It is known that men are not afraid of anything like doctors. They can lie in bed for a week with a temperature without seeking help, but as soon as the slightest pathological changes occur with the male genital organs, a visit to the doctor becomes a mandatory item on the agenda. One of these conditions is varicocele - varicose veins of the spermatic cord. The problem of varicose veins is observed in almost 20% of men of reproductive age. Moreover, in more than 90% of cases, varicocele develops on the left. It is the changes in the appearance of the male genital organs that make patients seek medical help.

Causes of dilated veins of the spermatic cord

The etiology and pathogenetic mechanisms of varicocele development today remain insufficiently studied issues. Studies suggest that the expansion of the testicular vein and the occurrence of varicocele is a compensatory response of the body to the state of renal hypertension. There are the following factors that cause the occurrence of varicocele:

  • testicular vein valve defect;
  • the inability of the venous walls to resist the pressure of the blood, which is the result of congenital weakness;
  • anatomical features: different lengths and small lumen of the veins of the spermatic cord;
  • Right-angle confluence of the left testicular vein into the renal vein.

Secondary varicose veins of the spermatic cord develop as a result of compression of the spermatic vein by neoplasms or inflammatory infiltrate in the abdominal cavity.

Clinical picture of varicocele: stages and symptoms

In accordance with the clinical picture of varicocele, it is customary to distinguish three degrees during the course of the disease:

  1. With first-degree varicocele in the vertical position of the body throughout the spermatic cord, the veins of the pampiniform plexus are dilated, but do not fall below the upper edge of the testicle. With the first degree of varicose veins of the spermatic cord, there are no clinical manifestations of the disease.
  2. In a second-degree varicocele, the veins of the entire pampiniform plexus are dilated, stretch the membranes of the spermatic cord and descend to the level between the edges of the testis. At the same time, the corresponding half of the scrotum and often the testicle itself are enlarged and lowered, the cremasteric reflex is reduced. During physical activity, patients complain of the occurrence of unpleasant pulling sensations in the scrotum. A characteristic sign of the second degree of varicocele is that when the body position changes from vertical to horizontal, the dilated veins collapse.
  3. With a varicocele of the third degree, significantly dilated veins descend beyond the lower edge of the testicle, to the bottom of the scrotum. This half of the scrotum becomes thinner, lengthens, acquires a bluish tint. The testicle is lowered and atrophied, the cremaster reflex is significantly weakened or may be completely absent. Painful sensation in the scrotum occurs even at rest, while changing the position of the body does not alleviate the patient's condition.

Varicocele can be complicated by phlebitis of the dilated veins of the spermatic cord, as well as the development of infertility, which occurs as a result of morphological changes in the testicles.

Diagnostic process of varicocele: basic methods

Diagnosis of varicose veins of the spermatic cord is not a difficult process: already during examination and palpation of the scrotum, it is possible to determine the degree of varicocele and the functional state of the testicle. It is important to remember that examination of a patient with varicocele must be carried out in two body positions: horizontal and vertical. Of the instrumental research methods, to clarify the etiological factors of varicocele, ultrasound scanning, urography, renal angiography and thermography are used. Selective renal phlebography helps to assess the condition of the renal and testicular veins, and color Doppler ultrasonography helps to identify small forms of varicocele. Ejaculate examination and testicular biopsy are performed if a patient with varicocele complains of infertility.

Surgical treatment of varicocele and prognosis for the patient

The treatment of varicocele is exclusively surgical, since conservative methods of treatment are ineffective in this disease. The most common operations are interruptions of the anastomosis between the renal and inferior vena cava, in order to stop the retrograde flow of blood from the renal vein system. For the treatment of patients with varicocele, methods such as transvenous embolization and transfemoral endovascular obliteration of the testicular vein have also been proposed. Sclerosing agents are injected into the testicular vein in the same manner as for arterial embolization. In general, with timely treatment, the prognosis for the life and reproductive function of the patient is favorable. But it should be remembered that with significant changes in the hemotesticular barrier,

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