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Abstract: A 26-year-old male patient presented with left scrotal swelling and discomfort six months ago, and his symptoms worsened 1 week ago with vague pain.
Basic information】Male, 26 years old
Type of disease】 Varicocele (left side)
Hospital】Xiang Ya Hospital of Central South University
Date of consultation】April 2022
Treatment plan】Medication (heptaosaponin sodium, diosmin tablets, ibuprofen extended-release capsule, vitamin E soft capsule)
Treatment period】Inpatient treatment for 1 week, review after 3 months of discharge from hospital and long-term follow up
Treatment effect] Symptoms improved, stable condition
I. Initial consultation
The patient complained of occasional discomfort in the left scrotum after sitting for six months, no fever and chill, no pain in the lower back and abdomen, no urinary frequency, urinary urgency, urinary pain and effort to urinate, light yellow urine. Outpatient ultrasound showed that the left testicle was 37x17x26mm and the right testicle was 37x18x25mm. The testicles on both sides were regular in shape with medium parenchymal echogenicity, fine light points and uniform distribution, and the epididymis was not large. A 3x2mm echogenic nodule was seen in the right epididymal head, with regular morphology, clear border, thin wall, and internal transmissive sound, and posterior echogenic enhancement, and no obvious blood flow signal was seen in the nodule by CDFI; the left spermatic vein was tortuous and dilated, with a wider internal diameter of 3.3mm, while the right spermatic vein did not show obvious varicose. The patient’s right epididymal head cyst was found after examination, but considering that the volume was small, no special treatment was carried out for the time being, and the patient was followed up and observed.
II. Treatment history
After the patient was admitted to the hospital, combining the examination results and his medical history, we considered that conservative treatment could achieve the desired effect. After communicating with the patient and obtaining his understanding, treatment was actively carried out. The patient was given sodium heptaoside tablets, which are anti-inflammatory, protect the collagen fibers of the vein wall, and help restore the elasticity and contractility of the vessel wall. The use of Diosmin tablets improves venous circulation, reduces capillary permeability, and decreases edema. As the patient complained of severe pain symptoms, she was given ibuprofen extended-release capsules to reduce the symptoms. Considering the patient’s need for fertility, he was advised to take vitamin E soft capsule to improve semen quality. The patient’s symptoms improved after 1 week of hospitalization with medication and was arranged to be discharged for convalescence and reviewed after 3 months, with prompt medical consultation if there was any discomfort.
III. Treatment effect
The patient’s left scrotal swelling and discomfort increased before treatment, accompanied by vague pain. After 1 week of admission, the patient complained of relief of vague pain and a significant reduction of scrotal swelling after treatment with anti-inflammatory, circulation improvement, analgesia and semen quality improvement drugs. The ultrasound showed that the testes were normal in size bilaterally, and no significant varicose veins were seen bilaterally. The patient recovered well and was instructed to stop the medication and to review once a year.
IV. Precautions
After the patient’s condition was stabilized, his anxiety was relieved and I, as a doctor, felt the same way. At the same time, I emphasized to the patient that the following points should be noted in life.
1. Patients should establish good habits of work and rest after discharge from the hospital, work and rest regularly, ensure enough sleep and avoid staying up late to help the recovery of the disease.
2, patients should follow the doctor’s instructions to take medication on time and in accordance with the amount, not because the symptoms improve or aggravate, and their own increase or decrease the amount of medication, replace new drugs, stop, etc., so as not to cause aggravation of the disease.
3. Pay attention to balanced nutrition and adequate vitamins, proteins and other nutrients required by the body to enhance physical fitness.
V. Personal insight
Varicocele is a common cause of male infertility, because the left spermatic vein is longer and merges into the deep vein at a right angle, which is easily compressed by the abdominal aorta, sigmoid colon and superior mesenteric artery, and varicocele occurs well. The patient in this case is a typical left spermatic varicocele, but after timely and effective treatment, he was cured without serious adverse consequences. After discharge, the patient should follow the doctor’s orders for regular review and long-term follow-up. If the enlargement of scrotum becomes worse and painful, the patient should seek medical attention in time to clarify the cause and then actively treat it.