How to diagnose and treat a varicocele
There is one, purely male problem that men do not hasten on reception to the doctor, feeling a sense of unease. And in vain: as the game progresses, this disease can cause many unpleasant consequences, including infertility.
We are talking about varicose veins of the spermatic cord, which is also called varicocele: causes, symptoms and ways to treat it and will be the subject of the article.
Anatomy of a problem
Testicles - paired organ, richly Sabaudia blood. Blood supply is carried out through an extensive network of blood vascular, part of which is lozovina plexus of the spermatic cord.
Poor circulation in this Department leads to deformation of the veins due to excessive pressure of blood against the walls of blood in the scrotum stays in one place, the veins swell, forming nodes.
For comparison, the blood pressure in the veins of the testicles in healthy men is approximately 85 mm Hg. article, and those who are sick varicocele, the pressure was raised to 200-240 mm Hg. article
Comparison of healthy and affected testes
Mainly the varicose veins of the spermatic cord develops on the left: this is because the seed Vienna could fall in renal under a right angle. It has a longer length than other similar vascular, so the blood pressure in it is higher. Accordingly, seed Vienna more vulnerable, and often affects the varicocele.
The superior mesenteric artery and the trunk of the aorta form the aorto-mesenteric "forceps", which is pinching of the left renal vein, resulting in venous reflux - the backward stuffing blood into the left testicular vein. Botryoidal plexus in the spermatic cord when it fills up with blood.
And even right-sided varicocele also occur, but much less frequently.
Thus, the examination of the man revealed varicocele: what is it and why does it occur, what can cause and how to treat it?
Experts distinguish two forms of this venous pathology - idiopathic and symptomatic. Idiopathic varices occurs for no apparent reason, and on the development of symptomatic forms is influenced by the number of factors that can be considered as the causes of varicocele.
The reasons lie in varicocele of valvular insufficiency testicular vein and weakness of the venous walls. This weakness may be either congenital or acquired during life, if a man carrying a heavy physical burden, under which there is excessive tension of the abdominal muscles.
A role inthe development of varicocele are playing and the usual constipation. The mechanism of their negative impact on blood vascular botryoidal plexus-like effect in heavy physical labour: from the constant voltage valve system of the veins of the spermatic cord weakens as blood vascular, resulting in symptoms of varicose veins.
Classification of the disease
In medicine adopted four classifications of pathology of the veins of the spermatic cord. They determine the course of the disease in the severity of the visual or palpation of the manifestations of varicocele:
I degree - evident only with palpation in the standing position with straining
Grade II - dilated veins are clearly visible, the consistency and size of testis normal
III degree - the egg is reduced, the consistency changed, the veins botryoidal plexus is dilated
According To Isakov
This classification is used in pediatric surgery to determine the stage of development of varicocele:
I degree - varices are not visible, their identification is only possible by palpation after a bit of tension in the muscles
Grade II - visible nodes, but the size and consistency of egg is not changed
III degree - varicose veins is pronounced, the egg is reduced and has testovatoy consistency
By B. L. Coolsaet:
This classification is built based hemodynamics of varicocele:
I degree - reverse output (reflux) of blood from the left renal vein in testicular
Grade II - back ejection of the blood from the iliac vein in the testicular
III degree - combined type refluxes
I degree - varicose veins are not detected neither visually nor by palpation, but the Valsalva test (test, during which the patient is asked to strain the abdominal wall and to hold the breath) positive: varicose veins are only visible when standing and lying down they collapse
II degree - the veins of the scrotum is not visible, but well be felt
Grade III - advanced vein and visualized, and palpated distinctly
How to spot the disease
Varicose veins of the cord - insidious disease: about half of the men learns that they have a varicocele on examination. In other words, the varicose veins they occurs without any symptoms or with only minor and momentary discomfort:
- Pulling pain in the scrotum
- A sense of heaviness and tension in it
So very often manifested varicocele: symptoms of disorders of the venous circulation observed only after considerable physical exertion and disappear completely after their termination and a short rest.
Expressed discomfort in which the pain is almost constant and not dependent onloads of character, patients report only on the third or fourth stages of varicocele. At the same time there is a change in the size and consistency of testicles: they shrink, losing the face, soften.
On the potency of varicose veins is not particularly affected, however some men is another symptom of varicocele is infertility, which they learn after several years of regular sexual life and unsuccessful attempts to conceive a child.
Varicocele and infertility
The testes (testicles) produce sperm, the quality of which is determined primarily by the number of Mature and motile sperm. The most important condition for production is the maintenance of a special temperature in the testicles. It normally does not exceed 32 degrees, but with the progression of varicocele, the temperature in the scrotum becomes much higher, therefore, the spermatogenesis is inhibited, the sperm loses its viscosity, and the number suitable for fertilization of sperm decreases.
