What is varicocele in men - symptoms, causes and treatment. What is a varicocele? How does a varicocele manifest?

Below we will look at the signs of varicocele in men in the photo depending on the stage.

1st stage

An alternative name is hidden varicocele, in which no visible signs changes in the spermatic cords, and the disease itself is often asymptomatic (without pain).

You can feel nagging pain only during severe physical strain - exhausting workouts or prolonged lifting of weights.

The disease cannot be determined even during palpation - Dopplerography and ultrasound are required to determine functional pathological changes.

A man who has a family and children can have the first degree all his life, but not cause any inconvenience to the patient. Considering the irregularity of men seeking preventive examinations, doctors more often diagnose grades with visible manifestations of varicocele in men.

Symptoms of varicocele - photo of stage 1:

2nd stage

It is possible to determine obvious changes in the veins inside the scrotum in a certain position only if the patient is in a standing position.

Positioning the patient on the couch (lying down) does not lead to the appearance of protruding veins, which have already appeared inside the leather pouch the shape of a so-called bunch of grapes. Despite pronounced reflux and severe changes in the veins on the testicles in men (photo below), the shape of the testicle does not change and corresponds to a healthy one.

What does varicocele look like in men - photo of stage 2:

3rd stage

You can detect swollen veins protruding through the scrotum with the naked eye if the patient has the third stage of varicocele. Pathological changes do not disappear when changing body position and are observed in horizontal and supine body positions.

Almost always the testicles are changed in size (reduced), the scrotum droops significantly, and the body of the testicle with its appendages is lowered.

A patient with this stage complains of frequent pain due to testicular varicocele, which occurs even without physical activity.

What is varicocele in men - this is a photo of stage 3:

What threatens the third stage?

If testicular varicose veins in the photo above are your case, be prepared for the following complications:

• . Impaired lymph flow leads to fluid retention inside the scrotum. As a result, its size increases significantly (2–4 times): the scrotum inflates and looks like a filled ball.
• testicular atrophy. Visual signs are a severe decrease in size, leading to a reduction or complete cessation of sperm production.
• epididymitis. Acute inflammation of the testicle due to improper outflow and inflow of blood.
• thrombophlebitis of the inguinal veins. The appearance of a blood clot complicates the transport of oxygen and nutrients to the appendage. Diagnosed only by laboratory methods.

The third stage is considered the only option for correction, especially if the varicocele is aggravated by other diseases.

How to determine varicocele yourself?

Having studied each stage step by step, we can definitely say that varicocele can be determined by yourself only from the second stage, if you use the palpation method.

Determination of the first stage is permissible solely on the basis of the appearance of uncomfortable conditions characteristic of varicocele.

Preventive measures that involve studying the condition of the genital organs will also provide invaluable support.

Self-examination of the testicles is carried out by gently palpating the scrotum for the presence of varicocele without any preparatory procedures.

During the study of the spermatic cord, one should be wary of its increase and the appearance of tuberosity, which is felt tactilely.

Possible pain sensations: localization of pain and its nature

How does a testicle hurt with varicocele? Discomfort in men is concentrated in the lower abdomen: nagging pain affects the left or right side (based on the location of the varicose veins).

E if varicocele is paired, then the pain syndrome is concentrated in the middle of the solar plexus and periodically radiates directly to the scrotum, lower back, thigh or penis.

Patients also note burning sensation(typical with the additional development of an infectious lesion) and stabbing pain in the testicles with varicocele along the entire length of the affected spermatic cord.

Fact. A cosmetic defect in varicocele can initiate the appearance of sexual complexes.

Which doctor should I see?

Contact a urologist or andrologist helps to undergo the necessary examination and get the correct one depending on your health condition.

At the first stage, conservative methods of correction are acceptable; for all subsequent stages, surgery is indicated.

If a man is of reproductive age, then the doctor may refer the patient to study the condition of the sperm, which is performed after obtaining a spermatogram.

Detection of varicocele by an experienced urologist is not very difficult- physical changes are visible to the naked eye.

The exception is stage 1 of the expansion of the spermatic cord, which is determined only through research.

If pronounced signs of the disease are detected, a man should definitely consult a specialist in order to prevent the development of complications, which include both the appearance of side diseases and complete loss of fertility.

Useful video

A lot of important information about varicocele in the “Live Healthy” program:

Only in the groin area. The veins of the spermatic cord are affected. If surgery has not been performed, then in the future such patients have a high risk of impaired spermatogenesis and the development of infertility.

Varicose veins of the spermatic cord

This disease is a purely male pathology. The process involves vessels located near the testicles.

This is a non-infectious disease in which the veins of the spermatic cord dilate. Most often, the pathological process is one-sided. In most cases, varicose veins are detected on the left. This is due to the anatomical features of the male genital organs.

Pathology has the following distinctive features:

• may be asymptomatic;
• does not pose a health hazard;
• can only be treated surgically;
• often diagnosed in.

This disease does not disappear on its own. Many men live with the pathology for years without even knowing it exists. The prevalence of varicose veins among men reaches 17%. Every fifth teenager aged 14-15 years suffers from this disease. Left-sided varicocele on the testicle develops in more than 90% of cases.

In 2-12% of patients, both venous plexuses are involved in the process. When examining men with varicocele, it was found that 20-70% of patients have spermatogenesis disorders. This is due to the fact that against the background of vasodilation and blood stagnation, the local temperature increases. These changes negatively affect the maturation of male germ cells, which is the main cause.

Why do veins expand?

