Varicocele in men: treatment, complications, danger

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POSSIBLE DANGER

Named pathology does not pose any danger to the health of men. Fatal outcome due to the development of the disease is almost impossible, but only if the patient does not have other diseases at advanced stage of development against the backdrop of a varicocele.

• However, the intervention should be carried out in due time, as the disease is a risk for the patient's reproductive system.
• In this case the appearance of infertility is a frequent complication of pathology.
• However, in the absence of intervention is likely to experience more dangerous processes - testicular atrophy, inflammation, and other phenomena.

Thus, the disease does not threaten the patient's life, but you need to treat the disease in a timely manner. It is not recommended to engage in self-help disease as a lack of information about the causes of varicocele significantly reduces the effectiveness of home therapy.

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Degree and their signs

The pathology associated with the blood vessels of the genitals. found 20% of men, The risk in the first zone fall adolescents (puberty). On the causes of varicocele in adolescents, see the separate article.

The first (1)

Changes grozdevoy weave no blood vessels. A patient It may feel a little discomfort, Which displays links to other causes.

At this stage, the disease can be kept for a long time, only triggers lead to its aggravation.

Complications arise when:

• prolonged stress state;
• hypothermia;
• injuries;
• weakening immunity.

Stage 1 is characterized inability to visually determine the disease.

Two (2)

Symptoms of the 2nd degree are not much different from the first to the patient. The only distinguishing feature is bulging veinsWhich can be seen through the thin skin of the genitals.

The temperature rises, limited nutrient supply, because of which decreased sperm count.

Third (3)

Man begins periodically sense neurologic pain, which intensified due to a rush of blood to the veins spread. Part scrotum affected by varicocele increases, and at its surface is expressed by venous drawing clearly.

Discomfort is more pronounced:

• in hot weather;
• long holding time in a standing or seated position;
• in the evening.

The fourth (4)

It is considered the last (running) varicocele stage at which the patient experiences constantly present pain.

Crimp blood vessels and provoke swelling resulting increasing the volume of the scrotumWhile decreasing egg itself.

Regardless of the position taken by the patient, begins to stand out the contours of the veins.

In this photo you can see the look of the symptoms 1, 2, 3 and 4 running degree of varicocele in men in the groin, to better understand what it is. do not look underage and nervous!

The localization in the testis

Varicocele is divided into types of localization: Left hand (88%), right-hand (3%), bilateral (9%):

• • Left hand. Most often, pain manifested in men on the left, where the kidney is located Vienna that is in contact with a number of vessels were passing, pinched her. This is explained by the physiological structure of the genital organs, and blood vessels in them.
  • Right hand. Varicocele on the right is very rare, has no pronounced symptoms. Present discomfort expressed nagging pain occurs only after exercise.

• bilateral. Due to irregularities which are provoked by the expansion of veins between the testicles and inguinal ring. Painful symptoms appear larger on the left, because of the considerable length of the venous trunk, so the disease is often diagnosed as a left-sided.

Photos of varicocele on the left, right and both testicles are presented below. Nervous to watch is not recommended as a minor!

diagnostic measures

Diagnosis depends on the pathology which developed:

1. Men rarely turn to a specialist because of discomfort, but even those who turn to face the problems of diagnosis. Since at this stage of disease are hidden all the symptoms, diagnosis using palpation or visual observation, it becomes impossible. To identify this pathology is possible only with the help of Doppler or ultrasound.
2. Since the second degree, a doctor can diagnose visual or palpation of the testes. The only condition, the patient must be in an upright position.
3. Confirmed the diagnosis after the instrumental (ultrasound and Doppler) and delivery of semen for analysis. Confirmation of the diagnosis indicates the progression of the disease.
4. In addition to the tool inspection and delivery of semen analysis, diagnose varicoceles can be in the doctor's office. The pathology seen in the scrotum of the patient irrespective of the position. By means of palpation, the doctor will determine the size of the testicles, as well as expanded veins.
5. Neglected diseases is visible without additional diagnosis (palpation or equipment). Complaints about the often throbbing pain, strongly dilated veins of the testicles or seminal canals provide the ability to quickly establish a diagnosis.

Threat to the life of the patient having a varicocele, there is so many men with this problem doctors prefer to bypass party. Ignoring the treatment results in the most innocent form of the disease to the last stage, but the result - childlessness.

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General information about varicocele

According to WHO (World Health Organization) varicocele occurs among women in 15-17% of cases. This reveals a wide range of frequency of occurrence depending on the region and the age of the subjects.

