Post Date December, 03 2023
With the increasing pressure of modern life and environmental pollution, the number of infertility patients is increasing year by year, and there is a trend of youthfulness. The infertility rate among the reproductive age population in China has reached 12.5% to 15%, with male infertility patients accounting for 40%. A survey shows that among many infertile patients, abnormal semen is the main cause of male fertility, and varicocele is one of the important reasons for abnormal semen.
Q: What is varicocele?
Answer: Varicocele refers to the pathological phenomenon of local venous dilation, tortuosity, and elongation caused by various reasons such as poor reflux or blood reflux caused by venous valve damage in the tendril-shaped venous plexus of the spermatic cord.
Q: What are the symptoms of varicocele?
Answer: Patients with mild varicocele usually have no obvious symptoms. When patients with varicocele of degree II or above stand, the scrotum expands and can touch earthworm like or clustered blood vessels. Sometimes, the pain of falling and stretching spreads down the abdomen, groin area, or waist. It worsens when walking or exerting force on the abdomen, and alleviates after lying flat or resting.
Q: What are the common causes of varicocele?
Answer: It is generally believed that the common causes of this disease are related to the following factors:
① People's daily activities are in an upright position, and the blood in the spermatic veins needs to overcome the effect of their own gravity and flow back from bottom to top. The left spermatic vein has a long course and flows into the left renal vein at right angles, resulting in high blood flow resistance and triggering varicocele. This is also one of the reasons why varicocele is more common on the left side;
② The weak connective tissue around the spermatic vein and the dysfunction of the cremaster muscle muscle reduce the lifting effect around the spermatic vein;
③ The superior mesenteric artery and aorta compress the left renal vein and affect the return of the left spermatic vein, which is called "nutcracker" phenomenon;
④ Abnormal tissue structure of the spermatic vein wall;
Q: Is there a correlation between varicocele and infertility?
Answer: Due to the fact that the temperature inside the testicles of patients with varicocele is 0.78 degrees higher than that of normal testicles, it affects the development of sperm. The low blood oxygen pressure in local arteries and varicose veins and the low oxygen content in veins, such as the increase of catecholamine, 5-hydroxytryptamine and prostaglandin E, can affect the blood supply of the testis, cause premature shedding of immature sperm or hinder sperm maturation in the epididymis. The normal development process of spermatozoa produces obstacles, resulting in the decline of sperm motility, the morphological immaturity of sperm cells, and the increase of the number of pointed spermatozoa, thus causing oligospermia and asthenospermia, leading to infertility.
Q: What should I do if I suffer from varicocele?
Answer: In recent years, research has shown that varicocele is the most common cause of male infertility that can be treated and corrected. Once discovered, it should be actively treated, especially in patients with infertility and semen abnormalities. Otherwise, the longer the course of the disease, the greater the damage to the testicles, which further affects reproductive function.
Q: So, how should we treat it?
Answer: Patients who have given birth without symptoms or with mild symptoms can receive outpatient follow-up or non-surgical treatment, such as scrotal traction, local cold compress, and avoiding excessive sexual activity. However, patients with varicocele accompanied by infertility or abnormal semen, regardless of the severity of the symptoms, are indications for surgical treatment.
Q: Which patients specifically require surgical treatment?
Answer: ① Patients with testicular atrophy and softening on the side of varicocele, with a volume smaller than the normal side by more than 20%, and decreased testicular spermatogenic function;
② Poor semen quality, low sperm motility and high sperm deformity rate;
③ Varicocele accompanied by related symptoms, such as pain in the perineum and testicles, and affecting quality of life;
④ Second or third degree varicocele, with a significant decrease in serum testosterone levels, excluding other diseases;
⑤ Bilateral varicocele and causing severe related symptoms.
Q: How effective is the surgical treatment?
Answer: Half a year to two years after the surgery for varicocele, the improvement rate of semen can reach 50% to 80%. During this period, it is necessary to come to the hospital for regular follow-up and keep track of postoperative recovery. When the number of sperm before surgery exceeds 10 million per milliliter, the improvement rate of postoperative semen reaches 85%, and the pregnancy rate reaches 70%; When the number of sperm is less than 10 million per milliliter, the improvement rate of semen is only 35%, and the pregnancy rate is 27%; People without sperm are less likely to have children after surgery. Due to the long-term and slow process of damage to testicular function caused by this disease, the postoperative recovery process also requires a certain amount of time.
Q: What are the surgical methods?
Answer: With the development of minimally invasive technology, the commonly used surgical methods currently include high ligation of the internal spermatic vein, laparoscopic high ligation of the spermatic vein, and microscopic spermatic vein ligation. The development of microscopic technology has improved the surgical quality of varicocele surgery. Due to the fact that this surgical procedure opens at a lower position with a shallower skin surface and does not enter the abdominal cavity, it generally does not harm the intestines, greatly reducing the risk of surgery. Moreover, it is performed under a microscope (with a magnification of 8-10 times), which allows for a clear view of lymphatic vessels and arteries, avoiding accidental ligation and greatly reducing surgical complications. Moreover, the surgical effect is better than all previous procedures, and the cost is also significantly reduced, Most foreign countries use microsurgical techniques.
