Varicocele: causes, infertility, incidence, symptoms, and conservative treatment

Male fertility continues to decline is an indisputable fact! 

It has been reported in the literature that male sperm quality is declining at a rate of 1% per year, which is by no means alarmist! 

This speed is amazing, male fertility has reached a dangerous moment! 

Everyone’s life, and the small “tadpole” inseparable. However, some diseases can cause these “little tadpoles” to lose their vitality or even death, varicocele is one of them. 

So what exactly is varicocele? And what caused it? Please read this article carefully. I think most of the questions about varicocele can be answered here:

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What is varicocele? What’s the cause?

Varicocele is a kind of vascular disease, which refers to the abnormal expansion, elongation and tortuosity of the venous plexus in spermatic cord, which can cause pain and progressive testicular dysfunction. It is one of the common causes of male infertility.

Varicocele has attracted much attention due to its associated pain and discomfort in the scrotum, infertility and testicular atrophy. Is a common male genitourinary disease.

Varicocele is more common in young adults, the incidence of 10% to 15% of the normal male population, in male infertility accounted for 19%, 41%.

Varicocele is a vascular spermatogenesis disorder caused by the dilation of the spermatic vein surrounding the spermatic cord and the racemose venous plexus. Usually seen on the left side, about 77%, 92%, but also bilateral disease, about 7%, 22%, rare single in the right side, about 1%.

In the traditional operation, the internal spermatic vein was ligated and part of the dilated vein in the scrotum was resected through a groin incision.

The prevalence of varicocele was 10% to 15% in the general male population, 30% to 40% in the primary male infertility and 69% and 81% in the secondary infertility. The prevalence rate of first-degree relatives of patients with varicocele was significantly increased: 21.1% of fathers and 36.2% of brothers were likely to have varicocele.

According to the age, varicocele can be divided into adult type and adolescent sex. According to the cause of disease can be divided into primary and secondary.

According to the etiology, it can be divided into primary and secondary VC.

1. Primary VC.

Varicocele is more common on the left than on the right.

  • The pressure in the vein was increased because the left spermatic vein had a long journey and flowed into the left renal vein at a right angle.
  • “Nutcracker” phenomenon (NCS), the superior mesenteric artery and aorta oppress the left renal vein, affect the left internal spermatic vein reflux and even lead to reflux, that is, “Nutcracker” phenomenon (NCS);.
  • Weak connective tissue around the internal spermatic vein and absence of venous valves are common on the left side.

Factors related to the development of primary varicocele:

  • The absence or dysfunction of the spermatic vein valve leads to blood reflux;
  • The wall of the spermatic vein and its surrounding connective tissue were weak, or anatomic factors such as hypoplasia of the levator muscle were found.
  • The upright posture affects the return of the spermatic vein.

2. Secondary VC.

The causes and diseases included left renal vein or vena cava tumor thrombus obstruction, renal tumor, intra abdominal or retroperitoneal tumor, left renal vein or vena cava tumor embolus, renal tumor, pelvic tumor, giant hydronephrosis, ectopic vessels oppressing the ascending spermatic vein and so on.

Why does varicose vein cause sterility?

Answer: varicocele and seminal fluid abnormity, testicular atrophy, testicular perfusion decrease and testicular spermatogenesis dysfunction, the specific mechanism may be:

  • The heat. Varicocele can increase the temperature of testis, increase the accumulation of CO2 in testicular tissue, lead to spermatogenic disturbance, and lead to the decrease of testosterone synthesis in Leydig cells of testis.
  • high pressure. High pressure of the spermatic vein leads to insufficient testicular perfusion and hinders the metabolism of the testis.
  • hypoxia. Varicocele caused by poor venous blood flow can lead to testicular congestion hypoxia, carbon dioxide accumulation, interference with the normal metabolism of the testis, affecting spermatogenesis and maturation.
  • The effects of toxic substances. When varicocele, the blood that adrenal gland refluxes can be countercurrent along spermatic vein, the metabolite such as steroid, catecholamine, 5-hydroxytryptamine that the adrenal gland and kidney secretes is brought into spermatic cord vein, bring about the mature obstacle of spermatozoa in testis.
  • When varicose vein is damaged epididymis makes the motive force that spermatozoa acquires to move forward abate speed drops.
  • There were communicating branches between the two spermatic veins, which affected varicocele on the opposite side.

How high is the incidence of varicocele?

Overall, the incidence of varicocele is about 20% in the general male population and about 40% in the infertile male population.

Varicocele is more common in adult males than in adolescents.

Chinese related literature reported that the total incidence of varicocele in adolescents aged 6 to 19 years was 10.76%.

Varicocele is a vascular disease, more common in the left side, about 85%, 90%, bilateral 10%.

Varicocele is the first cause of male infertility, accounting for 35% of primary infertility and 50%-80% of secondary infertility.

What are the common symptoms of varicocele?