Every experienced surgeon knows what causes this pathology. The following factors play the greatest role in the development of the disease:

• poor functioning of venous valves;
• blood stagnation as a result of a sedentary lifestyle;
• physical stress;
• weightlifting;
• underdevelopment of connective tissue;
• disruption of the formation of veins during the process of organ formation;
• increased pressure in the renal vein.

Appears for various reasons. Triggering factors include chronic constipation, overload, and prolonged standing. With varicocele, the causes of pathology include increased pressure in the abdominal cavity. Against this background, the veins gradually stretch, dilate and fill with blood. A small nodule forms.

The doctor can feel it during the examination. Of great importance is such a factor as the relative position of the superior mesenteric artery and the renal vein. The degree of vascular dilation varies. Varicose veins are often visible to the naked eye, or changes are revealed only during ultrasound. With varicocele there are no stages.

How does the disease progress?

You need to know not only what causes this pathology, but also what its clinical symptoms are. Most often, signs of the disease are detected in adolescence. This often happens during conscription for military service after graduation. In most cases there are no complaints.

Varicocele on the left may manifest itself with the following symptoms:

• enlargement of the scrotum;
• its omission;
• moderate pain on the affected side;
• feeling of heaviness;
• decrease in the volume of the left testicle.

Pain is a variable symptom. It has the following features:

• aching;
• worsens in an upright position of the body, during physical work and after sexual contact;
• weakens when a person lies on his back.

Signs of varicocele at grade 0 are not detected during palpation and examination. They are identified in the process of instrumental research. 1st degree is different in that varicose veins are determined in a standing position. Dilated veins are not visible to the eye. With grade 2 varicocele, the nodules can be palpated in horizontal and vertical positions.

During palpation, mild pain may occur. Grade 3 is different in that dilated vessels can be seen with the naked eye. In such men, the pain becomes constant. The direct connection with physical activity disappears. With varicocele, the consequences can be unfavorable for sick men.

What should the examination be like?

All men should know not only what varicocele is, but also how to identify it. This vascular pathology does not cause difficulties in terms of diagnosis.

If a varicocele is suspected, treatment is carried out after a comprehensive examination. It is organized by a phlebologist or vascular surgeon.

First, a detailed history is collected. Risk factors for developing the disease are identified. This pathology can appear for various reasons.

A physical examination (palpation) is required. The veins are palpated while the person is standing or lying on the couch, as well as at rest and during straining. During palpation, tortuous, dilated and soft vessels of the pampiniform plexus of the spermatic cord are determined.

If necessary, the following instrumental studies are carried out:

• Ultrasound of the kidneys and scrotum;
• spermogram;
• thermometry.

Sometimes the development of varicocele disease is associated with another pathology. In this case, varicose veins occur secondaryly. A common cause is. Not everyone knows how to determine varicocele. This pathology can be detected using computed tomography and magnetic resonance imaging.

Rheography may be needed to assess blood flow in the affected area. What varicocele affects is known to all phlebologists: the main complication is infertility. To assess testicular function and spermatogenesis in case of varicocele disease, a semen analysis is required. During it, a decrease in the total number of germ cells and their activity is often detected.

Therapeutic tactics for varicocele

Many men wonder whether varicoceles can go away on their own.

The changes occurring in the vessels are irreversible. If there are no symptoms with varicocele and stage 0 or 1 of the disease is detected, then surgery is not required.

The peculiarity of this pathology is that it does not progress. One degree does not transfer to another.

Treatment methods for varicocele are few. Only surgical intervention can help the patient. Indications for surgery are:

• severe pain syndrome;
• changes in ejaculate parameters (asthenozoospermia and oligospermia);
• testicular underdevelopment (for teenagers).

In some cases, patients agree to radical treatment if there is a pronounced cosmetic defect in the scrotum area. For varicocele, the classification is known to every surgeon. With stage 3 disease, severe sagging of the scrotum is possible. This can cause difficulty in movement. In such a situation, surgical treatment of varicocele is justified.

The most frequently performed types of operations are:

• vein embolization;
• raising the testis;
• vessel ligation;
• excision of the dilated vein.

In how to treat varicocele, endoscopic operations have recently been widely used. Such manipulations are less traumatic. Treatment methods for testicular varicocele include mini-access surgery. In some cases, X-ray endovascular occlusion is used.

Vein excision is performed less and less often. Before treating varicocele, you need to ask the patient if he has children and whether he plans to have them in the future. This question is very important, since this pathology can cause infertility. Not everyone knows what will happen if varicocele is not treated. The primary form of the disease does not pose a threat. With primary dilation of the vein, it is necessary to cure the underlying disease (thrombosis). With varicocele, complications include disruption of spermatogenesis (the process of formation of male germ cells).

Forecast and preventive measures

It is necessary to know not only why varicocele develops, why this disease is dangerous, but also how to prevent it. The main influencing factor is stagnation of venous blood. In order to reduce the risk of developing this pathology, you must follow the following rules:

• do not lift heavy objects;
• treat chronic intestinal diseases;
• normalize stool;
• move more;
• do not stand in one position for a long time;
• give up alcohol.

When a varicocele develops, restoration of the vessel wall does not occur. The health prognosis is favorable. Identification of this pathology in young people gives a deferment from military service. Recovery after varicocele and surgery occurs quickly (within a few days). Thus, varicose veins are a very common pathology among the male half of the population.

Video

Varicocele is a varicose vein of the spermatic cord and testicle. This is one of the most common diseases among men, which often leads to very unpleasant consequences.

In itself, varicose veins of the spermatic cord are not life-threatening and often do not require treatment.

However, sometimes varicocele can cause infertility because it affects the quality and quantity of sperm produced. Of all men with infertility problems, about 40 percent are affected by this disease in at least one testicle. Most often, boys in mid-puberty are affected by this disease.

