Varicose veins of the penis are a disease associated with impaired patency of the pampiniform (sometimes called “pampiniform”) plexus of testicular vessels.
The pathology is quite common, mainly detected in adolescents aged 14-16 years, less often in children under 10 years of age (during a comprehensive medical examination). It can be left-sided, right-sided and bilateral (less often), depending on the location of the ligament of damaged vessels.
Varicose veins of the penis are called “varicocele” in official medicine.
Varicocele is an enlargement of the veins of the scrotum, forming a pampiniform plexus around the testicle , which is why they are subsequently deformed.
At the same time, normal blood circulation in this area is disrupted and, accordingly, the replenishment of the testicle itself. Complications of varicocele can be the most severe, including infertility.
And for the most part, varicose veins in men in the groin affect the left testicle, which is explained by the specific structure of the organs of the reproductive system in men.
Why are varicose veins on the testicles dangerous in men? Impaired testicular functionality. With a significant deterioration in blood flow in this area, there is a considerable probability of testicular atrophy, after which infertility occurs .
Although the functionality of the second testicle is preserved, the quality of synthesized sperm is dramatically deteriorated.
According to statistics, in approximately 40% of cases of male infertility, it is confirmed that it was caused by varicose veins of the penis.
But the worst thing is that after testicular atrophy, it is not possible to restore its functionality. In such cases, doctors prescribe amputation of the damaged testis.
A separate category also includes the so-called “symptomatic” varicocele . It develops against the background of changes (deformation and expansion) of the inferior vena cava.
And this happens due to impaired blood circulation in the right kidney (provoked, for example, by a tumor or cyst). But the result is the same - the veins of the pampiniform junction are damaged. Read more about the causes of the disease.
What does a varicocele look like, photo below:
Isakov Yu. F. first described the symptoms of the disease and the clinical picture of its course in 1977.
He also created the first classification of varicose veins of this type (3 stages), which was subsequently slightly supplemented and strengthened by WHO (World Health Organization) standards.
But one of the first doctors who developed the technology for treating varicocele is the Soviet scientist-surgeon Ivanissevich .
The essence of the method is ligation and intersection of the vein affected by varicose veins. This version of the operation is still performed today, but more modern variations have been developed with less trauma to the male reproductive system.
An andrologist diagnoses and treats varicose veins of the spermatic cord : the disease in all respects fits his specialization. Primary diagnosis can be carried out by a urologist, surgeon, vascular surgeon, as well as a therapist (due to their wide specialization).
But the operation (if one has been prescribed) is performed exclusively by a vascular surgeon (allowed under general anesthesia, but depends on the technique used).
IMPORTANT ! In some hospitals, operations to eliminate varicose veins can be performed by a regular surgeon, but only if we are talking about the Ivanissevich technique. Unfortunately, a vascular surgeon is a highly qualified specialist, and not every clinic has one in their practice.
With varicocele, the penis itself does not visually change in any way . At stages 2-3, only an increase in the size of the scrotum is noticeable (on one side with unilateral varicose veins, on both sides with bilateral varicose veins).
At stage 4, a cluster-shaped tumor of blue or burgundy color is noticeable under the scrotum. When it is compressed, the patient feels a dull, severe pain and discomfort, which negatively affects his sex life. Typically, the size of the tumor does not increase over time.
What does the scrotum look like after the operation? Its size becomes normal, and the suture itself, as a rule, is located on the side of the peritoneum.
If a section was performed, then a cosmetic suture is made in that place, so there are practically no traces left . Visually, the entire penis remains the same even if the doctor has prescribed testicular amputation.
Will a man be able to have children in the future if he has undergone surgery to remove varicocele? As a rule, if surgery was performed before the age of 27, and the stage of varicose veins was no more than 3, then in the future the guy will be able to live a full sex life .
Fortunately, at this age, soft tissue regeneration occurs very quickly, so the functionality of the testicle is quickly restored. Also find out whether people with a similar disease are accepted into the army?
In summary, varicose veins of the penis are a violation of the blood flow of the pampiniform plexus around the testicle. More often found in adolescents. The only true treatment option for the disease is surgery.
And the sooner the operation is performed, the faster the rehabilitation will take place and the functionality of the reproductive system will be restored.
Varicose veins in the area of the testicles and spermatic cords are called varicoceles. With this pathology, the pampiniform venous plexus is affected. Statistics show that dilated veins on the testicles occur much more often in adolescents than in other age categories. However, the disease can affect every man. Varicocele is considered the most common pathology of the scrotum, occurring in 15–20% of men. In addition, varicose veins on the testicles can lead to infertility.
