Varicocele disease - causes, symptoms and treatment methods

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Varicocele is an enlargement of the veins in the seminal vesicles, which results in impaired venous flow in the testicles. Discomfort in the testicles is a pathology that is sometimes manifested by pain and dilated veins when seen with the eye. Dilated veins can sometimes become inflamed or ruptured, causing bleeding into the testicles. If varicocele is not treated in time, the size of the sperm will decrease, the process of spermatogenesis will be disrupted, leading to infertility and "early menopause" in men.

Varicocele is an enlargement of the veins in the seminal vesicles, the disease itself is not life threatening and does not cause any discomfort. However, it can lead to "painless" infertility in men. When the sperm fluid of patients suffering from varicocele was examined, it was found that the process of spermatogenesis was impaired in 20-70% of them. In medicine, there are also indicators that determine the level of varicocele based on a spermogram. Varicocele rarely causes pain.

According to WHO statistics, 15-17% of men worldwide have varicocele. The frequency of varicose veins also depends on the age and living conditions of men. It is detected in 14-15% of adolescents aged 19,3-5 years, and in 7-35% of conscripts. When UTT (UZI) examination, varicocele is detected in 3% of sexually mature men. In most cases, the veins of the left seminal vesicle are found to be dilated. This is explained by the anatomical differentiation of the left and right seminal vesicles. Right-sided varicocele occurs in 8–2% of patients, while bilateral varicocele occurs in 12–XNUMX% of patients.

Causes of varicocele

The cause of varicocele is a dysfunction of the valves of the venous blood vessels. Venous valves do not allow blood to flow back to normal, but strong physical exertion cannot prevent blood from flowing back due to strong pressure in the vertical position. If this condition continues, the venous blood vessels slowly begin to dilate and the size of the venous congestion increases.

Modern scientific research in the field of phlebology describes the causes of primary (idiopathic) varicocele as follows:

  • Lack of connective tissue in the wall of venous blood vessels;
  • Insufficient or underdeveloped valves of the venous vessels in the seminal vesicles;
  • Inadequate formation of inferior vena cava during fetal development;
  • Due to the increase in pressure in the renal veins, the re-flow of venous blood into the seminal vesicles results in valve insufficiency and dilation of the venous vessels;
  • Increased intra-abdominal pressure causes blood to stagnate in the venous clots in the seminal vesicles and their wall to expand. For example, constipation, exercise strain, tension when standing upright.
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Secondary (symptomatic) causes of varicocele are caused by disease in another organ. For example, when there are any pathological conditions in the kidneys, small pelvic cavity or posterior area. At the same time there is a violation of normal blood flow in the veins of the seminal vesicles.

Classification of varicocele
Classification of varicocele

Classification of varicocele

The following levels of varicocele are distinguished:

0 degrees. No signs of varicocele are detected on palpation. Dilation of veins is known only on instrumental examination (UTT (ultrasound), dopplerography);

Level 1. Dilated veins in the supine position are not detected. Symptoms of varicocele are felt on palpation while standing;

Level 2. Palpation of the veins of the seminal vesicles reveals dilation both in the supine and in the supine position;

Level 3. The dilation of the seminal vesicles and testicular veins is also visible to the naked eye.

Symptoms of varicocele

Clinical signs of varicocele appear depending on its degree. Grade 0 and 1 varicocele has no symptoms. Varicocele disease is detected only in prophylactic examinations.

Patients with grade 2 varicocele complain of pain in the testicular area. In this case, the intensity of pain is in different forms. In some people, they experience discomfort and pain when walking, while in others it manifests as sudden-onset neuralgic pain. There may be irritation and excessive sweating in the testicular area. Most patients with varicocele complain of decreased sex life. On physical examination, it can be seen that the veins of the testicles are dilated and descending below the testicles, i.e. both sides of the testicle are asymmetrical in appearance.

In grade 3 varicocele, the connection between physical activity and the onset of pain disappears, and the pain becomes permanent. The patient is bothered by pain both when standing still and when sleeping. External examination reveals a clear dilation of the venous plexuses. The testicle is enlarged and the asymmetry is intensified.

Diagnosis of varicocele disease

Detection of varicocele is usually not a problem for the phlebologist. Information is collected from the patient about how long the pathology has been going on and the trauma received in the testicular area. Visual inspection focuses on the asymmetry of the testicle, the dilation of the venous plexuses.

On palpation, soft venous congestion is felt in a worm-like form. In some patients, varicocele is clearly seen in the enlarged testicle.

When detecting varicocele, palpation is definitely checked, both in the lying and standing position of the patient. If the right venous artery is found not to dilate even when standing, it is indicative of primary varicocele. If the patient is found to have dilated veins on both sides or on the right side while lying down, this is a sign of secondary (symptomatic) varicocele. In such cases, it is necessary to determine the root cause of the disease, that is, an ultrasound examination of the kidneys and peritoneal cavity. If vascular thrombosis and other pathologies causing secondary varicocele are not detected on UTT examination, computed tomography or MRI examination is performed. Spermogram examination is also ordered in adult patients. In this case, the spermogram reveals asthenoospermia (decreased sperm activity) and oligospermia (decreased sperm count).

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Thermometry, UTT (ultrasound) of the testes, dopplerography, thermography and rheography are additional diagnostic methods. UTT (ultrasound) and dopplerography examination provide much better data in the detection of subclinical varicocele.

Treatment of varicocele

Treatment of secondary (symptomatic) varicocele is to eliminate the underlying disease. At level 0 and 1 of primary varicocele, no surgical treatment is required. In this case, prophylactic measures are taken to reduce bleeding only in the area of ​​the small pelvis (reduction of physical exertion, elimination of chronic constipation, etc.). Treatment of grade 2 and 3 varicocele is only a surgical procedure, because at this level a person feels pain and discomfort, which can also affect normal life activities. The instruction on surgical practice is in the following cases:

  • Pain syndrome;
  • Asthenoospermia and oligospermia;
  • Decreased testicular size on the affected side during puberty;
  • In case of cosmetic defect.

There are 3 different types of surgical treatment of varicocele:

  • Lifting the testicle;
  • Embolization of varicocele;
  • Narrowing of the veins.

The practice of narrowing the veins is performed in the subingvinal (at the entrance to the duct), invinal (at the entrance to the duct) and retroperitoneal (at the exit from the duct). In recent years, microsurgical and laproscopic treatment of varicocele has been widely used, i.e., ligation of veins. This significantly reduces the risk of complications and recurrences. In addition, X-ray endovascular occlusion of sperm in children and adults gives good results.

Varicocele prevention

To prevent varicocele, reduce physical exertion in its early stages, relieve chronic constipation, stop drinking alcohol and smoking tobacco products, take vitamins, have sex regularly and get timely rest. will be needed.

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