Mostly the left testicle of a man begins to suffer from varicocele, and much less often the right one. The disease, as a rule, develops during puberty and may not manifest itself for a very long time.

Causes

Why does varicocele develop and what is it? The cause of varicocele may be insufficient functioning of the valves of the spermatic cord veins. Venous valves, which normally prevent the reverse flow of blood, cannot cope with the increased pressure under increased stress (physical stress, vertical body position). Due to increased pressure, the veins gradually expand, eventually forming tumor-like venous nodes.

In more than 80% of all cases, varicocele is formed on the side of the left testicle. Typically, the pathology begins to develop in teenage boys at the age of 10-12 years and can become noticeable at about 14-15 years.

Degrees

Considering the intensity of damage to the venous system of the scrotum, the following degrees of varicocele are known:

• Primary degree. Externally, there are no signs of venous disease, but pathological changes are visible during Doppler ultrasound.
• 1st degree. Dilated vessels are not visible and are not palpable. You can notice them when straining - the Valsalva maneuver.
• 2nd degree. The blood vessels are dilated, not visually noticeable, but can be easily felt upon palpation.
• 3rd degree. An expanded venous network is clearly visible on the scrotum and can be felt during palpation.

Varicocele 1st degree

First degree varicocele may be accompanied by testicular dysfunction. The parameters of the ejaculate are examined: consistency, volume, sperm count, relative percentage of motile and immobile sperm, which is extremely important for diagnosing male infertility. Despite the absence of signs, grade 1 varicocele requires surgical treatment, especially for young men planning to have a child in the future.

Varicocele 2 degrees

Grade 2 varicocele can only be determined when the patient is standing, as well as during physical activity. There are no signs of varicocele in a quiet standing or lying position. In this case, it is also appropriate to conduct an instrumental examination and take a spermogram. The second degree of varicocele indicates the development of the disease.

Varicocele 3 degrees

With grade 3 varicocele, the veins affected by varicose veins are visible even to the naked eye and in any position. At this stage of the disease, the scrotum becomes doughy in nature, since in a standing position, dilated blood vessels reach the very bottom of the musculocutaneous formation and deform them. The glands may be severely swollen.

A patient with grade 3 varicocele suffers from constant pain that does not stop under the influence of analgesics. The skin of the scrotum becomes inflamed to a purple hue, the affected organ is noticeably smaller, and the grape-shaped venous weaves on it become rigid. The severe stage of the disease requires surgical treatment.

Signs

Men should pay attention to signs that may indicate testicular varicocele.

• visible or palpable (by palpation) enlarged vein;
• nagging and aching pain in the scrotum;
• feeling of heaviness in the testicle(s);
• atrophy (shrinkage) of the testicle(s);
• higher testosterone levels (although testosterone levels seem to rise further after varicocelectomy).

Symptoms of varicocele

With varicocele, symptoms are most often mild. The disease in men can occur without any noticeable symptoms. Varicocele usually manifests itself as mild bursting or nagging pain in the testicle.

In an upright position, the pain intensifies. Exacerbation of pain is observed during physical activity. The pathology can only manifest itself as a certain feeling of heaviness in the scrotum area without pain. There may be immobility and drooping testicles.

The tests diagnose in most cases weakness of spermatogenesis. To make a diagnosis, the following methods are used: ultrasound, palpation of the pampiniform plexus, and also a Valsalva maneuver.

Consequences of varicocele

As we have already said, the disease itself does not pose a threat to the patient’s life, but complications that may still occur are pain and male infertility.

Factors of infertility in this disease are as follows:

• testicular ischemia;
• increase in testicular temperature to general body temperature;
• accumulation of free radicals in testicular tissue that damage these tissues;
• reflux of biologically active substances into the testicles from the adrenal glands and kidneys.

It is possible that complications will arise after surgery, although this does not happen often. The most common consequence after surgery is lymphostasis. This is due to the fact that the lymphatic vessels are damaged. This complication disappears within a week.

Prevention measures

To reduce the expansion of the veins of the spermatic cord, it is necessary to eliminate the congestion that has formed in the pelvic organs. Thus, effective prevention measures are:

• normal stool;
• do not overexert yourself;
• regular sex life;
• rejection of bad habits;
• physical activity;
• sport;
• more fresh air and walks;
• proper nutrition;
• taking vitamins into the diet.

Treatment of varicocele

For varicocele, treatment and diagnosis are carried out by surgeons or urologists.

Treatment of pathology is only surgical; the main indications for surgery are:

• impaired sperm quality;
• discomfort or pain in the scrotum;
• aesthetically unsatisfactory appearance of the genitals;
• testicular atrophy.

For this purpose, several methods of surgical intervention have been proposed:

1. Embolization of blood vessels (in other words, blockage of blood vessels). The advantages of this method are quick recovery, no stitches from surgery. The disadvantage of this method is the possibility of blood flow through bypass paths and recurrence.
2. Laparoscopic surgery (introduction of micro-instruments through small punctures with ligation of veins).
3. Surgical correction of varicocele (with the possibility of microsurgical access and full-fledged surgery). Mainly performed in complicated cases.

The essence of all operations is to reduce the flow of blood through the testicular vein by ligating it or redirecting the flow to other, smaller veins.

How to treat varicocele without surgery? Non-surgical treatment is possible only in the early stages and is ineffective. Includes wearing supportive swimming trunks, as well as medications that improve the tone of the veins.