This pathology is not life-threatening. Moreover, a man may not be aware of its presence for a long time and lead a normal lifestyle. Unfortunately, after the development of the clinical picture, few men turn to a specialist, which is why the moment of timely diagnosis is missed. Infertility associated with dilation of the veins of the scrotum is diagnosed in men in 60–80% of all cases, and its cause is the reluctance of patients to deal with the problem.
The pathogenesis of the disease is associated with an increase in pressure in the venous bed above 85 mm Hg, which causes expansion. Varicose veins of the scrotum are most often the result of three etiological mechanisms.
The cause of hypertension in the renal vein is a narrowing of its lumen. A decrease in the diameter of a vessel is most often associated with its pinching between two arteries. The main sign indicating such a cause of varicocele is the rapid manifestation of vein dilation in a vertical position and the disappearance of symptoms in a horizontal position. Due to the narrowing of the renal vein, the blood seeks a bypass route to provide nearby structures with adequate venous outflow. The most convenient option is to ensure the passage of blood through the pampiniform plexus of the testicle, which is not adapted to such volumes of blood, which is why it gradually expands.
Also, narrowing of the renal vein may be associated with birth defects. Varicocele caused by this problem most often occurs in childhood and is more severe than other forms, which is associated with severe circulatory disorders in this area.
A secondary increase in pressure is also associated with a narrowing of the renal vein, but changes in the lumen are caused by scar processes and other organic lesions. Also, the development of secondary hypertension can be triggered by compression of the artery by a tumor. Therefore, testicular varicose veins in men should be differentiated from oncological processes.
Insufficiency of the valve apparatus is usually associated with pathologies of a systemic nature, for example, venous insufficiency. All veins in the human body are equipped with valves that ensure the movement of blood in the right direction. When the functioning of these structures is disrupted, stagnation begins, which leads to varicose veins, including the testicular area.
During adolescence, the load on the body’s circulatory system increases, but the veins cannot cope with it, which is why the disease develops. The appearance of varicocele in elderly men is due to physiological changes of an age-related nature.
In most cases, veins are visible on the testicles on the left, which is due to certain anatomical features. The left testicular vein is completely dependent on the correct functioning of the renal vessel, as it communicates with it. On the right, the testicular vein connects to the inferior vena cava, so any changes in the pressure of the renal vessel do not affect it. In addition, the left testicular vein is more likely than others to lack valves.
Varicocele is asymptomatic for a long time, and men do not pay attention to the swollen veins on the testicles. However, with further progression of the pathology, the following symptoms may appear:
There is a classification adopted by doctors for the convenience of assessing the severity of pathology. With its help, the direction of further treatment is determined. The following degrees of damage are distinguished:
Varicocele can be primary in nature, arising for the reasons described above, or secondary. The symptomatic version of the pathology is characterized by compression of the venous vessels by any neoplasms, for example, cysts or tumors. Due to impaired venous outflow, varicocele develops, and due to testicular ischemia, its atrophy and decrease in basic functions. In addition, an inflammatory process may develop, which develops into a severe autoimmune reaction, since the testicle is protected by a special barrier, and during ischemia it is disrupted.
If a man discovers that a vein in his testicle is swollen, he should contact a specialist to find out the causes of this condition. Ignoring such a pathology as varicocele ends in infertility in almost all patients.
Spermatogenesis with varicose veins is disrupted due to the triggering of the following mechanisms:
In the absence of adequate treatment and a man’s untimely referral to a specialist, the following pathological changes gradually develop in his testicle:
Infertility with varicocele can only be avoided if you carefully monitor your own condition and make a timely diagnosis in a medical institution.
Diagnostic measures for testicular varicose veins are required to confirm the diagnosis, since often an examination of the patient already allows one to draw an approximate picture of the pathology. The following diagnostic methods are carried out:
Ultrasound and Doppler sonography are done in horizontal and vertical positions. During diagnosis, the causes and degree of blood return to the testicular veins should be taken into account, which will allow you to choose the right treatment and avoid relapses.
The only effective treatment option for varicose veins is surgery. In adolescents and children, surgery is recommended in any case to prevent the development of infertility. In older men, treatment is not always required and depends on the severity of the process and the presence or absence of a clinic. If the disease does not bother the patient, then a wait-and-see approach is prescribed to assess the progression of the pathology.