Knowing this, doctors-reproductologists always direct it came to the examination of men for advice to the surgeon to exclude the negative impact of the narrowing of the veins of the spermatic cord in the production of healthy sperm.
Varicose veins cord can be diagnosed based on typical complaints or accidentally, during a medical examination for any other reason.
In addition to clarifying the nature of the discomfort in the area of testicles, inspection and feeling their specialist also conducts clarifying a diagnosis with the use of ultrasonic equipment.
The study in patients with varicocele men usually reveals characteristic changes in the veins of the spermatic cord is twisted or knotted anechoic departments. The diameter of the veins at the same time in varying degrees, exceeds its rate of three millimeters.
Ultrasound examination is essential not only for accurate diagnosis of varicose veins, but also in the preparatory phase before the surgery: varicocele refers to a category of diseases that can be treated only surgically.
Hardware diagnostics gives the technician accurate information about the condition of the tissue and the degree of blood flow in them.
The only effective way to treat varicocele - surgery. Today medicine allow us to perform surgery with maximum safety.
Patients with varicose veins men operate on one of the two methods of treatment: occlusive and reocclusion with the imposition of a veno-venous anastomosis. The choice of the methodology is carried out by the specialist on the basis of data obtained by ultrasonic examination of the patient.
Is it always necessaryoperation?
It should also be said that the operation is not yet available in all cases of varicocele: it is usually recommended only to those men who have pronounced pain, as well as in cases where a venous disease can affect the ability to conceive. In other cases, shows the monitoring and control of the development of varicocele - evaluation of the General condition of patients, changes in the size and consistency of testicles.
The operation is not shown to men of elderly and senile age, and also patients suffering from decompensated forms of some chronic diseases:
- Peptic ulcer of the stomach and intestines
- Coagulopathy (bleeding disorders of different etiology)
Surgery should be delayed at the time of treatment of SARS and other infectious diseases, and in the first six months after a stroke or heart attack.
How is the procedure performed for the treatment of varicocele? The main methods which operate on varicose veins of the cord, is an operation of Ivanissevich.
- Method Marmara
- Ligation of the testicular vein from the inguinal access (microsurgical technique)
- Video endoscopic method or laparoscopic varicocele
- Retroperitoneoscopic maryceleste
The operation of Ivanissevich belongs to the category of open surgical operations. Its essence consists in the ligation (tying) and excision of the left seminal vein. This injected intravenous anesthesia, and then are layered cuts tissue that leads to varicose portion of the vessel.
Despite the growing popularity of high-tech methods of treatment of varicocele, the operation of Ivanisevica is still considered to be not only technically simple, but also safe.
A less invasive method is considered Marmara - operation in which is performed a small incision (about 2 cm). Through it the spermatic cord is popped out and swollen are tied off and excised separately.
Alternatively, the aforementioned interventions are frequently applied technique that allows the surgeon to accurately visualize the area to be ligation and excision. The fact that the absence of good optics in some cases does not allow to clearly identify the artery, vein and lymphatic vascular, resulting in increased risk ligation not seed veins and arteries and lymph vascular.
Optical magnification of the area under operation eliminates the possibility of a medical error. The main drawback of this technique- the necessity of using special equipment and the high cost of the operation itself.
Retroperitoneoscopic maryceleste more effective treatment of varicocele, as carried out through a smaller craniotomy intervention of short duration, requires minimal anesthesia, does not give serious complications. The undoubted advantages of the approach include a significant reduction in the time patients stay in hospital and easier course of the rehabilitation period.
In addition, after the operation there remains only one small (1.5-2 cm) seam, then after the usual interventions without the use of minimal access remains to the three long scars.
Prevention of varicocele
Any surgery is a serious burden for the organism, is not the exception and removal of varicocele: varicose vein of the spermatic cord is associated with certain risks.
To avoid this, you need to take care of the health of blood vascular life. It will help to strict dosing of physical activity, binding, interleaving them with the rest.
It is necessary to monitor timely and complete emptying of the intestines, to eliminate constipation. Healthy food with lots of fiber, plenty of water, and other useful drinking, mobility and activity will help to maintain normal peristalsis.
Regular intake of vitamins, control of blood pressure with the use of antihypertensive drugs affect the good tone of blood vascular, not allowing them to thin and weaken.
Doing a sedentary office job or spend several hours behind the wheel, men need from time to time to get up from the computer or steering wheel, to warm up, performing simple physical exercises in order to "disperse" the blood and prevent its stagnation in the pelvic organs and legs.