Varicose tortuosity of the spermatic cord veins is one of the common pathologies in men. The peak diagnosis of varicocele occurs in 14-15 years. In general, 15-30 years is exactly the age when the pathology is most common. Most of this disease is observed in athletes and persons engaged in physical labor. Therefore, it can be confidently stated that muscle load plays an important role in the expansion of the veins of the spermatic cord.
This pathology has a significant effect on male reproductive function. And given that up to 30% of the male population suffers from varicocele, the urgency of the problem becomes apparent.
What is a varicocele?
The spermatic cord, in addition to other elements, includes the sphenoid venous plexus. It is it that is affected by varicocele. The veins of the spermatic cord pathologically change, become dilated and convoluted.
Why it happens? This disease occurs due to a violation of the venous outflow, as a result of which blood accumulates in the venous plexus, stretching and deforming the walls of blood vessels.
Etiology of varicocele
The vessels belonging to the system of the inferior vena cava are equipped with special valves, because the blood flows through them from the bottom up. Were it not for this device, most of the blood simply would not reach the heart; however, the presence of a valvular apparatus is very effective in fighting blood stasis and its retrograde (in the opposite direction) movement.
The main cause of varicocele in adolescents is testicular vein insufficiency. Normally, blood from the plexus plexus enters the renal vein system or directly into the inferior vena cava through the testicular veins. It is problems with valves at the level of the latter that are the main cause of the development of the disease.
Valvular insufficiency can be primary (as a result of congenital pathology of the testicular veins, muscle weakness of the latter or
connective tissue dysplasia) and secondary (arising as a result of increased pressure in the system of the inferior vena cava or renal veins). The causes of secondary valvular insufficiency include all pathological processes that compress the spermatic cord, testicular, renal veins or directly the inferior vena
cava, making it difficult for blood to flow through them: tumors of the abdominal cavity, hernia, adhesions, etc. One way or another, a situation arises when the blood begins stagnate in the vessels of the spermatic cord.
Classification of varicocele
WHO recommends the following classification of the disease:
- The veins of the plexus plexus are not only well defined to the touch, but are also visually visible. The testicle is wrinkled.
- Veins can be palpated, although they are invisible.
- Positive test of Valsalva. Neither see nor palpate veins outside the specified sample is impossible.
However, in our country, the classification of Yu.F. Isakov is most often used. She, like the previous one, distinguishes three stages, although the severity of the disease is indicated in the reverse order. It looks like this:
- Veins are invisible, not detected by touch. Varicocele can be suspected only by the Valsalva test.
- Veins are well palpated, but invisible.
- The veins are both visible and palpable. The testicle is modified.
By the way! The Valsalva test is performed as follows. The patient in a standing position is asked to cough. As a result of this, the pressure in the abdominal cavity rises, and the veins of the plexus plexus swell. Often, for comparison, carry out the specified test and in the supine position. In this case, the test will be negative.
Clinical picture
Typically, varicocele in adolescents occurs without any subjective sensations. Rarely, some patients complain of a feeling of heaviness or pain in the scrotum after exercise. However, these symptoms should be treated with caution, because often they are the first signs of inflammatory processes of the testicles and their membranes (orchitis and orchoepididymitis).
What is the danger of varicocele?
The testicles in men are the place where the formation of sperm, germ cells, fertilizing the egg takes place. These organs are extremely important in terms of their participation in the reproductive function.
With varicocele, due to the accumulation of a large amount of blood in the venous plexus, a local increase in temperature occurs, which adversely affects spermatogenesis. In addition, with varicocele, the supply of tissues and cells of the testicles with oxygen deteriorates, hypoxia occurs; the hematotesticular barrier is disrupted, which can lead to the production of antibodies in the body that destroy sperm (after all, they become perceived by the immune system as hostile agents). Varicocele is often accompanied by hormonal disruptions, which also badly affects the spermatogenesis process.
The testicles in men are extremely sensitive to all of these processes, so any of them can easily lead to impaired sperm and sperm formation.
However, it should be noted that the role of varicocele in the formation of infertility is still being studied. Not everyone believes that the above mechanisms underlie the pathogenesis of varicocele in adolescents. Therefore, the role of spermatic cord vein expansion in male infertility remains somewhat controversial.
What to do?
The most commonly diagnosed varicocele in adolescents. Treatment, respectively, is performed in adolescence. It is known that there are two types: conservative and surgical. If we talk about varicocele in adolescents, the first point can immediately be excluded. Conservative treatment of this pathology does not exist. But the number of operations used to rid patients of this ailment is large.
Types of surgical interventions for varicocele
All operations on the testicles can be divided into several groups:
1. Surgery based on excision of the spermatic cord veins. At present, they are no longer used, since after their use in 90% of cases testicular atrophy was noted.
2. Operations fixing the testicle to the elements of the inguinal canal or muscle aponeurosis. Now they are not used, as they are accompanied by testicular atrophy (20-70% of cases).
3. Resection of the scrotum with external fixation of the testicle. Relapse of varicocele occurs in 100% of cases, so this operation is ineffective and is not currently used.
4. Ligation of the testicular vein over the inguinal fold. This type of operation leads to the cessation of retrograde blood flow and gives the lowest percentage of relapses. However, studies have shown that varicocele is not always an independent pathology. This disease can only be a symptom, indicating the presence of a problem leading to venous hypertension. In this case, this operation may aggravate the situation.
5. Surgery to create vascular anastomoses. Their essence lies in the fact that venous reflux persists, but due to the creation of an anastomosis, excess blood is discharged, and the expansion of the veins decreases.
Currently, in the treatment of varicocele in adolescents, surgery is not always an extensive intervention with opening the abdominal cavity. Minimally invasive methods of treatment exist.
Mini Access Surgery
The most common operation for treating varicocele is Marmara. It is performed under local anesthesia. In the inguinal region, from the side where the pathological process developed, an incision of 2-3 cm is performed. Elements of the spermatic cord are dissected from this access, a vein is extracted, it is pulled by the ligature and intersected. The wound is sutured in layers.
As follows from the description, the operation is not abdominal and can even be performed on an outpatient basis. Sutures are removed on the 8th day.
In the postoperative period, during the first week, fixation of the scrotum is important (achieved by wearing swimming trunks). In the 1st month should abandon sexual activity.
Laparoscopic clipping
Another method with a good cosmetic effect. Through a puncture in the anterior abdominal wall with the help of special tools, testicular veins are isolated, clip and cross them.
Compared with an open operation, this method has several advantages:
- A short postoperative period due to the almost complete absence of a wound, because surgical intervention is carried out through a puncture, not an incision.
- There is no risk of postoperative hernia.
- Good cosmetic effect.
- A small probability of postoperative complications.
Endovascular phlebosclerosis
This method is an alternative to surgery. Its essence lies in the fact that a sclerosing substance is injected into the testicular vein, which helps to form a blood clot and stop the flow of blood through the vein. It is performed only if there is no reason to assume secondary valvular insufficiency and venous hypertension.
The main thing that should be understood by patients suffering from varicocele is the timing of the operation is extremely important. It is proved that timely treatment significantly reduces the risk of developing spermatogenesis disorders and the formation of infertility.