• However, when using ultrasonic inspection methods varicocele detected in 35% of the male reproductive age.
• During military service varicocele detected in 5-7% of young people, and the highest incidence between the ages of 14-15 years - 19.3%.
• Usually, varicocele there is only one side - the left (80-98%). This is due to various flowing into veins testicle on the right and the left.
• bilateral varicocele It occurs in 2-12% of cases, while the right-sided varicocele occurs only in 3-8% of cases.

symptoms of varicocele

In most cases, the disease begins in puberty, quickly reaches a certain extent and no longer progressing. varicocele can does not manifest itself, and are diagnosed by chance during any medical examinations.

If we talk about the complaints of patients, as a rule, they do not happen.

In general, this condition is painless and without any anxiety causes. Young people have noted an increase, ptosis of the left half of the scrotum, a slight "pulling" sensation in the testicle, ive scrotum groin area on the affected side, worse when walking and physical stress, sexual excitement; with significant varicocele pendulous scrotum prevents walking; point reduction in the left testicle. The increase in the left half of the scrotum often appears in a standing position and disappears in the supine position.

In severe cases, the pain is permanent. Noted a significant increase in the scrotum, contouring tortuous veins, reduction of the left testicle.

As already noted, the main complication and other symptom is infertility varicocele. In vitro assays such patient sperm detected reduction in the number of spermatozoa and their motility.

By how much dilated veins of the testicle and spermatic cord are 4 degrees of varicocele:

• 0 degree - testicular veins are not palpated hands, their varicose determined only instrumental (ultrasound, Doppler).
• 1 degree - veins palpable in the standing position, in a prone position varicocele is not defined.
• 2 degree - dilated veins palpable in the standing position and a lying position.
• Grade 3 - dilated veins testicle and spermatic cord are visible to the naked eye.

Extremely rare one degree varicocele turns into another.

Causes and risk factors of varicocele

The development of this disease is due to the fact that the valves in the veins that exist, and which should prevent backflow of blood, do not work or work poorly, and with increasing pressure in the veins (e.g., the vertical position of the body during physical exertion), this pressure begins to be transmitted in the reverse direction, gradually causing the expansion of the venous vessel. Thus, expanding the vein surrounding the spermatic cord.

Another reason varicocele It is a special relationship between the anatomical renal vein and upper mesenteric artery to form the so-called aortomezenterialnogo "tweezers".

Gradually, under the influence of elevated pressure, the veins start to grow in size, stretch, expand. Depending on the strength of the vein walls for different people and on the value of venous pressure, this stretching may reach different degrees.

• Venous network around the testicle becomes more and more, and in severe cases, the egg is, as it were immersed in the sponge from the veins.
• This blood "cushion" of the veins around the testicle leads to the fact that the temperature control function of the scrotum is lost, and the egg is no longer cool.
• Consequently, the low temperature required for sperm production, is no more, and normal spermatogenesis is suppressed.
• That is why the varicocele is one of the main factors of male infertility.

Thus, infertility factors with varicocele are:

• Raising the temperature in the testis to body temperature (normal testes temperature is lower than body temperature, that necessary for normal spermatogenesis (for the same reason testicles "taken out" outside the abdominal cavity scrotum).

• Reverse casting biologically active substances from kidney, adrenals in testicles.

• Hypoxia (lack of oxygen, ischemia) eggs.

• The accumulation of free radicals in the testicular tissue (which are potent cellular poisons) that damage them.

complications of varicocele

If we consider the structure of the causes of male infertility, varicocele It is the main factor causing infertility:

• 60% of patients with varicocele were impaired spermatogenic testicular function,

• 40% of men surveyed about infertility, varicocele detected.

Thus, varicocele primarily be directed to the prevention and treatment of male infertility.

diagnosis of varicocele

to diagnose varicocele in some cases there is a sufficient inspection and palpation "pampiniform" (grozdevidnogo) plexus (as vine grapes) with the patient standing. More distinct results obtained by palpation Valsalva maneuver (probed with straining: with increasing pressure in the abdominal venous blood supply increases testicular).

• If a significant increase in the veins, and the diagnosis is in doubt, the further investigation is required.
• If the degree of varicocele is small, it is necessary to conduct a special examination - Doppler ultrasound or scrotum.
• Doppler ultrasound or suspected varicocele must be carried out in two positions of the patient - lying and standing.

