Varikotsele

General characteristic of a disease

Varikotsele represents a phlebectasia, surrounding a seed cord and a small egg.

This disease in many cases is the reason of male infertility – thermal control and supply of fabric of a small egg is broken that, in turn, brings to deterioration in morphological indicators and mobility of spermatozoa, to decrease in their quantity.

Varikotsele is one of the most widespread diseases of a male reproductive system. This pathology can be bilateral, right-hand and left-side, at the same time about 90% of all cases fall to the share of the last type.

At the varikotsel operation is necessary already at a stage of definition of a disease, otherwise the small egg atrophy is possible.

Causes of illness

To varikotsela the retrograde blood flow in a yaichkovy vein which can result from inborn weakness of a vascular wall or supertension of blood in veins of a scrotum or a small pelvis is the reason. In the first case the disease results from genetic predisposition – at relatives defects of valves of heart, flat-footedness, a phymosis, a phlebectasia of extremities or other diseases connected with insufficiency of connecting fabric can be observed. In the second case to a varikotsela it is caused by absence or bad operation of the valves existing in veins which have to serve as an obstacle to the return blood flow. Disturbance of operation of these valves leads to the fact that increase in pressure in veins at a physical tension or at stay in vertical position causes expansion of venous vessels.

Diagnosis and symptoms to a varikotsela

It is possible to diagnose a disease in several ways: a palpation of a pampiniform texture, ultrasonography and dopplerography in a standing position and lying, Valsalva's test (a strong exhalation at the closed mouth and a nose, at an intense prelum abdominale). Also the level of sex hormones in blood can be investigated, and the spermogram is made.

Clinical symptoms to a varikotsela are insignificant:

• omission of the left half;
• increase in a half of a scrotum;
• not strongly expressed pains in testicles, a scrotum, in a groin, usually pulling character;
• strengthening of pain at an exercise stress, sexual excitement or walking.

If timely not was treatment is begun symptoms to a varikotsela can be aggravated: constant and long pain, reduction of the left small egg, significant increase in a scrotum, konturirovaniye of veins of a seed cord.

Allocate four degrees to a varikotsela:

1. At the first degree the disease can be revealed only by means of ultrasonography or Valsalva's test which will confirm increase in a pampiniform texture.

2. At the second degree the varikotsela can see expanded veins with the naked eye in a standing position.

3. At the third degree the palpation both in a prone position, and in a standing position will allow to diagnose a disease.

4. At the fourth degree the varikotsela can see expanded veins with the naked eye while a small egg to the touch soft, and its sizes are reduced.

In most cases it is found to a varikotsela when performing some medical examination, for example youths of premilitary age or concerning infertility.

Treatment to a varikotsela

Today at the varikotsel operation is the only way of treatment which allows to keep a spermatogenesis.

There are several ways of treatment of a disease of a surgical way, however, as a rule, at the varikotsel operation assumes removal of a part of expanded veins or suspension of a small egg the lower pole (use a strip of an aponeurosis of an oblique muscle of a stomach).

If symptoms of a disease do not disturb, and the man does not plan to have children, the varikotsela can carry out treatment by a nonsurgical way, for example carrying a suspenzoriya.

Complications of operational treatment to a varikotsela

After the varikotsel the next unpleasant moments in certain cases can be observed:

• In the early postoperative period bandaging and damage of absorbent vessels can provoke a lymphostasis. This phenomenon meets in the first days after the varikotsel quite often, however, as a rule, within two weeks morbidity and puffiness of a scrotum completely pass.
• The atrophy or hypotrophy of a small egg can become the most terrible complication of operational treatment to a varikotsela. Accidental bandaging of a seed artery can provoke this phenomenon. Reduction in volume of a small egg, up to an atrophy, is observed in less, than 1% of cases of microsurgical methods of treatment.
• After the varikotsel pain decreases or disappears in 90% of cases, however from 100 operated pain in the field of a small egg and a seed cord continues to disturb each 3-5 man. Similar pain can remain rather long time, sometimes within several years.
• Crossing of absorbent vessels through ½-4 years after operation, and sometimes in the first months, at 0,5-9% of patients can provoke to a gidrotsela (hydrocele). As the microsurgical technique of treatment to a varikotsela assumes preservation of lymph nodes, in this case this complication meets at less, than 1% of patients.
• At adult men repeated emergence to a varikotsela is observed less than children have 2-9% and 1-20% respectively. In this regard many urologists advise to treat this disease of an operational way after puberty.

Success of treatment to a varikotsela is demonstrated by improvement of the quantitative and qualitative characteristics of sperm observed after operation usually in 3-6 months.