Varicocele of the left testicle: treatment, symptoms, and consequences
Varicocele - this is a purely male disease, which is the extension of the internal testicular vein and botryoidal plexus and occurs according to various estimates from 10 to 25% of men.
Predominantly detected left-hand drive form. Left varicocele is more often diagnosed in boys at the age of about 15 years. Often, this pathology is defined in young men.
The disease does not bring discomfort to the patient, but the implications of it are quite dangerous for the reproductive function, as it can lead to the inability to conceive. So, almost half of men with secondary infertility, a varicocele is diagnosed.
Why develop a varicocele
In its origin the veins of the testis and of the spermatic cord can be of two forms:
- primary (idiopathic);
- secondary (symptomatic).
The second type is the least common and develops as a result of any illnesses that contribute to poor circulation in the veins of the testicle and of the spermatic cord due to compression.
Thus, the venous extension in this case is a symptom, for example, renal tumors, metastasis of lymph nodes and the like May with equal frequency be observed both right-and left-handed forms.
Is mainly symptomatic varicocele affects men older.
But in the practice of the urologist is more common primary extension of the internal testicular vein and botryoidal plexus. In most cases we are talking about a varicocele on his left testicle.
The development of the disease can be due to several nuances of anatomy.
- Due to a congenital underdevelopment of the venous valves, which are unable to deter backflow of blood or do it well enough. As a result, when any loads or vertical position of the body blood pressure on the veins increases and is transmitted in the opposite direction. Because of this venous dilation of blood vascular.
- Left-sided varicocele widespread due to the fact that the left Vienna egg is longer and enters the left kidney vein at an angle of about 90 degrees.
- Swelling of the veins in the testicles can occur when increased pressure in the left renal vein, if that, like tweezers, is clamped the aorta and the sub-mesenteric artery. Specifically an increase in pressure occurs when the vertical position of the body during physical activity.
Knowledge of etiological factors explains why a varicocele of the left testicle more common.
The bilateral form isa fifth of all cases, right type found only in 2% of patients. A rise in pressure in the blood vascular during physical activity leads to the fact that it is in these moments a man or a boy might be followed by unpleasant symptoms.
Is it possible to suspect a varicocele?
The expansion of the testicular veins botryoidal plexus and has no clear symptoms. The vast majority of patients the disease is detected in the process of medical examination.
Sometimes the person is concerned about a dull, aching pain in the groin and in the left part of the scrotum.
And pain syndrome is intermittent, increases with load and high ambient temperature, and completely disappears at rest and in horizontal position. With a strong degree of varicocele scrotum may interfere with the process of Jogging or walking.
If these symptoms bother you at least periodically, you should visit a doctor, as the disease have dangerous consequences.
What can cause varicose veins
Unpleasant result of the venous expansion around the egg are fertility issues, due to several factors.
- Blood stagnation leads to weak nutrition of the egg, which negatively affects the formation of sperm. The sperm of the patient may contain fewer germ cells, and many of them are weakly mobile.
- The accumulation of decay products cause damage to tissues of testicles.
- For normal operation of the testicles and maturation of germ cells, the temperature inside the scrotum should be around 34-36 degrees, which causes this anatomy of the male reproductive system. When a varicocele is swollen veins prevent normal thermoregulation, warming the testis.
- Circulatory disorders eventually lead to the development of the autoimmune response when the body perceives the tissue structure of testes as foreign, producing antibodies.
The latter fact to the greatest extent determines the relationship of venous disease to infertility. Impairment of spermatogenesis observed in more than half of patients with varicocele. Therefore, the diagnosis of venous extension is the important stage of identifying the cause of problems with conception, as well as their prevention.
How to identify varicocele
Varicocele diagnosis usually presents no difficulties and may include various survey methods.
- To identify the extension Lutovinovo plexus is usually obtained at the first reception on palpation in the standing and lying down. More accurate examination if the patient is straining, pumping pressure in the abdominal cavity, leading tofilling of the veins of the testicle. This so-called sample of Valsalva.
- In some cases, the extension is detected only during ultrasound and/or color Doppler, which should be done in two positions: standing and lying.
- Additional methods that allows to evaluate changes in the structure and blood flow in the renal and testicular vein and to identify aortomesenteric "tweezers" are venography of kidneys and testicles.
- To determine the etiology of symptomatic varicocele is sometimes necessary to undergo angiography, CT and MRI.
Patients are prescribed and laboratory tests:
- urinalysis, which rarely detects impurities in the blood and protein;
- sperm at intervals of 1-3 months, is required for sperm evaluation.
The diagnosis is not enough, it is also important to determine the extent of the disease. According to the severity of the signs of varicoceles can be of four forms.
- Varicocele of 1 degree to the left can be detected only by ultrasonography. On palpation, the changes are not detected.
- Vein with second degree varicocele palpated if the patient is standing. In the supine position are not defined.
- In the third form changes the veins be felt in any position of the patient.
- The fourth form can be determined even visually.
Based on the survey selected the most suitable treatment of varicocele on the left.
Is it possible to get rid of
As with any varicose veins, varicocele, there are 2 tactics of treatment:
- dynamic monitoring is possible a maximum at 1-2 degree varicocele;
- surgical intervention is used quite often.
Surgical techniques are displayed in several cases:
- if a visual defect;
- for infertility;
- in the case of pain syndrome.
Many urologists believe that it is necessary to operate all the young men who have problems with the veins of the testicle, to avoid problems with conceiving in the future. Also recommended surgery for varicocele 2 degrees left, the young men who are considering fatherhood.
Surgical treatment can be done in different ways.
But the most widely 4 options:
- Open surgery to Ivanissevich aimed at the ligation of the testicular vein, which is accessed through an incision in the iliac region.
- During operations from minimal access produce the ligation of the veins of the spermatic cord through a small incision that is made 10 mm from the base of the penis.
- Endoscopic method, the stomach isthree tiny puncture through which is introduced the camera with lighting and special small tools. The surgeon separates the desired area of the veins and imposes titanium brackets or tighten the thread. The procedure takes about half an hour.
- Microsurgical remasculate aimed at the normalization of blood flow through transplantation of testicular veins in the upper abdomen.
In some cases, especially with frequent relapses may designate roentgeno-endovascular surgery, in which through an incision in the groin into the femoral vein catheter is gradually promoted through the venous channel under the control of the x-ray machine. After reaching the left testicular vein block the blood flow, for example, via a tube.
The choice of methodology may exercise only the doctor. With timely and successful surgery the prognosis for patients is favorable.