If this is not done, the survey makes no sense.

Doppler ultrasound of the scrotum or in the lying and standing must be carried to all men with infertility and pain in the testicles.

In addition to all the above, with varicocele have to be done by semen. Necessary to carry out at least two trials with an interval of 4-12 weeks. Also mandatory is abstinence before delivery spermogrammy for 2 to 7 days.

varicocele treatment

As with varicose veins in the legs, the only realistic way of treatment is the operation in one form or another.

On the other hand, as a varicocele - a disease harmless, and usually asymptomatic, in itself, its detection in an adult male is not an indication for surgery.

Surgical treatment is required in the following cases:

1. The presence of pain in the testicle.

2. Male infertility (by reducing the quantity, quality and motility).

3. Aesthetic defect in the scrotum.

4. Cessation of growth of the affected testis at puberty.

However, many experts believe that in children and adolescents for prevention of potential infertility in varicocele surgery should be done anyway.

There are 4 basic operational method of treatment Currently:

1. The open (normal) operation.

2. Operation of minimal access.

3. Endoscopic surgery.

4. Microsurgical testicular revascularization.

Varicocele - what is it?

Varicocele - a male disorder characterized by varicose veins of the spermatic cord due to violation of the venous outflow of blood from the testes and is the anomaly of venous network testicle. The disease in men is not uncommon, it is mainly developed at the age of 14 years. More often than not, which is more than 90% of cases, the disease is a "left-hand", that is developing in the left testicle, rarely happens "Bilateral" varicocele and in rare cases, the "right-hand", which is associated with the anatomical structure of the veins testicles. As a result of loss of blood supply to the testicle develop its swelling, fever, ischemia and subsequent atrophy of the organ. Depending on the volume of veins, varicocele disease is classified into three grades. The degree can be determined visually and by means of palpation. Men with varicocele disease in the majority of cases have other problems with blood vessels - varicose veins and hemorrhoids.

Causes and symptoms of varicocele

Predisposing factors for the development of a varicocele can be chronic constipation or diarrhea, scrotal trauma, phimosis, flat feet, frequent and prolonged stay in the "standing", often riding on horseback or on bike. Genetic predisposition - the weakness of the vascular system.

Men with varicocele disease often complain of discomfort, heaviness, pain in the scrotum. The pain may be given in the lower back, perineum, abdomen and is usually worse when walking, heavy physical exertion during sexual intimacy, hence, as a result - decreased sex drive. Quite often, a man with a similar disease experience problems with urination.

Also varicocele may be asymptomatic, especially in the early stages, so all men regardless of age It recommended to regularly (at least annually) to come to the reception to the urologist, even if it seems that there is no reason to concern.

Marichev Vladimir, urologist of the highest category, a member of the Russian Association of Urology, member of National and International Congresses of Urology and Andrology, work experience more than 40 years

The varicocele is dangerous for men, whether or not "panic"?

In a panic, of course, do not need to indulge itself varicocele disease a man's life is not threatened, but, as I said, it can cause quite a strong pain. Scary another consequence of varicocele, especially at a young age - it is male infertility. Among infertile about 40% of men observed varicocele. The fact that the blood disorder is a violation of thermoregulation of the scrotum and leading to problems with sperm production and motility.

Diagnosis and treatment. Operation testicular varicocele

To diagnose the disease is not difficult, it can be done and the patient himself. In most cases, varicocele can be determined by visual inspection and palpation. US scrotum in combination with vascular Doppler allows to diagnose varicocele with 100% accuracy. To determine the quality of sperm - sperm count and activity - performed semen analysis, studied the level of sex hormones.

Conservative treatment of the disease does not result in a cure, however, surgical treatment is carried varicocele. Low-traumatic surgery, it boils down to the fact that through small incisions doctor is ligation and excision "varicose" veins.

Usually, local anesthesia is used. Afraid of the operation is not necessary, it takes about 15-20 minutes.

Varikotsele postoperatively

The recovery period after surgery varikolele fast enough on the second day a man will be able to return to the familiar life. Pain syndrome insignificant and pain usually disappears after taking pain medication. Complications and recurrences in patients after surgery of varicocele is usually not found. Within two weeks after the surgery the patient must restrict physical activity and sexual intercourse, to eliminate the use of alcohol, follow the normal functioning of the intestines. As a rule, men with varicocele is not difficult to decide on the operation, because they know that this is a necessary measure, which would improve the quality of sexual life, self-esteem and to solve problems infertility. Many also important a good cosmetic result.