Indications for surgical intervention:
There are 4 types of surgical tactics when diagnosing varicocele:
A surgical incision is made in the iliac region on the affected side. The essence of the operation is to ligate the venous plexus. With this intervention there is a risk of ligation of the spermatic cord, so the surgeon must be very careful and careful. Also during the operation, the functionality of the testicle is assessed.
Mini-access consists of making a small incision, which is located in the area of the inguinal ring where the spermatic cord emerges. With this access, the cord and the veins located next to it are found and ligated. Venous outflow in the future will be carried out through superficial vessels.
Endoscopic or laparoscopic surgery is one of the most successful and least traumatic types of treatment for testicular varicose veins. During the surgical procedure, several punctures are made in the abdominal area, through which a camera and instruments are inserted. Using a camera, the doctor sees on the screen what is happening in the body, and with the help of instruments, he identifies the vessels and ligates the necessary ones. The duration of the operation does not exceed half an hour, and complications or relapses are extremely rare.
With the help of such a surgical intervention, adequate blood supply to the testicle is restored. The essence of the surgical procedure is to transplant the testicular vein into the epigastric vein. From the point of view of the mechanism of development of varicocele, this type of treatment is the most appropriate.
Before choosing any treatment option and to predict the postoperative period, the following indicators are taken into account: the patient’s age, the functional activity of the testicle, the degree of development of the pathology, whether it is one-sided or whether the process affects both testicles, hormonal activity. In this case, the most successful operation can be expected in persons with a significantly developed varicocele, a testicle without pathological changes in the absence of an autoimmune reaction and with normal hormone levels. In such cases, complete recovery almost always occurs, with the exception of any individual characteristics of the patient. The worst results are expected in men who have slightly dilated veins, but have pathological changes in the testicles, decreased sex hormones and signs of the development of an autoimmune reaction.
In order for recovery to be successful and without dangerous consequences, you should consult a doctor in a timely manner.
Today, varicose veins are widespread in men, this primarily concerns the testicles. Although this disease is not life-threatening, it is not recommended to ignore the first symptoms, because it leads not only to impotence. Swollen veins in the testicles lead to tissue atrophy in the male genital area and impaired spermatogenesis, which negatively affects reproductive function in the future. At risk are teenagers and young people under 25 years of age, among whom every sixth has dilated veins in the scrotum. Due to anatomical features, the left testicle is most often subject to modification, and attention should be paid to it first.
Enlargement of the veins in the testicles occurs due to a disruption in the circulatory process when special valves fail. Some of the blood does not move further. A blockage of the vein near the spermatic cord occurs, the capillaries on the scrotum increase in size, and blood stagnates in a certain area, which leads to terrifying consequences.
Varicose testicles in men depend on the degree of neglect. Experts note several stages:
Whatever the stage of varicose veins on the testicles in men, the symptoms should not be ignored. In order not to aggravate the problem, you should consult a doctor immediately if the blue veins on the testicles have increased in size. Timely examination will help identify testicular varicose veins in men and maintain men's health.
Young men and parents of teenagers need to know about the factors that influence the expansion of veins in men in the groin area. Experts identify the causes of varicose veins in men, especially the testicles.
Congenital testicular varicose veins also occur.
A man’s lifestyle and occupation also play an important role in the development of the disease, which causes dilatation of the veins in the testicles. Risk factors that influence the enlargement of the vein in the scrotum and can aggravate the situation with men's health are the following:
Varicose veins on the testicles can cause irreversible changes in the groin area. A healthy lifestyle that excludes nicotine and alcohol addiction, moderate physical activity, and regular visits to a specialist will help to avoid them.
You should know what manifestations testicular varicose veins have in men in order to prevent irreversible changes in the tissues. Phlebologists recommend paying attention to the characteristic signs of the disease:
Due to the physiological characteristics of the left and right testicles in men, varicose veins on the testicle are more often left-sided than right-sided or bilateral . The first symptoms should alert a man, and parents should not ignore adolescent complaints of nagging or aching pain in the groin area. You should immediately contact a health care institution for help, because varicose veins on the testicles in men are an insidious ailment that can occur hidden throughout life without revealing itself.
The earlier the disease is detected, the greater the chance, with proper treatment, of preserving men's health for many years and preventing the development of infertility. A swollen vein in the testicle with discomfort in the groin area is a serious reason to consult a doctor.