Possible complications after varicocele surgery

After surgery for varicocele, in some cases the following unpleasant complications may occur:

1. In the early postoperative period, ligation and damage to lymphatic vessels can provoke lymphostasis.
2. The most serious complication of surgical treatment of varicocele can be testicular atrophy or hypotrophy. This phenomenon can be caused by accidental ligation of the spermatic artery.
3. After surgery, pain decreases or disappears in 90% of cases, however, every 3-5 men out of 100 operated on continue to be bothered by pain in the area of ​​the testicle and spermatic cord.
4. Crossing the lymphatic vessels ½-4 years after surgery, and sometimes in the first months, can provoke testicular hydrocele in 0.5-9% of patients.
5. In adult men, recurrence of the disease is observed less frequently than in children - 2-9% and 1-20%, respectively.

The success of varicocele treatment is evidenced by an improvement in the quantitative and qualitative characteristics of sperm, observed after surgery, usually after 3-6 months.

Varicocele in men (Varicocele) - causes, symptoms, treatment methods. The history of varicocele in men and adolescents dates back to the 16th century. Already at this time, Ambraoise Pare, considered an outstanding surgeon of the Renaissance, identified the pathology of the vessels entwining the testicles, although some medical historians argue that the first mention of this ailment was made by Celsius in antiquity, describing the strange condition of the testicle when swollen veins appear above it.

Then it would not be amiss to recall that Hippocrates, the aesculapian of ancient Greece, spoke about a disease in men when thick black bile blood accumulates in the genital area.

Varicocele in men: causes, symptoms, treatment. In the 17th century, the term “sarcoceles” appeared, which was used to describe enlarged veins in the scrotum. The 19th century brought a new name for the disease “varicocele”, but it referred only to the dilation of the veins of the scrotum, and the word “sarcoceles” remained for the pathology of the spermatic cord. It was only in the second half of the 19th century that both of these diseases began to be called by the same term “varicocele”.

Around the same time, in the 19th century, the British surgeon Barfield addressed this urological problem, who associated the named disease with male infertility. The same idea was proven in the 20th century, when active study of the problem and the search for treatment methods began. At the same time, evidence is emerging that you can get rid of infertility if you treat varicocele. The disease is still being studied today.

The problem remains relevant, since the disease affects the demographic situation. This is another reason for not only doctors, but also people outside medicine to know what varicocele is in men and what it looks like.

Stages of the disease

The disease develops over 4 stages:

1. At the first stage, varicose veins are not noticeable outwardly and can only be detected with Dopplerography or ultrasound;
2. The second stage is characterized by an increased size of the veins, which can be determined by touch while standing;
3. At the third stage, the veins are already dilated to such an extent that they are easy to feel in any position;
4. At the fourth stage, enlarged veins are visible to the naked eye.

Why is male varicocele disease dangerous?

Having told so much about testicular varicose veins, it remains to find out why varicocele is dangerous for a man’s health and his family happiness. The male disease itself is not dangerous, since it does not guarantee death and does not shorten the life of patients. However, varicocele affects the ability to conceive children.

Male infertility is the main complication of the disease. Since the testicle is responsible for the reproduction of sperm, this function is reduced due to illness. In rare cases, the disease threatens the development of inflammation or testicular atrophy.

Varicocele - symptoms in men

According to the modern version of the mechanism of disease occurrence, scientists have concluded: Varicocele symptoms in men and the mechanism of formation are similar to the symptoms of varicose veins, therefore the principle of treatment is based on eliminating the primary source. The primary source is blood thickening, circulatory problems, or hormonal imbalances.

There can be many causes of varicocele disease:

• Poor oxygen saturation of the testicles;
• Improper operation of the valves, difficulties appear in the movement of blood in the direction and back;
• The appearance of a tumor;
• Congenital weak vascular walls;
• Accumulation of radicals in the scrotum;
• Increased temperature of the testicles appears due to stagnation of blood in the scrotum;
• Regular participation in strenuous sports, which may interfere with the proper functioning of the valves;
• Increased blood pressure on the veins that are located in the scrotum, which causes stretching of the veins;

In addition to the above, there may be other causes of varicocele; in any case, if you discover this disease, you should immediately consult a doctor.

Varicocele can be detected by several signs:

• Increase in size or sagging of part of the scrotum;
• Dilated veins;
• Experiencing discomfort and unusual sensations in the scrotum area;
• Painful sensations in the scrotum area.

Very often, the symptoms of varicocele may not appear, so it would be prudent to regularly see a doctor so as not to start the disease and not cause complications. Varicocele can be detected 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.

Causes of varicocele in men

The development of this disease is explained by the fact that the valves that exist in the veins, and which should prevent the reverse flow of blood, do not work, or work poorly, and when the pressure in the veins increases (for example, in an upright position of the body, during physical stress), this pressure begins to transmitted in the opposite direction, gradually causing dilation of the venous vessel. Thus, the veins surrounding the spermatic cord dilate.

Another reason for varicocele in men is the special anatomical relationship of the renal vein and the superior mesenteric artery with the formation of the so-called aortomesenteric “tweezers”. Gradually, under the influence of increased pressure, the veins begin to increase in size, stretch, and expand.

Causes of varicocele in men and adolescents. Depending on the strength of the vein walls in different people and the magnitude of venous pressure, this stretching can reach different degrees. The venous network around the testicle becomes larger and larger, and in severe cases the testicle appears as if immersed in a sponge of venous vessels.

This blood “cushion” from the venous vessels around the testicle leads to the fact that the thermoregulatory function of the scrotum is lost and the testicle stops cooling. Consequently, the reduced temperature required for sperm production is no longer present and normal spermatogenesis is suppressed. That is why varicocele is one of the main factors of male infertility.

