Varicocele : causes, symptoms, treatment , complications
Urology / / August 12, 2017
What is a varicocele?
varicocele - is varicose veins of the scrotum and spermatic cord.Quite a common disease that affects one in six men aged 16 years do25.It is not life threatening, and often does not require treatment.However, sometimes varicocele can cause infertility because it affects the quality and quantity of produced sperm.
Of all men with infertility, about 40 percent have varicocele, at least one testicle.
The disease may progress over time and cause a decrease in testicular size.Fortunately, in most cases, easily diagnosed varicocele.At occurrence of symptoms of pain and infertility solve problems and can restore normal function surgically.
Causes and risk factors for the development of varicocele
any major risk factors, in addition to stagnation in the pelvic organs, constipation, irregular sexual life, heavy physical work and being overweight, for the development of this disease is not observed.
In rare cases cause a varicocele can kidney tumor
cause of varicocele are defective valves veins of the scrotum, regulating blood flow to the testicles.Valves veins of the scrotum under heavy load (which can be physical stress) can not cope with the increased pressure, the blood stagnates, and the veins start to gradually expand.
addition varicose veins can occur due to anatomical features, but also because of the failure of the connective tissue, its underdevelopment in utero.
also cause may be complications caused by pathological processes in the kidneys, retroperitoneum, or pelvis.
disease usually manifests at puberty, and about 85 percent of the cases observed in the left pane of the testicle.Poor circulation caused varicocele increases the blood temperature, which adversely affect sperm production process.
Even if there is a varicocele in one testicle, it can affect sperm production in both testicles.
Varicocele is one of the main causes of infertility in men of reproductive age.Timely detection of the disease and its appropriate treatment with a positive outlook.
100 000 adult men disease affects 15 000 people.
Of the 100 000 men suffering from infertility, 40,000 have a varicocele.
incidence increases closer to adolescence and to adulthood.
- 800 of 100 000 boys between the ages of 2 to 6;
- 1,000 of the 100,000 boys between the ages of 7 to 10;
- 7800 of 100 000 boys aged 11 to 14;
- 15,000 out of 100,000 boys over the age of 15.
Bilateral testicular damage is unusual for boys under the age of 11 years.After 11 years, 100 boys out of 1,000 cases may be bilateral varicocele.
Symptoms of varicocele
nature of onset of symptoms depends on how dilated veins of the spermatic cord, so in the early stages of varicocele usually causes no symptoms.
The longer the illness, the stronger the symptoms.
varicocele main symptoms include:
- Pain. Typically, patients complain of dull, aching pain in the scrotum.It can also vary from feeling discomfort and gravity during walking, to severe, acute pain and a burning sensation in the testes.The pain may be aggravated during the day due to the increasing pressure in the affected veins, especially in hot weather or after exercise, and if the patient is forced for a long time to sit or stand.Usually, the pain diminishes when the patient lies on his back.
- Testicular atrophy. Some patients complain of sexual dysfunction.When deletion of a testicle on the affected side may be observed asymmetry and sagging scrotum, as well as a decrease in testicular size.
- Changes venous pattern. With the progression of the disease varicose veins can be observed under normal inspection.
- Fertility Problems. There is a relationship between varicocele and infertility or subfertility.Other signs of varicocele may be a reduction in sperm count, decrease in mobility or an increase in the number of deformed sperm.It is not known exactly which contribute to these problems makes varicocele, but the general theory is that in this state of increased testicular temperature that affects the production of sperm.
Detection swelling in the scrotum, the testicles change the size and the presence of different character of pain is a signal for immediate access to medical care, as these symptoms may be caused not only by a varicocele, but also with other, more serious diseases.
diagnosis of varicocele
The disease is usually diagnosed in boys during sports physicals, or before joining the army.
varicocele can be found in normal visual inspection, since veins uviform plexus have the ability to increase or decrease in size in different postures: standing, they increased in the supine position - decrease.Status veins can also be determined by careful palpation of the scrotum.
other methods of examination and diagnosis of varicocele are:
- Ultrasonic doplegrafiya - to evaluate disorders of blood flow to the testicles and the severity of congestion;
- Thermography - absolutely harmless, non-invasive method of investigation that allows to detect local hyperthermia (increase in temperature) because testicular veins;
- phlebography - a study of veins by injection of contrast medium, which allows to see the blood vessels.