Initially, a specialist prescribes ultrasound diagnostics, which allows timely detection of subtle deviations from the norm. Characteristic manifestations are captured in photos on the Internet, where swollen veins in the testicles of men are clearly visible. But only a doctor can make a final diagnosis based on the examination results.
Depending on the severity of the disease, the specialist chooses the diagnostic method:
Based on the results of the examination, a diagnosis of varicose veins on the testicles in men is made, treatment of which occurs individually, based on the stage of the disease, the patient’s age and the presence of concomitant diseases. It should be remembered that due to the specifics of the disease and taking into account the fact that during its development the veins in the testicles, a delicate place, are enlarged, parents will not be able to independently diagnose varicocele in a teenager. In order not to waste time, regular examinations (twice a year) by a phlebologist should become the norm.
Today, the most effective method is considered to be surgical intervention, which guarantees the restoration of normal blood flow, reducing the pressure inside the vein on the eggs in men. The essence of the surgical intervention is to tighten the vein around the spermatic cord. At the third and fourth stages of varicose veins, treatment of the testicles requires radical intervention, so doctors recommend surgery. It does not last long and is classified as simple. But varicose veins on the testicles can be cured with surgical intervention only after 18 years of age. Before this age, surgery is contraindicated, because if the outcome is favorable as a result of hormonal changes, there is a chance that the young man’s problem will go away.
In the first and second stages, conservative treatment of testicular varicose veins is allowed. This therapy involves:
By following the doctor’s instructions, you can independently evaluate their effect: whether the veins on the testicles have decreased. If the patient is elderly and does not plan to have children, the doctor may give preference to the conservative method even at stages 3 and 4, taking into account the individual characteristics of the human body.
Varicose veins in the testicles in men: danger
The delicate male sphere requires close attention, because varicose veins on the eggs today can be diagnosed at the first stage and treatment can be started in a timely manner. Keeping silent about the problem at a young age due to shyness can lead to dire consequences. Impaired blood circulation due to dilation of blood vessels in the groin area leads to difficulty in gas exchange, because oxygen in the required volume does not enter the veins in the balls, which leads to overheating of the scrotum. Elevated temperature leads to tissue atrophy, impaired spermatogenesis and infertility.
If treatment is not started on time, the advanced stage of the disease leads to irreversible consequences, including tissue death, leading to gangrene and blood poisoning. If, with timely treatment, surgery can help restore blood circulation and erectile function in men, then in advanced forms, varicose veins can lead to amputation of the limb.
You should not resist the advice of phlebologists and neglect the recommendations of specialists, because treatment started on time guarantees longevity, restoration of reproductive function and preservation of male strength.
A varicocele is the formation of a grape-shaped lump in a man's scrotum. A similar phenomenon is associated with varicose veins of the testicle and spermatic cord.
As a rule, the disease develops during puberty, that is, in adolescents. Most often, the left-sided form of varicocele occurs due to the characteristics of male anatomy.
Right-sided and bilateral forms of the disease are quite rare in practice. Let's look at varicocele in men: the causes, symptoms and other important nuances are described in our article.
In order to answer this question, we need to consider the pathogenesis of varicocele. Veins in the human body are responsible for transporting blood containing carbon dioxide. Movement along them is directed from bottom to top. The walls of the veins are elastic compared to the arteries, and are equipped with special valves that should prevent the reverse flow of blood.
When the valves of the veins surrounding the testicle with the spermatic cord malfunction, the blood stagnates, stretching the walls of the vessels, forming a seal resembling a bunch of grapes.
However, infection with bacteria, viruses and fungi can lead to inflammatory processes in the male genital organs, which indirectly contribute to the development of varicocele.
Can the disease develop for psychosomatic reasons? What is psychosomatic in varicocele?
Any severe stress is accompanied by the release of the hormones adrenaline or norepinephrine into the blood. The selectivity of hormonal release depends on the individual characteristics of the man’s body:
What other causes of varicocele in men are there, and why it develops, we will consider further.
What causes varicocele in men? All causes of the development of the disease in question can be divided into the following groups:
The result of such heredity is congenital defects of the venous valves or their complete absence, as well as thin or insufficiently elastic walls of the veins in the scrotum area.
A decrease in the lumen is also caused by the presence of a tumor, the location of the vein between other vessels, and chronic stress with the release of the hormone adrenaline into the blood.
It differs from the left-sided one in that the veins remain inflated in a horizontal position. Secondary is called a varicocele, which is a consequence of another disease.
