Varicocele - a gradual process of varicose veins in the spermatic cord and around the testis. The process is formed as a result of pressure rise in testicular vein area or valvular disorders therein.
In most cases, varicocele detected in adolescent boys due to the formation of secondary sexual characteristics and the beginning of spermatogenesis (sperm formation under the influence of hormones). 10-12 years varicocele almost does not occur often, the first time it is diagnosed at the initial examination in the military.
Most often affects the left testicle and its vessels, this is due to anatomical venous plexus. About 30% of cases of varicocele is reversible, and the right-hand is very rare, mainly as a manifestation of other pathologies - tumoral process in the kidneys or abdomen.
Although the life and health of the disease does not stop, and it is quite possible to live, the urgency of this problem is that often running process can lead to painful scrotum or reduce male fertility - the ability to conceive children.
Minimal changes (according to ultrasound) Can be found in 30-35% of men, and expressed infringements detected in 7% of young people aged 15 to 25 years.
Causes
In the development of varicocele, there are several main reasons:
- disruption or failure of the valve apparatus of the veins in the spermatic cord,
- inborn error ratio anatomical renal vein with the upper mesenteric artery, with This forms a pathological extension vein as a result of its clamping (as tweezers) between the artery and aorta. vein wall expands, twists, there is stagnation of blood in the eggs begin to squirm small veins, the egg may become, as it were braided convoluted network of small veins.
All of these changes in the scrotum lead to malfunction of the testis and sperm production by;
- increase scrotal temperature due to stagnation of blood around the testis,
- hypoxia (oxygen deficiency) the eggs,
- accumulation in the tissues of the testis free radicals that damage it.
For the development of varicocele there is a genetic predisposition traced hereditary testicular malfunction in a family in the male line. This is due to the inheritance of particular weakness of the vascular wall in the pelvis and scrotum, failure or shortening of valves in the veins.
stands out:
1. Primary varicocele occurs for the reasons described above as an independent disease.
2. Secondary varicocele, arises as a result of common diseases or pathological states of the organism, such as:
- chronic constipation or diarrhea,
- heavy lifting,
- voltage of the anterior abdominal wall,
- abdominal trauma with the formation of edema in the retroperitoneal space, where the veins,
- long breaks in sexual life with stagnation of blood in the pelvis,
- tumors of the abdominal cavity and vein shears violate outflow of blood.
Kinds
According to the degree of manifestation varicocele share his clinical and subclinical (not detectable change only visible by ultrasound).
In the first case, there are three steps:
- visual changes are not visible, palpable varicocele straining,
- varicose veins easily felt but not seen them visually,
- changes are easily visible during inspection and probed well.
symptoms of varicocele
Varicocele usually formed at puberty and progresses no further. In most cases it is asymptomatic and detected on prophylactic examinations.
By the manifestations of severe varicocele include the following features:
- increased half scrotum, particularly in a standing position,
- the omission of the scrotum, usually on the left,
- feeling of heaviness in the scrotum or stretching zone,
- heaviness in the testicle or discomfort in the groin, especially when standing,
- decrease in size during testicular palpation,
- palpation of the veins in the form of crimped laces,
- infertility.
In severe cases, there are:
- in testicular pain,
- a significant increase in the scrotum,
- protruding vein in the groin and scrotum,
- the affected testicle is dramatically reduced.
Since varicocele can lead to infertility, usually verified by semenWherein detected:
- reduction of spermatozoa
- impaired sperm motility,
- nekrospermiya and teratospermia (dead or abnormal forms).
Without operation varicocele chance of having children is about 10% with timely operational correction of disturbances rises to 80-90%.
may gradually decrease due to varicocele production testosterone and there comes a premature aging. Furthermore, due to circulatory disturbances, the reverse flow to the testicle adrenal biologically active substances (the prostaglandins) and metabolic disorder occurs in the testes area with their gradual atrophy.
Diagnostics
Usually varicocele detected on inspection or examination for infertility. Basis of diagnosis - inspection and palpation of the scrotum blood vessels. However, the inspection method is rather subjective and can not catch the early changes in the vascular zone.
Complementing the research scrotal ultrasound vessels with dopplerography - color display on the screen flow and appearance of the veins. It is necessary to conduct research in the standing, lying down and straining to assess the degree of stagnation of blood in the veins.
varicocele treatment
Diagnosis and treatment of varicocele engaged in surgery and urology. varicocele treatment with surgery alone, the main indications for him:
- violation sperm quality,
- discomfort or pain in the scrotum,
- aesthetically unsatisfactory appearance of the genitals,
- testicular atrophy.
The essence of the operation - this ligation of varicose veins and blood redirection of normal testicular veins. For this purpose, several methods proposed operations:
vascular embolization (in other words, their blockage). Advantages of this method - fast recovery, no seams on the operation. The disadvantage of this method is the possibility of blood flow through the bypass paths and recurrence.
Laparoscopic surgery (microtools introduction through small puncture with ligation of vein).
Surgical correction varicocele (with microsurgical access and full operation). Mainly it performed in complicated cases.
Forecast
When the timely correction of the reproductive function and the work of the eggs quickly restored in full.