- semen analysis. Spermogram to determine the quantity and quality of sperm: ejaculate volume, semen consistency, sperm count per 1 ml of semen, sperm aktivnopodvizhyh percentage, the percentage of slow-moving sperm, the percentage of fixed sperm, percentage of dead sperm.
results of semen can be:
- oligospermia - reducing the volume of ejaculate,
- oligozoospermia - reduction in the number of sperm in the semen,
- spermatoschesis - no
sperm - azoosperimya - absence of sperm in the semen
- asthenozoospermia - decrease sperm motility in semen,
- nekrozoospermiya - the presence of dead sperm,
- piospermiya - the presence of pus in the semen,
- gemospermiya presence of blood in the semen.
Treatment of varicocele
In the initial stage of varicocele treatment is usually not required.All activities at this stage are intended to prevent stagnation in the pelvis, by limiting physical stress, eliminate constipation, wear comfortable underwear.
indications for treatment are in constant pain, discomfort, testicular atrophy and infertility.
to remove the painful symptoms and discomfort are usually prescribed anti-inflammatory drugs, the use of soft and comfortable underwear.
is most effective surgical treatment of varicocele.
Surgical treatment usually involves dressing the affected vein to redirect the flow of blood to normal veins.The surgery is performed on an outpatient basis, using both open and laparoscopic techniques, under general or local anesthesia.
Laparoscopy is performed under general anesthesia by introducing laparoscopy in the abdominal cavity through a small incision.
possible postoperative complications are:
- Accumulation of fluid around the testicle (hydrocele);
- Recurrence of varicocele;
- Damage to the artery.
Achievements in the field of medicine, the use of special operating microscopes minimize possible complications.
Patients usually tolerate surgery well, experiencing minimal pain after the operation.To eliminate the pain of discomfort in the first few days after surgery, the doctor may recommend painkillers, such as acetaminophen (Tylenol) or ibuprofen.
Recovery is fast and already after two days, patients can return to normal activities.However, it is within two weeks refrain from significant physical activity and intercourse.
After three - four months it will be possible to hand over analyzes and to determine how the operation affect fertility.
Approximately half of the men in the first year after surgery successfully overcomes the problem of infertility.
Percutaneous embolization - minimally invasive method of treatment of varicocele.Produced under local anesthesia.The subclavian vein in the inguinal or catheter inserted through the lumen which is to close the vessel installed spiral.This procedure leads to scarring of veins and create blockages in the veins of the testicles facilitating overlapping flow of blood.
Complications are very rare, some of them can be attributed
- Penetration of infection;
- Tissue damage scrotum or nearby blood vessels;
- Allergic reactions.
If you have varicoceles, does not cause you much discomfort except for minor pain, and did not affect fertility, you can try the following means:
- Use painkillers, such as acetaminophen (Tylenol, etc.) Or ibuprofen.
- Wear comfortable, it is possible sportswear.
itself varicose veins of the spermatic cord is not a big problem, the patient's life is not threatened, and with it you can safely live life without any worries.
varicocele can cause the following complications:
- A decrease in the size (atrophy) of the affected testicle.The exact reasons appealing this size reduction is not known, although researchers believe that it results from damage to the tubules in which sperm is produced, due to increased pressure in the veins of the scrotum and the effects of toxins present in the blood.
- Infertility.Vienna scrotum promote cooling by passing eggs arterial blood, and thus maintain the optimum temperature for sperm production.Varicocele causes blockage of blood flow, thereby increasing the temperature of the testes and disrupting the formation and motility.
connection between varicocele and male infertility is a subject of ongoing debate.Of the 1,000 men who have infertility, 400 suffer from varicocele.The exact mechanism of the harmful effects of varicocele on sperm quality or quantity is unknown.
There is some evidence that testicular atrophy, low number and poor sperm motility associated with varicocele.Some of these parameters are improved after surgery.
To reduce varicose veins of the spermatic cord is sometimes enough to eliminate stagnation in the pelvic organs, so effective measures to prevent the disease include:
- normalization of stool;
- exclusion of long-term physical exertion;
- regular sex life;
- avoiding alcohol and smoking;
- physical activity and sports;
- enough rest;
- balanced diet and taking vitamins.
As a result of such measures, in some cases decreases veins, the disease does not progress.