Pressure in the lower abdomen increases with regular constipation, intense physical activity associated with lifting weights, chronic stress and neuroses, accompanied by the release of norepinephrine into the blood.
Alcohol consumption leads to deformation and premature wear of all blood vessels in the body.
Eating fast food, canned food, and cheap confectionery with a high content of margarine and sugar causes insufficient formation of connective tissue in the body. When combined with a sedentary lifestyle, obesity can develop.
Overweight men are predisposed to developing varicoceles due to the formation of cholesterol plaques on the walls of blood vessels and the possibility of compression of the veins in the scrotum by the fatty layer.
Separately, it is worth mentioning beer , which, when consumed regularly, can change the hormonal balance of the male body due to the suppression of testosterone synthesis and an increase in the concentration of estrogen-like substances in the blood, which causes varicocele and also the development of testicular tumors.
The use of anabolic and steroid drugs changes the hormonal balance, which is why varicocele appears in men, as this adversely affects the condition of blood vessels. In combination with intense strength training aimed at results, the likelihood of developing testicular varicose veins increases.
Doctors have not yet come to a consensus about the influence of intense sexual activity, and whether masturbation can cause varicocele. Common sense dictates that you should always listen to your body and stick to the golden mean . Violence against your body cannot be useful.
Recently, the occurrence of varicocele in boys has been associated with the use of diapers, which overheat the scrotum and cause vein defects in the testicles. This hypothesis has not yet received official confirmation.
We have already considered everything that causes varicocele. In the absence of congenital anomalies, the occurrence of varicocele can be prevented by taking care of the health of blood vessels and capillaries. To prevent varicocele you need to:
We looked at the causes of varicocele, the treatment of this disease is described in our next article.
You can learn more about the symptoms and causes of varicocele in men from the video below:
Varicocele is dangerous for men's health due to the development of infertility. Like any disease, it is better to diagnose it at an early stage. This will allow you to maintain full male health and the ability to become the father of your child in the future.
Currently, a huge number of people are faced with such a problem as varicose veins. This disease can affect anyone, regardless of gender and age. Quite often in men, varicose veins form on the testicles. This is a pathological condition, which is an expansion of the veins of the spermatic cord. In most cases, this disease is called varicocele.
As a result of this disease, the activity of the venous valves malfunctions, which begin to impede the reverse blood flow. This condition is typical for 1-7% of men. If you do not consult a doctor in a timely manner, you can get serious consequences. As consequences, testicular varicose veins can result in a small amount of oxygen supply to the tissues, infertility, impaired sperm activity, and tissue destruction due to stagnation. In the distant past, this condition can develop into cancer.
There are a huge number of reasons why the veins of the testicles dilate. The main development factors are the following reasons:
Depending on the nature of the disease, in medical practice there are 4 levels of such a disease as varicose veins of the testicles in men. Level 1 is determined only by ultrasound examination. At level 2, you can notice small veins. Level 3 can be determined by a doctor in a standing or lying position. At level 4, the expansion of the veins is clearly visible. The testicles are reduced in size.
During the disease, dilation of the veins of the testicles manifests itself as clinical symptoms. They are characterized by the following condition:
If you feel that you have constant pain in the groin area, consult a doctor immediately. Today there are several ways to diagnose varicose veins:
If an ultrasound is prescribed, then in this case Dopplerography is used. During the examination, the doctor pays attention to the pathological state of the blood flow. After this diagnostic method, if testicular varicose veins are detected, a decision is made on surgical intervention. Ultrasound in men is performed 2 times. Initially, the examination takes place in a horizontal position, only then in a vertical position. If a detailed examination is required, the patient is prescribed venography.
When a man is diagnosed with varicose veins, but at the same time he wants to conceive a child, the first thing he does is take an analysis to determine sperm parameters. Tests will show the ability to conceive a child with varicose veins. To maintain normal spermatogenesis, the only treatment option is surgery.
This method can be neglected only if the man no longer plans to become a father.
After the doctor diagnoses the disease varicose veins of the testicles, comprehensive treatment is prescribed. It usually includes drug therapy, hardware massage, sclerotherapy and surgery. The use of medications can strengthen vascular walls, improve blood flow to the male pelvic organs and increase their tone. Hardware massage is used only if there is swelling of the scrotum. It is designed to relieve this swelling.
As for sclerotherapy and surgery, they are intended to treat enlarged veins in men in later stages of the disease. Sclerotherapy involves the injection of drugs into a vein. Surgery is performed to remove the affected veins.