Thus, the factors of infertility with varicocele are:

• Hypoxia (oxygen starvation, ischemia) of the testicle;
• An increase in the temperature in the testicle to body temperature (normally it should be lower than that of the body, which is necessary for the normal course of spermatogenesis (for the same reason the testicles are “moved” outside the abdominal cavity into the scrotum);
• The accumulation of free radicals in testicular tissue (which are strong cellular poisons), which damage them;
• Reverse reflux of biologically active substances from the kidneys and adrenal glands into the testicles.

Treatment of varicocele

Modern medicine claims that the most effective way to treat the disease is surgery. Traditional treatment options for varicocele do not bring effective results. If a man experiences severe pain in the genital area or is diagnosed with infertility, then surgery to eliminate varicocele is a mandatory procedure that is performed immediately.

If a man does not complain about anything, does not intend to have children, or has reached an advanced age, then surgical treatment may not be performed. If a varicocele is found in a boy, a young man or a mature guy, then surgical treatment is mandatory. Currently, there are quite a lot of treatment techniques (operations).

How to treat varicocele? Testicular treatment methods. As a rule, the operation is performed under general anesthesia, sometimes local anesthesia is also used. Surgical treatment to eliminate varicocele is not a particularly traumatic way to get rid of the disease, and a man can return to normal life within a couple of days after the operation. If the operation is successful, the number of sperm begins to increase, they become healthier and more active.

According to medical statistics, many sperm parameters (in the spermogram) after surgery to eliminate varicocele improve significantly. Pregnancy may occur (in 45%), and compensatory testicular growth is also possible. Which varicocele treatment method should I choose? The choice of method depends on the characteristics of the disease, the age category of the patient and his financial capabilities.

There are several types of operations for varicocele:

• Endoscopic surgery. When the patient has an asymptomatic varicocele or the patient is in the middle age category and still wants to have children. These treatment methods are carried out if there is a relapse of the disease after previous interventions and with bilateral varicocele.
  With revascularization, the testicular veins are completely removed and then restored using plastic surgery. Endoscopic surgery is considered the most progressive and least traumatic for the patient’s health;
• Operation Ivanissevich. This type of operation is popular because it is quite inexpensive. This operation can be done for any degree of disease. Local anesthesia is used. This is the first operation that was used to treat varicocele in men. The disadvantages of this type of operation are that it is traumatic and does not always bring the expected effect;
• Endoscopic surgery. This is the least traumatic type of surgery for varicocele. It is performed under general anesthesia. There are practically no complications. If a person has a bilateral varicocele, then only this operation will help him. This type of operation is prescribed in the frequent case when the disease is characterized by very strong, cutting pain in the scrotum;
• Revascularization(microscopic surgery) of the testicle, when the patient has severe or moderate pain in the groin area or there are abnormalities in the spermogram;
• Laparoscopic surgery. It is considered one of the most popular and effective operations. This method is preferred due to the fact that it is often performed under general anesthesia, does not leave large scars, and rehabilitation after surgery requires very little time;
• Microsurgery. It is performed using general anesthesia. The effect of varicocele treatment is noticeable immediately after the operation. The downside is that after microsurgery it takes a lot of time for rehabilitation, since the level of trauma is quite high;
• Operation Marmara. This is a very popular type of operation. It is particularly effective. Most people prefer it because there is no need to make incisions or enter the abdominal cavity. It leaves no scars, which take a long and painful time to heal. A huge advantage is that there are no complications after the operation, and recovery is quick and painless.

What to do after surgery

After varicocele surgery, it is recommended to refrain from any type of physical activity and emotional stress. During the next 2-3 months after recovery, restrictions on physical work are imposed. Restrictions on sexual activity vary from 20 to 30 days; at the discretion of the doctor, the period can be extended, it depends on the degree of varicocele.

Varicocele after surgery: recovery period. We must not forget about regular examinations with the attending physician. This is the only way to achieve complete restoration of all necessary functions. After varicocele surgery, as a rule, there are no complications, patients feel well, pain disappears. But there are isolated cases when complications arise.

Although improvements after surgery are noticeable, some unpleasant symptoms may still appear. Some patients complain that veins remain after surgery. This can only happen in the unfortunate event that the operation was performed poorly. Then you need to consult a doctor.

There are also complaints such as: after surgery, the varicocele has become enlarged or the testicle, vein and suture are sore, the left testicle is swollen, high temperature, atrophy, dropsy or groin disorder. But these are just isolated cases, which consist in one or another reaction of the body to surgical intervention.

You need to consult a doctor who will prescribe the necessary medications for you and tell you what procedures need to be carried out to get rid of unpleasant sensations. Varicoceles rarely return after surgery, so you can lead a daily life and do your usual activities, but still take certain precautions into account.

After the operation, the patient is able to lead a normal lifestyle. You can return to your normal rhythm of life within a few weeks. Playing sports after varicocele surgery is also possible, you just need to wait some time for the scars to heal and the body to fully recover after the operation.

Cost of varicocele surgery

Varicocele surgery in men is possible in many medical institutions, but it is best to go to a special urological clinic. The cost of varicocele surgery depends on the clinic chosen by the patient and the method of surgical intervention.

If you perform varicocele surgery in men using the Ivanissevich method, the average cost of the procedure will be 30 thousand rubles. Varicocele surgery using the endoscopic method will cost approximately 40-60 thousand rubles. An operation using the Marmara method, depending on the chosen clinic, can cost from 30 to 90 thousand rubles.