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Varicocele - what is it?

Varicocele - is varicose veins of the spermatic cord and testicles. A distinction is generally three degrees of varicocele.

• The first degree of varicocele: advanced wreaths palpable in the standing position, when the boy is, they disappear. The child did not bother.
• Second degree varicocele: child complains of pain in the scrotum, burning. Veins are visible, they sink below the testicles, scrotum asymmetrical. Needless egg while the touch is no different from healthy.
• Third degree degree varicocele: clusters of veins "hang" in the scrotum, the testicle is small and soft. It is often impaired spermatogenesis may develop testicular atrophy.

Varicocele - a very common disease, it occurs, on average 10-15% of men. As a rule, it can occur at puberty and later, so do not forget that boy visiting a urologist or andrologist should do the same binding as a dentist or a gynecologist for women. As the saying goes, it is better to detect trouble in advance, not when already "late to drink mineral water."

A curious fact: usually develops varicocele on the left. Much rarer bilateral varicocele varicocele or right. This is most likely due to the different outflow of venous blood from the right and left testicles: Vienna from the left testicle passes a greater distance before flowing into a large container. As a result, the left venous pressure above which gives a prerequisite for the development of varicose veins.

The dangerous varicocele.

Varicocele itself is not dangerous. With it, you can live a normal life and work - especially if it does not cause concern. The main problem - a typical complication of the disease, male infertility.

Varicocele disturbed nutrition eggs, which can lead to atrophy. In addition, a network of veins around the testicle create a kind of "cushion" that can prevent the outflow of heat. For normal spermatogenesis requires a relatively low temperature of from 32.5 to 34.4 degrees. When varicocele temperature is higher due to the formation of sperm disturbed or ceases altogether.

Another possible complication of varicocele: immune inflammation of the testicle.

Varicocele.

Unfortunately, varicocele can not be cured without surgery - really only effective surgical methods of treatment.
The need for treatment is solved individually. Naturally, if the varicocele worries manifested by pain in the scrotum or infertility, the cure is necessary.

If a man with a varicocele does not bother the need for surgery - a moot point. Usually, if a man still plans to have children, it is best to treat varicoceles and do the operation, if a varicocele found in older men, for whom the issue of procreation is no longer so urgent, then we can do without operations. Since we're talking about teenagers, it makes sense to be treated: as you want grandchildren?

Currently Crafted few basic ways to treat varicocele. In this case, all the ways of treatment are divided into two major groups: obstructive and non-obstructive methods (do not violate the venous blood flow).

For obstructive methods of treating varicocele include several kinds of operations. The first - open surgery. During her varicose wreath completely ligated or removed. The operation is performed through an incision 3-5 cm in length. The second method - endoscopic (laparoscopic) surgery. On the abdomen of the patient make three small puncture in one of them entered the endoscope, the surgeon then ties up the "bad" vein of the affected testicle. The operation takes about 15-20 minutes. Compared with open surgery to endoscopic surgery requires no special training, it is easier for the patient: blood is lost, the person recovers quickly. In addition, a long scar, too, will not.

Another method of treatment of varicocele: hardening of the affected veins hay cord. The catheter is inserted through a puncture in the diseased vein and sclerosing substance is injected, cause the interruption of blood flow through the vessel.

All of these methods (and some others, for example, Palomo, Marmara) belong to the obstructive process, ie, they interrupt the venous blood flow.

Varikotsele eliminated in this case, but not always improved venous outflow of blood from the eggs, respectively, is not improved temperature control.

There is another approach to treatment varicocele, obstructive, venous outflow noralizuyuschy: forming venous anastomoses. Anastomosis - a connection between blood vessels. Thus, the purpose of formation of venous anastomoses - creating artificial venous outflow tract of eggs.

The choice of treatment is necessary, of course, carried out in conjunction with experts. As a rule, the treatment prognosis is quite successful, especially when it comes to teenagers who have a testicle had not yet subject to change due to varicocele.

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The varicocele is dangerous for a man?

varicocele It is a pathological condition that develops due to violation of the outflow of blood from the testes tissue. Veins which form acinar plexus become wider and swell, which subsequently occurs swelling of tissues scrotum and testicles.

Statistics say that varichkotsele affects about 15% of men. The process of varicocele is similar to varicose veins of the lower extremities, and enlarged veins of the testicles look exactly the same as varicose veins in the legs. They can swell and show through the skin, getting knotted izvivistuyu form. The severity of the disease can be exacerbated with time.