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One of the most unpleasant and dangerous diseases for men's health associated with dilated veins is varicocele.
With this disease, the veins located in the testicles dilate, often on the left side.
In the absence of timely medical care, the disease almost always leads to infertility, so it is important to know everything about varicocele in men - what it is, why it is dangerous, how it manifests itself and is treated.
Varicocele is characterized by a malnutrition of the testicle , resulting in a gradual process of atrophy. Enlarged venous vessels located around the testes interfere with the normal thermoregulation of this part of the male body. Overheating occurs.
Most often, varicose veins develop on the left . According to experts, this is due to the difference in the venous supply on the right and left sides. The vein coming from the left testicle is much longer than from the right. The pressure there is higher, which means the likelihood of developing varicose veins is higher.
Varicocele in itself does not pose a particular danger to a man’s life, but it often leads to male infertility. Almost half of the patients have problems with sperm production , and the percentage of those suffering from infertility increases the longer they are ill.
According to WHO statistics, varicocele occurs in 15-17% of men . These numbers may vary depending on where you live and your age. This disease occurs in 19.3% of adolescents aged 14-15 years. Among young people serving in the army, varicose veins occur in 5-7% of young people.
Signs of the disease are observed in 35% of sexually mature men undergoing ultrasound . In almost everyone, this disease affects the left testicle. On the right side, varicose veins occur only in 3-8% of men, on both testicles - 2-12%.
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Experts have not yet precisely determined the causes of the development of testicular varicose veins. Judging by the fact that it often occurs in adolescents, there is an assumption of the hereditary nature of the disease , in which a deficiency of connective tissue occurs in the body. If they are deficient, the venous valve develops poorly, as a result of which reverse blood flow through the vein is disrupted.
Another reason for the appearance of varicocele is considered to be increased pressure in the abdominal cavity . Most often this is associated with intestinal disturbances (constipation) and excessive physical activity. Blood circulation may also be impaired with the development of malignant tumors in the genitourinary system.
The disease develops over four stages:
The main complication of varicose veins is male infertility , which occurs as a result of impaired thermoregulation of the testicles and cessation of sperm production.
Other dangers may be: disturbances in the functioning of the heart valves, phimosis and flat feet - all these problems indicate a lack of connective tissue in the body.
Varicose veins sometimes indicate the presence of malignant tumors. Therefore, at the first signs of illness, you must consult a doctor and undergo all the necessary examinations .
At the beginning of its development, varicocele occurs almost without symptoms. Varicocele can be identified by pain in the testicle and scrotum , which will intensify as the disease progresses.
The pain can be of a pulling nature, and it can occur not only in the scrotum and testicles, but also in the entire groin area. Sometimes you can notice an increase in the size of the scrotum, as well as its descent on the side of the affected testicle.
The pain usually gets worse while walking, lifting heavy objects, and during sexual intercourse. If the disease is in the early stages of development, the pain disappears after the person lies down and rests. At stages 3 or 4, the pain is almost constant and does not depend on the patient’s physical activity.
You should go to the hospital at the slightest sign of varicocele - if pain appears in the scrotum or testicle area, especially after physical exertion, or when you feel enlarged veins on the testicles. Varicose veins are diagnosed by a urologist or phlebologist.
Diagnosing this disease is quite easy . During an examination by a phlebologist, the medical history, duration of symptoms, and the likelihood of injuries to the lumbar region are clarified.
In some cases, the doctor determines dilated veins during a visual examination of the patient, or by palpation of the diseased area. Sometimes the testicle affected by varicose veins becomes smaller in size and its elasticity is reduced.
Palpation is carried out in several positions of the patient - standing, lying, and also when straining.
If the veins are not identified when standing or straining, then varicose veins are most likely at stage 1 of development.
If the veins are visible to the naked eye, we may be talking about more severe stages of the disease.
an ultrasound examination of the retroperitoneum and kidneys is required . If vascular thrombosis is suspected, CT or MRI is prescribed.
Ultrasound of the scrotum, thermography, thermometry or Doppler sonography may be prescribed as additional diagnostic methods . To determine the correct course of treatment, renal-testicular venography or testicular venography is sometimes prescribed. If the decision has been made to undergo surgery, antegrade venography is usually indicated. It is carried out not only before surgery, but also during it, as well as after surgical treatment.
