Varicose tortuosity of the veins of the spermatic cord is one of the most common pathologies in men. Peak diagnosis of varicocele occurs at 14-15 years of age. In general, 15-30 years is exactly the age when pathology occurs most often. For the most part, this disease is observed in athletes and people engaged in physical labor. Therefore, it is safe to say that muscle load plays an important role in the expansion of the veins of the spermatic cord.
This pathology has a significant impact on male reproductive function. And considering that up to 30% of the male population suffers from varicocele, the urgency of the problem becomes obvious.
What is a varicocele?
The spermatic cord, among other elements, also includes the pampiniform venous plexus. That is what is affected by varicocele. The veins of the spermatic cord pathologically change, become dilated and tortuous.
Why is this happening? 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 the vessels.
Etiology of varicocele
Vessels belonging to the system of the inferior vena cava are equipped withspecial valves, because the blood flows through them from the bottom up. Without this device, most of the blood simply would not reach the heart; however, the presence of a valvular apparatus is very effective in combating blood stagnation and retrograde (in the opposite direction) its movement.
The main cause of varicocele in adolescents is valvular insufficiency of the testicular vein. Normally, blood from the pampiniform plexus enters the renal vein system or directly into the inferior vena cava itself 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.
Valve insufficiency can be primary (as a result of congenital pathology of the testicular veins, weakness of the muscle layer of the latter or connective tissue dysplasia) and secondary (resulting from an increase in 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: neoplasms of the abdominal cavity, hernia, adhesions, etc. One way or another, a situation is created when blood begins to stagnate in the vessels of the spermatic cord.
Classification of varicocele
WHO recommends the following classification of this disease:
- The veins of the pampiniform plexus are not only well defined by touch, but also visible visually. The testicle is shriveled.
- The veins can be palpated, although theyinvisible.
- Valsalva test positive. It is impossible to see or palpate the veins outside the specified sample.
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 reverse order. It looks like this:
- Veins are invisible, not palpable. Suspecting a varicocele is possible only by the Valsalva test.
- The veins are well palpated but not noticeable.
- Veins are both visible and palpable. Testicle modified.
By the way! The Valsalva test is performed as follows. The patient in a standing position is asked to cough. As a result, the pressure in the abdominal cavity increases, and the pampiniform plexus veins swell. Often, for comparison, the specified test is carried out in the prone position. In this case, the test will be negative.
Clinical picture
Usually, varicocele in adolescents occurs without any subjective sensations. Rarely, some patients complain of a feeling of heaviness or pain in the scrotum after physical exertion. However, these symptoms should be treated with caution, because they are often the first signs of inflammation of the testicles and their membranes (orchitis and orchiepididymitis).
How dangerous is varicocele?
The testicles in men are the place where the formation of spermatozoa, the germ cells that fertilize 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 worsens, hypoxia occurs; the hematotesticular barrier is violated, which can cause the body to produce antibodies that destroy spermatozoa (after all, they begin to be perceived by the immune system as hostile agents). Varicocele is often accompanied by hormonal disruptions, which also adversely affects the process of spermatogenesis.
The testicles in men are extremely sensitive to all of these processes, so any of them can easily lead to disruption of the formation of sperm and spermatozoa.
It should be noted, however, that the role of varicocele in infertility is still being studied. Not everyone believes that the above mechanisms underlie the pathogenesis of varicocele in adolescents. Therefore, the role of the expansion of the veins of the spermatic cord in male infertility remains somewhat controversial.
What to do?
The most commonly diagnosed varicocele is in teenagers. Treatment, respectively, is performed in adolescence. It is known to be of two types: conservative and surgical. If we talk about varicocele in adolescents, the first point can immediately be excluded. There is no conservative treatment for this pathology. But the number of operations used to rid patients of this disease is large.
Types of surgical interventions forvaricocele
All operations on the testicles can be divided into several groups:
1. Surgical interventions based on excision of the veins of the spermatic cord. Currently, they are no longer used, since after their use, testicular atrophy was noted in 90% of cases.
2. Operations that fix the testicle to the elements of the inguinal canal or the muscular aponeurosis. Currently not used, as they are accompanied by testicular atrophy (20-70% of cases).
3. Resection of a part of the scrotum with external fixation of the testicle. Recurrence 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 that indicates the presence of a problem leading to venous hypertension. In this case, this operation may aggravate the situation.
5. Operations 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 an opening of the abdominal cavity. There are also minimally invasive treatments.
Surgical intervention from mini-access
MostA common operation for the treatment of varicocele is Marmara. It is performed under local anesthesia. In the inguinal region, from the side where the pathological process has developed, a 2-3 cm long incision is made. From this access, the elements of the spermatic cord are dissected, a vein is isolated, tied with a ligature and crossed. The wound is sutured in layers.
As follows from the description, the operation is not open and can even be performed on an outpatient basis. The 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, you should give up sexual activity.
Laparoscopic Clipping
Another method with a good cosmetic effect. Through a puncture in the anterior abdominal wall with the help of special instruments, the testicular veins are isolated, clipped and transected.
Compared to open operation, this method has a number of advantages:
- Short postoperative period due to the almost complete absence of a wound, because surgical intervention is carried out through a puncture, not an incision.
- No risk of incisional hernia.
- Good cosmetic effect.
- Small chance of postoperative complications.
Endovascular phlebosclerosis
This method is an alternative to operation. Its essence lies in the fact that a sclerosing substance is injected into the testicular vein, which contributes tothrombus formation and cessation of blood flow through the vein. Performed only if there is no reason to suspect secondary valvular insufficiency and venous hypertension.
The main thing to understand for patients suffering from varicocele is that the timing of the operation is extremely important. It has been proven that timely treatment significantly reduces the risk of spermatogenesis disorders and infertility.