Classification of varicocele

Classify the disease depending on the severity of the pathological process. The World Health Organization offers the following classification of varicocele:

• І power - varicose veins in the scrotum are not visible and not palpable;
• ІІ power - veins visible, but well palpated;
• ІІІ power - veins easily visible because of their bulging through the skin, the veins are well palpable.

​possible complications

Threatening complication of the disease is considered to testicular atrophy and impairment of spermatogenesis, is characterized by a decrease in the number of healthy sperm. When testicular atrophy in its tissues may develop irreversible damage, that damage the epithelium of the seminiferous tubules, thus there is a decrease in testicle and it takes a soft consistency. In case of violation of spermatogenesis reduced sperm count in semen, reduced their mobility. As a result - the complete or partial infringement of reproductive function in men and infertility.

The causes of varicocele and its symptoms

The main reason is the presence of varicocele dysfunction intravascular valves. valve defects can cause reduced blood flow and stagnant processes in acinar venous plexus.

Also today, doctors consider varicocele not only as an independent disease, but also as one of the manifestations of genetic disorders in the development of renal veins or acquired during the life of disease.

It should be noted that any disease of the inguinal canal, scrotum and abdomen, resulting in the compression of spermatic cord, can serve as a starting point for the development of the outflow of blood disorders, and as a result - to varicocele.

It is also necessary to consider the factors that can lead to impaired spermatogenesis:

• overproduction of the hormone hydrocortisone;
• violation testis barrier between the tissues and the blood circulating therein;
• violation of the production of various hormones of the pituitary gland;
• increase testicular temperature.

If the inspection may show scrotal veins uviform plexus. A man may feel heaviness in the scrotum or pain. During the exercise, while sitting or standing patient's condition may deteriorate. If the patient goes into a reclining position - disappear symptoms.

How to diagnose varicoceles abroad?

For accurate diagnosis, the doctor conducts the initial examination the patient's scrotum. This allows you to determine the degree of severity of the disease. Later in foreign clinics recommend holding ultrasound with Doppler ultrasonography. This study was conducted at the patient standing or lying. During the ultrasound examination is carried out Valsalva maneuver:

• upright patient's vein in the testes increases;
• if the patient is in the supine position, Vienna is reduced in size.

Then carried out urine tests before and after exercise. Also, patients with varicocele show such research:

• retrograde renal venographyWhich is produced after introduction into vein testicular contrast agent;
• examination hormonal profileWhich may include by testosterone, prolactin, estradiol, follicle-stimulating hormone and luteinizing hormone;
• semiological examination or investigation of spermIn which it can be detected by reduction in the number of motile spermatozoa and an increase in unhealthy sperm.

Effective treatments varicocele abroad

In foreign clinics varicocele treatment plan for each patient individually. If there are no pronounced symptoms, doctors recommend limited to the medical supervision of the disease.

Varicocele surgery on abroad is only carried out in cases where the patient concerned about severe pain, signs of testicular atrophy or disorders of spermatogenesis.

How it is treated in Israel?

Treatment of this disease in the medical center "Mayer" is based on the degree of severity of the process performance and the presence of characteristic symptoms. In after a hard cases, when the disease is started, carry out surgery. Surgery for varicoceles in Israeli hospitals carried out by means of dissection of varicose veins, helps to restore the physiological blood flow in the veins of the scrotum.

Most effectively in Israel carried out surgical treatment of varicocele. The operation does not require general anesthesia and hospitalization of the patient. The doctor makes a small incision in the skin in the scrotum, excised, and / or completely remove the enlarged portion of the veins. This operation helps to normalize the blood flow to the testicle. Doctors recommend hold semen analysis in a few months after the operation, which allows us to estimate the number and degree of sperm motility.

Varicocele surgery sometimes is of a preventive nature, and its purpose - to prevent irreversible infertility.

New ways of treating varicocele used in MC "Meir"

Also surgery clinic with varicocele "Mayer" actively used unconventional methods of treating this disease. The effectiveness of drug treatment of varicocele has been proved in practice. Such treatment may be administered after operating the patient to normalize spermatogenesis. The most frequently prescribed reception complex vitamins, dietary supplements containing zinc, selenium. Sometimes it can be administered hormones. Currently, MC "Meir" successfully used microsurgical techniques of treatment of varicocele. This reduces the risk of recurrence or complications after surgery

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