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Varicocele can be completely cured only with surgery. If the disease is in the initial stages of development, surgery can be avoided with the help of special diets, reducing physical activity and normalizing intestinal activity. If the disease has already reached severe stages, only surgical intervention will help.
Operations for testicular varicose veins most often come in two types: in the first case, ligation or removal of the dilated vein is performed, in the second case, a sclerosing substance is introduced into the vein through a puncture in the thigh, due to which blood flow in the affected vessel is stopped.
Learn more about male varicocele disease and the need for its treatment from this video:
By following certain preventive measures, you can minimize the risk of development and recurrence of varicocele:
Since the disease is often a hereditary disease, you should undergo regular examinations with doctors , starting from adolescence. With timely detection and diagnosis, it will be possible to cure varicocele without surgery.
Increasingly, couples in which the woman is healthy, the man does not complain about anything, his urological history is ideal, but pregnancy does not occur, turn to urologists-andrologists with questions of family planning. And after taking a spermogram, it turns out that sperm motility is very low, their appearance is changed, and in more advanced cases, the sperm does not contain male germ cells at all. Often, against the background of such a picture, after a thorough examination, a man is diagnosed with “varicocele,” or the patient remembers that it was already diagnosed in childhood.
Varicocele is a varicose dilation of testicular vessels, in particular the venous plexus, the cause of almost? cases of infertility in men. This pathology, as it is also called “varicose veins of the testicles,” causes disruption of the temperature circulation in the scrotum due to increased venous pressure. The male gonads overheat, growth and development of sperm do not occur or their progress is disrupted.
Varicocele is often diagnosed in adolescents with an active, accelerated period of puberty.
The appearance of varicocele in men occurs due to blood flow in the opposite direction (into the veins, not out of them), and increased pressure in the veins. From the testicles, blood flows out into three veins:
With testicular varicocele, venous discharge occurs in the testicular vein in 80-90% of cases, in the cremasteric vein in 2-15% of cases, and in a maximum of 1% of cases in the vein accompanying the spermatic cord. In addition to venous discharge, venous blood stagnates in the vessels of the testicle, which provokes the development of dangerous processes:
The testicles perform spermatogenic and endocrine functions in the body (testosterone synthesis). According to the primacy of occurrence, in first place is a decrease in the number, changes in morphological characteristics (teratozoospermia) and mobile activity (asthenozoospermia) of sperm. In the process of prolonged circulatory disorders, in the later stages of the development of the disease, testicular hyperthermia, endocrine function is also disrupted. With varicocele, testosterone decreases, as a result of which changes in metabolism occur over time, muscle mass is lost, osteoporosis develops, body weight increases due to fat, and lipid metabolism is disrupted.
The influence of varicocele on potency has been proven - both a decrease in potency and a complete inability to perform sexual intercourse. This disease can cause prostatitis, since venous blood with residual metabolic products also accumulates in the prostatic venous plexus. If a bacterial infection is added to this, then prolonged prostatitis is guaranteed. Often, after healing from testicular varicocele, prostatitis, for which specific treatment did not help, is also cured.
The causes of varicocele are divided into two groups:
The initial method in the complex of diagnostic measures is the collection of anamnesis and an initial examination of the patient. Varicocele is often diagnosed in a teenager aged 14-16 years, during puberty. In the process of collecting an anamnesis of illness and life from an already adult patient, he recalls that he had such a diagnosis in adolescence, but his parents did not pay enough attention to getting rid of it.
It is almost impossible to determine any specific symptoms of varicocele - occasionally the patient may complain of pain in the perineum, localized in the scrotum during physical exertion. In the early stages, varicocele almost does not manifest itself.
Diagnosis of varicocele continues with ultrasound examinations and Doppler mapping of the scrotum while lying down and standing. Before testing, the patient must warm up his body at room temperature (in cold weather) and stand for a while. The fact is that filling of the veins of the testicle occurs only when the man is standing. Often the patient is given an incorrect diagnosis (only left-sided pathology is diagnosed) because the study was carried out incorrectly.
There is a misconception that this pathology occurs only on the left, although this is precisely what is written about in many textbooks on urology and is repeated by domestic urologists. Modern Western scientists prove that testicular varicose veins are a bilateral pathology and its treatment should be carried out on both sides.
The patient often keeps silent about problems with fulfilling marital duties, because he does not know whether varicocele affects potency. In this case, you should also carefully question him about his sex life and possible problems.
Diagnosis of bilateral varicocele requires a thorough examination, proper research, and patients following all prescribed rules.