If, in addition to the cost of the operation itself, the costs include payment for hospital stay, food and doctor’s supervision, then in total the treatment of varicocele will cost approximately 90 thousand rubles. As with varicose veins in the legs, the only real treatment is surgery in one form or another.

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

Surgical treatment is required in the following cases:

• Aesthetic defect in the scrotum area;
• Presence of pain in the testicular area;
• Cessation of growth of the affected testicle during puberty;
• Male infertility (due to a decrease in the quantity, quality and motility of sperm).

Many experts believe that in children and adolescents, to prevent potential infertility, surgery for varicocele should be performed in any case.

Currently, there are 4 main surgical treatment methods:

1. Operation from mini access;
2. Microsurgical testicular revascularization;
3. Open (conventional) surgery;
4. Endoscopic surgery.

Diagnosis of varicocele

Every man should know how to identify varicocele and which doctor to contact if he suspects this disease. Since many not only know nothing about this ailment, but are also embarrassed by any problems associated with the intimate area, it’s time to call a doctor who not only treats this disease, but also diagnoses it.

At the first unpleasant symptoms of the disease, a man should visit a urologist. There is another specialist who treats male ailments. This is an andrologist. However, andrology is a new direction in medicine, so such specialized specialists are not available in every small city. Decide for yourself which specialist to contact, just remember that it is undesirable to delay treatment, so timely diagnosis and examination for varicocele is important.

Symptoms of varicocele and its diagnosis. Any urologist (andrologist) can diagnose varicocele using various diagnostic methods. The simplest method is palpation in a standing and lying position or the Valsalva maneuver. By palpating the scrotum area, the doctor determines the condition of the veins of the spermatic cord. At an early stage of the development of the disease, they are not visually visible, but it is these diagnostic methods that make it possible to identify the disease at an early stage and stop its development.

A more modern and accurate diagnostic method is ultrasound and doppelography for varicocele. These methods make it possible to determine the nature of blood flow, testicular size, formation of nodes, and thickening of the spermatic cord. Such an examination must be carried out in two positions: standing and lying down. After this, the results are compared and a diagnosis is made.

Doppelography allows you to determine the type of varicocele and the diseased vein that drains blood into the pampiniform plexus of the testicle.
Sometimes the doctor prescribes a laboratory test of sperm - a spermogram. This research method allows you to assess the condition of sperm. Semen analysis allows you to identify the volume of ejaculate, the number of sperm in 1 ml of seminal fluid, the percentage of active, sedentary, dead and inactive sperm.

Disease Prevention

By following certain preventive measures, you can minimize the risk of development and recurrence of varicocele: eat right, eat foods that have a beneficial effect on the intestines, take vitamins; avoid heavy physical activity; Use protection measures during sexual intercourse.

Since the disease is often hereditary, you should undergo regular examinations by doctors, starting from adolescence. With timely detection and diagnosis, it will be possible to cure varicocele without surgery.

Other treatments and possible complications

For the treatment of varicocele, operations using the Ivanissevich method and the Marmar method are also used. Ivanissevich’s method for eliminating varicocele is considered the most traumatic, but this is the only method that is used by state medicine for men with low financial status. Treatment of the disease using the Marmara method is considered a more progressive option, but it is only suitable for patients with stage 1 and 2 disease.

After any type of surgery to eliminate varicocele in men, the following complications may occur:

• Dropsy of the testicle (hydrocele);
• Manifestation of allergic reactions;
• Damage to the iliac artery;
• Recurrence of varicocele;
• Testicular atrophy or hypertrophy;
• Attachment of infection;
• Thrombophlebitis of deep veins in the pampiniform plexus;
• Impaired spermatogenesis, testicular azoospermia;
• Perforation in the walls of blood vessels;
• Severe postoperative pain in the scrotum and groin.

However, such complications are rare. To avoid any complications, the patient must adhere to the postoperative regimen and periodically visit the urologist.

Questions and answers

Answers to questions about varicocele.

1. Is it possible to get pregnant with varicocele without surgery? If varicocele is already at the second stage, then the risk of being infertile increases several times: as a result of vasodilation, less oxygen reaches the testicles, so the quality and motility of sperm deteriorates significantly;
2. For how long after surgery can you not have sex? Like any other surgical intervention, surgery to get rid of varicocele involves a certain period of time for the body to recover. Experts believe that it is best to abstain from sexual intercourse for about a month so that the man’s condition returns to normal. Otherwise, unpleasant consequences of varicocele in men may appear: pain in the scrotum area, and a relapse of the disease may occur and the operation will have to be performed again;
3. How long after surgery will my sperm improve? From the moment of varicocele surgery, sperm quality is restored within six months. It is important to regularly take sperm tests and monitor the current condition of sperm;
4. Can a man have children after varicocele surgery? They can if the man has an unadvanced stage of varicocele disease; otherwise, even surgical intervention will not help cure infertility caused by varicocele;
5. Can varicocele relapse in men if the scrotum is injured some time after the operation? No, he can not. Injuries caused to the scrotum non-surgically will not affect the recurrence of varicocele;
6. How long after varicocele surgery can an ultrasound be performed if there is a suspicion of recurrence of the disease? It happens that the operation is performed poorly, so a recurrence of varicocele occurs. This can be found out no earlier than after 2-3 months using an ultrasound scan. During this period of time, it may seem that nothing has changed, since the condition of the veins does not return to normal immediately, but gradually;
7. At what age is it better to have varicocele surgery to avoid unpleasant consequences? Varicocele appears already during puberty, when the blood flow of the veins in the testicles increases significantly. There are no contraindications for varicocele surgery at age, but it is best to consult a doctor. The effectiveness of varicocele treatment decreases with age: the operation will be effective in 90% of cases at the age of 13 years; at the age of 20, the effectiveness of the operation will decrease significantly and will already be 35-50%; by the age of 30, the effectiveness may decrease to 0-2% if the varicocele is already in an advanced stage.

