Overview
Varicocele is a common disease in young men. The veins in the spermatic cord are obstructed in blood return for some reason, causing the trapezius plexus in the spermatic cord to become tortuous, elongated and dilated, forming a worm-like mass in the scrotum, which is called varicocele.
Symptoms
1. Patients may be completely asymptomatic and only found during physical examination.
2, the affected scrotum or testicles have a feeling of swelling or pain, the scrotum is enlarged, the affected scrotum and testicles are lower than the healthy side when standing, the scrotal surface can be seen dilated and tortuous veins. The scrotal surface can be seen as dilated and tortuous veins. There are earthworm-like soft masses when touched, and the symptoms can be reduced or disappeared by lying down.
Patients may have symptoms of neurasthenia, such as headache, fatigue, hypersensitivity, etc. Some patients have sexual dysfunction. Some patients have sexual dysfunction.
4, varicocele can sometimes affect fertility. 9% of varicocele patients have infertility, and 39% of male infertility is caused by varicocele. Severe cases can cause testicular atrophy. The reason is that the temperature in the scrotum of the affected side increases and reflects to the opposite side, causing the degeneration and atrophy of spermatogonia and the decrease of sperm count; or the left adrenal gland secretes pentraxin or steroids through the left internal spermatic vein into the testis, causing the decrease of sperm count.
[Etiology].
(a) Anatomical factors: Blood from the testes and epididymis flows back through the spermatic cord vein, which can be divided into three groups, and they have lateral circulation at the outer ring to traffic with each other.
Posterior group: external spermatic vein → inferior abdominal wall vein → femoral vein → external iliac vein.
Middle group: vas deferens vein → superior vesical vein → internal iliac vein.
Anterior group: internal spermatic veins: the veins of the testes and epididymis mainly return through the trapezius plexus of the spermatic cord, which merges into two to four veins in the inguinal canal and crosses the internal ring to the peritoneum to form one vein, called the internal spermatic vein. On the right side, the internal spermatic vein enters the inferior vena cava obliquely; on the left side, it enters the left renal vein at a right angle.
The reasons why varicocele is mostly seen on the left side are.
1. the left internal spermatic vein is long and enters the renal vein at a right angle, and the blood flow is subject to certain resistance. The left internal spermatic vein near the left renal vein has no valve, so the blood is easy to backflow.
2.The left internal spermatic vein is located after the sigmoid colon, which is easily compressed by the feces in the intestine and affects the blood reflux.
(B) Physiological factors: The sexual function of young adults is more vigorous, and the blood supply of scrotal contents is strong. So some varicocele can disappear gradually with age. In addition, standing for a long time and increasing abdominal pressure is also a factor in the development of varicocele.
(C) Other factors: retroperitoneal tumor, renal tumor, hydronephrosis, etc. compressing the veins in the spermatic cord can cause symptomatic or secondary varicocele. The primary ones disappear quickly when lying down, while the secondary ones often do not disappear or disappear very slowly.
[Diagnosis
The diagnosis can be confirmed by the feeling of swelling in the scrotum and the varicose vein can be found in the scrotum when standing and disappears after lying down. The testicle on the side with severe varicosities is smaller and softer than the opposite side, suggesting reduced testicular function. In some patients with varicocele with infertility, there are abnormal changes in semen quality, reduced sperm count, reduced motility and increased immature sperm. In recent years, new technologies such as Doppler ultrasound stethoscope, scrotal temperature recorder, spermatic venography and radionuclide scrotal blood pool scan are used, which have important diagnostic value for varicocele, especially right-sided or occult ones.
【Treatment
Asymptomatic mild varicocele does not require treatment.
Non-surgical treatment: for more severe varicocele or with neurasthenia, the scrotum can be supported and cold compresses can be applied.
Surgical treatment: For severe varicocele, sperm count below 20 million for three consecutive times or testicular atrophy; if the varicose vein can disappear when lying down, high level ligation of the internal spermatic vein is feasible.
The surgical routes are as follows
1.High ligation of the internal spermatic vein via inguinal canal: the same as the hernia incision, the spermatic cord is revealed, the main trunk of the internal spermatic vein and its branches are identified and ligated. This surgical route is simple and commonly used. The dilated external spermatic vein and the testicular lead vein can be ligated at the same time. If an operating microscope is used during the operation, the result is better, the recurrence rate is low, and the complications are few.
2.Translateral iliac fossa route: an oblique incision is made in the left lower abdomen, the peritoneum is pushed open, and the internal spermatic vein is found behind the peritoneum and in front of the external iliac artery and ligated. The disadvantage is that the traffic branch cannot be treated at the same time.
Recently, a catheter has been inserted through the inferior vena cava and left renal vein to the left internal spermatic vein, and then injected with 5% sodium cod liver oil or gelatin sponge and steel ring to embolize this vein to treat varicocele. The disadvantage is that the vein is deformed and has collateral circulation, which is not suitable for embolization, and special equipment is required.
Prevention
1, pay attention to maintain a relaxed mood, avoid anger injury liver, pay attention to diet adjustment, avoid eating spicy things.
2, pay attention to the combination of work and rest, to prevent strenuous exercise, heavy physical labor and long standing.
3, abstain from sexual intercourse, often wear tight underwear or scrotal support to prevent the scrotum from falling.