those with degree 3, treatment is preferred. Because varicoceles are mostly fertile, but treatment of varicoceles when they become infertile in adults is often ineffective, so the advantages and disadvantages of treatment need to be weighed to deal with them.
The treatment of varicocele includes internal spermatic vein embolization and vascular ligation of the spermatic cord, the latter being the best. In recent years, laparoscopy has been gradually used in clinical practice because of the advantages of less damage, faster recovery, and simultaneous treatment of both sides.