Video “Varicocele in adolescents and men”

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Varicocele is a disease of the male genital area. It is characterized by varicose veins of the spermatic cord. It is mainly diagnosed during reproductive age, less often in childhood and adolescence. The disease has several types and forms, differing in the degree of damage and accompanying symptoms.

Description of the disease

The spermatic cords are paired organs formed in infancy when the testicles descend into the scrotum. They are necessary to maintain the latter and conduct sperm. The veins of the cords regulate the outflow of blood from the genital organs to the inferior vena cava and renal veins. With varicose veins, blood circulation is impaired.

Due to the peculiarities of the anatomical structure, left-sided varicocele is most often diagnosed; the pathology of the right testicle is determined only in 10-20% of cases. Bilateral varicose veins occur very rarely.

Fact: the right-sided type of the disease is most often the result of a tumor or other formation that compresses the veins and impairs the local blood supply.

The main reason for the development of varicocele is a malfunction of the valves that regulate blood flow. When this pathology appears, stagnant processes occur and the pressure in the veins changes. This is often accompanied by varicose veins of the lower extremities and hemorrhoids.

Varicocele code according to ICD 10 is I86.1. It belongs to a group of diseases that arise as a result of varicose veins of the lower extremities.

Classification of pathology

The type of disease is determined by its origin, the degree of manifestation of varicose veins and the severity of the course. There are several of its most common types.

By origin:

1. Primary. It occurs as an independent disease and is often asymptomatic.
2. Secondary. It is a consequence of other pathologies of the genital organs or blood supply system.

Types of varicocele by degree of manifestation:

1. I degree. Dilated veins are determined by palpation of the spermatic cords or when the man tenses in a standing position.
2. II degree. The course of varicocele is noticeable upon visual examination, while the testicle itself remains in normal condition.
3. III degree. Reduced size and altered structure of the testicle with severely enlarged veins.

Through the vein that supplies the vessels of the testicle:

1. Renal.
2. Ileum.
3. A combination of the first two types.

Classification as defined by the World Health Organization:

1. I degree. Determination of pathological changes when the patient strains.
2. II degree. Normal external condition of organs, detection of varicose veins upon palpation.
3. III degree. Clear visualization of dilated veins.

There are differences in the disease and in the severity of symptoms.

Causes of varicocele

The main reasons contributing to the occurrence of varicocele in men:

• high intra-abdominal pressure is a consequence of constipation, strong physical exertion, chronic stress, entails overflow of the veins, stretching of their walls, and subsequently deformation;
• genetic predisposition - in the presence of this factor, there is a high probability of the appearance of a congenital disease characterized by pathologies of the venous valves or low elasticity of the veins in the scrotum;
• kidney disease – contributes to the development of the right-sided type of disease;
• reduction of the venous lumen as a result of inflammatory processes, injuries, surgical interventions, hormonal imbalances and growth of formations;
• improper lifestyle - alcohol and smoking abuse, a large amount of fast food, preservatives and heavy foods in the diet, a sedentary lifestyle - all this entails an increase in the number of cholesterol plaques, thinning of the walls of blood vessels, compression of the veins by the fatty layer;
• Irregular sex life or its absence - causes blood stagnation in the pelvic area and scrotum, increases the risk of other genital diseases;
• taking hormonal medications - without a doctor’s prescription, this can disrupt the functioning of the endocrine organs.

In childhood, pathology most often develops due to intrauterine disorders, vascular diseases, and increased intra-abdominal pressure. In adolescents, varicocele is often a consequence of heavy lifting or weightlifting.

Fact: an unhealthy lifestyle in children leads to pathologies more often than in adults - this is due to the ongoing development of the body and insufficient elasticity of blood vessels.

Symptoms of varicocele

The intensity of symptoms depends on the degree of varicose veins. The first stages of the disease are most often asymptomatic - this condition is also possible in the absence of progression of varicocele for a long time.

Symptoms:

• pain in the scrotum area - varies from aching to acute, most severely manifested when walking, after physical activity and in hot weather, weakens when lying on your back;
• decreased potency – varicocele negatively affects sexual function;
• testicular atrophy - manifested by changes in their size and location;
• prolonged absence of conception with low sperm motility leads to infertility;
• visual determination of varicose veins;
• swelling and swelling of the scrotum.

The second stage is accompanied by periodic pain. At the third stage, the symptoms of varicocele appear most clearly. Men during this period complain of constant pain, which intensifies with physical activity. It is during this period that the expansion of the veins is most noticeable to the naked eye, the shape of the scrotum and the location of the testicles change.

What are the dangers of varicocele if left untreated?

Without proper treatment, the disease progresses. Stagnant processes in the scrotum area lead to a lack of oxygen in the tissues and an increase in local temperature, which provokes the death of sperm.

Subsequently, the affected testicle, enlarged in size, begins to shrink and dies; the functionality of the organ cannot be restored.

Possible consequences of varicocele in the absence of medical intervention:

• hydrocele, or testicular hydrocele – accumulation of fluid in the scrotum, which is manifested by its enlargement and smoothness;
• teratozoospermia - a decrease in the number of viable sperm, leads to infertility;
• prostatitis – can occur with a long course of bilateral varicocele;
• orchitis is an autoimmune inflammatory process in the testicles, characterized by damage to male germ cells;
• testicular cancer – the influence of varicocele on its occurrence has not been proven, but the presence of the disease increases the risk of developing oncological processes.