In addition to the above-described measures for identifying the disease, the patient is prescribed a blood test to determine the testosterone content in it, and a spermogram to determine the number, appearance and motility of sperm. Changes in the normal values of these studies are signs of varicocele and other diseases of the male genitourinary system.
With a protracted process, varicocele embolization is possible - blockage of a vessel with an embolus, which is a dangerous consequence of an untreated disease.
The next step after identification is the appointment and start of treatment, because with a protracted, advanced process, complications of varicocele will also have to be treated - male infertility, prostatitis, inflammatory processes in the scrotum.
Treatment of pathology is only surgical. Treatment methods for varicocele are varied, but all are aimed at overcoming the main problem - getting rid of blood stagnation in the pampiniform plexus, returning “poisoned” blood from the kidneys to the testicle.
Modern urologists use the following types of operations:
All these operations have their pros and cons, contraindications and features.
The Ivanissevich operation is a classic in the treatment of testicular varicose veins, known and used in medicine for 100 years. In its process, an incision is made in the left iliac region layer by layer (skin, subcutaneous fat, aponeuroses of the abdominal muscles, intraperitoneal fascia). In the retroperitoneal space, the testicular vein is brought out, ligated and excised, followed by layer-by-layer suturing of the wound.
The Palomo operation is similar to the previous one, but in addition to cutting the vein, the artery is also cut. This type of operation is indicated for varicocele in adolescents.
The advantages of these operations are efficiency, lack of specific instruments (instruments are used for conventional abdominal operations), and technical ease of execution.
The disadvantages include: difficulty in ensuring the safety of the draining lymphatic ducts, the safety of the cremasteric vein, small veins behind the peritoneum, which does not exclude recurrence of varicocele, long postoperative recovery (up to 2 months) due to damage to a significant array of muscles and fascia.
Endovascular occlusion of the testicular vein involves closing its lumen, carried out inside the vessel. This is a method of x-ray surgery. Under X-ray control, a catheter is inserted into the vein, through which a substance or coil is introduced. Of the administered substances, sclerosing agents (ethoxylerol) are mainly used. This method is used to treat varicocele in adolescents.
Advantages of the method: no violation of tissue integrity (only a puncture is made on the surface of the thigh), ensuring the safety of lymphatic vessels.
The disadvantages are similar to retroperitoneal operations: the cremasteric vein remains in the body, which can cause a recurrence of varicocele. Also, the operation is performed not by a urologist, but by an x-ray angiosurgeon, so the presence of a urologist during the operation is mandatory.
From an anatomical point of view, the described methods program one-way blood flow.
Laparoscopic treatment of varicocele has been carried out for more than 25 years; under general anesthesia, three laparoscopic ports, including a viewing one, are inserted into the patient through a puncture in the abdominal wall. The testicular vein is isolated and a ligature is applied.
Pros: minimal disruption of tissue integrity; can be performed for varicocele in a teenager.
Disadvantages - the occurrence of relapse of varicocele, for the same reasons as in previous operations.
Subinguinal microsurgical varicoceleectomy (removal of varicocele)
Since 1997, with the light hand of New York Cornell University professor Irwin Holstein, an operation has been performed during which the testicular and cremasteric veins are ligated.
Microsurgery of varicocele is performed by isolating all the veins of the spermatic cord, including small ones, excluding the cremasteric vein and the vein accompanying the spermatic cord, and then ligating them. A microscope and magnifying equipment are used.
The operation to remove varicocele is performed through a 1.2-2.2 cm long incision on the inguinal ring. Then other veins of the spermatic cord are isolated and ligated. The suture material used for dressing is non-absorbable. This method almost prevents recurrence of varicocele.
A man should take care of his health at any age. Regarding teenagers, trusting relationships in the family and sex education are very important, so that the boy does not hesitate to come to his parents if he discovers a problem. First of all, you should know that to prevent the worsening of the disease, parents should limit physical activity if their child has varicocele, and take him to a urologist as soon as possible.
When identifying a disease in a man after 30, the doctor must outline to him a clear relationship between “varicocele and infertility,” since many men, having read incompetent literature, insist on the absence of a connection. Attention should be paid to the importance of removing varicocele in the initial stages of its development.
Contraindications for varicocele are not sex, moderate physical activity, or driving. Patients also often ask the question: is it possible to combine varicocele and sports? The answer is simple - everything in moderation is healthy. The exception is lifting weights - barbells, kettlebells, tension in the abdominal muscles.