Fact: with a long course of unilateral varicose veins of the seminiferous tubule, a second healthy organ is also affected, which is likely to lead to infertility.

With high sperm resistance to environmental influences, the risk of complications is reduced. In this case, the ability to fertilize is preserved, but the likelihood of conception decreases.

Diagnostics

To make a diagnosis, it is necessary to carry out a set of diagnostic measures aimed at assessing the condition of the male genital organs and differentiating varicocele from other diseases. Main research methods:

• medical examination - visual assessment of the size and location of the testicles, their palpation and determination of the condition of the veins;
• Ultrasound with doplegraphy in a relaxed state and during straining - identification of varicose veins and blood supply activity, a more detailed examination of the testicles;
• scrotal thermography – determination of the temperature difference between the testicles;
• X-ray with contrast agent - assessment of the condition of blood vessels;
• spermogram - study of sperm composition and sperm motility;
• general urinalysis - obtaining indicators to determine kidney function;
• general blood test - its results reveal the state of the body, the course of inflammatory processes;
• study of hormonal levels.

If it is difficult to make a diagnosis based on the test results, additional diagnostic measures may be prescribed.

Treatment of varicocele

The method of treating pathology is determined by its degree, the age of the patient and his individual characteristics. If conception is necessary, surgery is needed - this method of treating varicocele is considered the most effective. In other cases, drug treatment is prescribed.

Conservative therapy

This method of treating varicocele involves taking medications and changing the rhythm of life. Patients are prescribed the following types of medications:

• antioxidants (Antiox, Triovit, Vitamax plus C) – necessary to replenish nutrients in the body, contain vitamins;
• means for improving blood circulation (Orbiflex, Trental, Agapurin) - eliminate congestion in the scrotum, normalize blood flow;
• venoprotectors (Esuzan, Detralex, Phlebodia) – restore the functioning of veins and increase their elasticity.

Important: only a specialist can determine how to treat varicocele - all medications and other types of therapy are prescribed strictly based on research results.

In parallel with taking medications, it is necessary to follow some rules to prevent further progression of the disease:

• exclusion of physical activity such as long walking, heavy lifting, horseback riding, cycling, dancing;
• elimination of constipation and bloating;
• regular sex life;
• weekly swimming lessons;
• hardening the scrotum by dousing it with cold water;
• wearing a special support bandage is most important in the last stages of the disease;
• giving up bad habits - smoking, alcohol.

The conservative treatment method is effective only at the first stage of varicocele. In the future, it is used as maintenance therapy.

Surgery

Indications for surgical intervention to remove varicocele:

• lack of effectiveness of conservative treatment;
• constant pain;
• changes in the size and structure of the testicle;
• sexual dysfunction;
• detection of pathologies on spermogram;
• prolonged absence of conception;
• contraindication for military service;
• psychological discomfort of the patient.

Types of surgical treatment:

1. Traditional. An outdated method, carried out using local anesthesia, the length of the incision does not exceed 5 cm. The damaged vein is ligated or crossed.
2. Operation Marmara. It is considered one of the most effective and is performed using local anesthesia. The length of the incision is about 1 cm; no instruments are inserted into the abdominal cavity to perform the manipulations. The rehabilitation period after the intervention lasts no more than two days, after which the patient is discharged from the hospital.
3. Laparoscopy. To carry it out, three small incisions are made through which an instrument with a video camera at the end is inserted. Requires the use of general anesthesia. Laparoscopy is an effective and safe type of surgical treatment for varicocele.
4. Sclerosis of veins. A catheter is inserted through a puncture in the femoral vein, then it is advanced into the inferior vena cava, into the left renal vein and into the required vessel. The latter is filled with a sclerosing substance, which stops the flow of blood. This method is most often used for bilateral varicoceles.
5. Microsurgical operation. It takes place under general anesthesia. Its principle is to transplant the testicular vein into the epigastric vein, which restores blood supply. The method is characterized by a low risk of complications.

In the first days after surgery, the patient feels pain in the scrotum and swelling. This is considered normal and goes away within a few days. Full recovery occurs a month after the operation.

Rules that must be followed after varicocele surgery:

• exclusion of sexual contacts;
• limiting the use of salt, spices, sauces;
• complete refusal of physical activity.

If prescribed by a doctor, you can wear a special support bandage.

Complications after surgery

Complications can occur for a short period of time. In some cases, they develop as a result of improper treatment or as a result of the manifestation of the individual characteristics of the patient.

Possible complications:

• lymphostasis – occurs when lymphatic vessels are damaged;
• the presence of pain - in rare cases it does not disappear even after a successful operation;
• hydrocele;
• relapse of the disease;
• testicular atrophy is a consequence of medical error during surgical intervention.

The success of treatment is determined by the condition of the sperm - normally the number of viable sperm should increase within six months.

Preventive measures

Prevention of varicocele involves preventing congestion in the pelvic area and scrotum. To do this, you should avoid staying in one position for a long time and regularly engage in gymnastics or other sports.

Advice: to prevent the development of any diseases of the genital organs, it is necessary to undergo an annual examination by a urologist.

A man should normalize his lifestyle. To do this, you need to have regular sexual intercourse and include as much healthy, vitamin-rich food in your diet as possible. If you have any diseases, you must immediately begin their treatment, otherwise they can provoke other pathologies of the body.

Conclusion

Treatment of varicocele in men is most effective in the early stages. Timely medical intervention ensures a speedy recovery and minimal consequences from the disease. To prevent the development of pathology, you should lead a healthy lifestyle, do not abuse alcohol and smoking, and undergo regular medical examinations.