Varicocele of lower degree is usually asymptomatic, and most of the patients are found in routine physical examination or infertility.

The patient that has a symptom basically expresses for meeting scrotum ministry bilges, have heaviness and fall bilge feeling, can spread to below abdomen and waist, motion and or stand long after the symptom is aggravation, recumbent and after resting can alleviate.

The degree of varicocele and symptoms are sometimes inconsistent, some patients will have neurasthenic symptoms, such as headache, fatigue, nervousness, and so on; some patients will appear sexual dysfunction, severe cases can cause testicular atrophy.

Varicocele mostly occurred on the left side. When the patient was standing, the scrotum of the affected side was obviously drooping, and there were curved veins on the skin surface. The internal veins of the scrotum are convoluted. In the testicular above the spermatic cord touches the varicosity but also can compress the soft mass, sometimes may also touch the thrombus formation small nodule. Masses of the same nature can also be felt below and behind the testicles.

After supine, the mass disappears quickly; if it can not disappear after supine, it should be considered as secondary. According to the degree of varicose veins can be divided into light, medium and heavy three degrees.

  • Mild: mild local varicose veins can not be seen, palpation is not obvious, but patients hold breath to increase abdominal pressure can touch the varicocele vein, recumbent varicocele vein immediately disappeared. The length of the countercurrent in the internal spermatic vein was up to 5cm.
  • Medium: the naked eye can not see varicose veins, palpation can be found varicose veins. The varicose veins gradually disappeared during recumbent.
  • Severe: scrotal swelling, visible to the naked eye of the scrotum surface varicose venous mass, was earthworm-like mass, accompanied by scrotal testicular part of the sense of falling swelling.

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Which varicocele needs surgery?

Surgical treatment of varicocele is recommended in the following situations:

  1. The volume of testis on the affected side was smaller than that on the contralateral side (less than 20% of the volume).
  2. Abnormal semen examination;
  3. The symptoms associated with varicocele (such as perineal or testicular distention, pain, etc.) were serious, which obviously affected the quality of life and could not be cured for a long time.
  4. The level of serum testosterone in patients with Ⅱ or Ⅲ degree varicocele decreased significantly, which ruled out other diseases.
  5. Bilateral varicocele;
  6. Adolescent varicocele (10-18 years old): grade Ⅱ or Ⅲ varicocele; testicular volume of the affected side was lower than 20% of the healthy side; testicular spermatogenic function decreased; more serious related symptoms were caused by varicocele; bilateral varicocele.

Conservative treatment of varicocele?

Asymptomatic or mild symptoms of patients are recommended to take non-surgical treatment, commonly used methods are scrotal support, local cold compress, to avoid transitional life caused by pelvic and perineal congestion, and so on.

Patients with mild varicocele, such as normal semen analysis, should be regularly followed up (1-2 years), such as abnormal semen analysis, testicular shrinkage, such as soft texture should be timely surgical treatment.

The specific modalities of conservative treatment are as follows:

1.Physical therapy

It is necessary to pay attention to the law of life, the law of work and rest, and exercise appropriately. Avoid heavy physical labor and exercise, avoid long standing, long climbing, and so on, so that the combination of work and rest. Excessive exercise leads to excessive venous pressure affecting the spermatic vein. Smoking and alcoholism also have some influence on the disease.

2.Drugs for varicocele:

  • Aescinate saponins: the representative drug is Maizhiling, which has the functions of anti-inflammation, anti-exudation, protecting the collagen fiber of vein wall, recovering the elasticity and contraction function of vein wall step by step, increasing the return speed of venous blood and reducing the venous pressure. Thus improve the symptoms caused by varicocele, such as testicular swelling, pain and so on.
  • Flavonoids: the representative medicine is 2 tablets of Aimailang taken twice during lunch and dinner, and the flavonoids are purified by granulation. The absorption rate of small intestine is 2 times of that of non-particulate flavonoids drugs. It has anti-inflammatory and anti-oxidation effects, and can rapidly increase venous tension. Reduce capillary permeability, improve lymphatic reflux rate, reduce edema. It can improve the pain symptoms caused by clinical varicocele and delay the development of subclinical varicocele to clinical varicocele.

3.Anti-inflammatory treatment

Other drugs to improve symptoms of local pain discomfort can be used in patients with non-steroidal anti-inflammatory drugs, such as indomethacin, ibuprofen, Sinoxicam, and so on. Studies have shown that these drugs can alleviate to a certain extent caused by varicocele related symptoms for some patients may also improve the quality of their semen.

4. Drugs to improve semen quality:

  • Carnitines: they are composed of L-carnitine and acetyl-L-carnitine, both of which are natural substances in human body. They mainly have two physiological functions: one is an important factor in the process of β -oxidation of fatty acid mitochondria, which participates in energy metabolism; The other is to increase cell stability by reducing reactive oxygen species (Ros) (ROS) and inhibiting apoptosis.
  • Estrogen receptor antagonist: a non-steroidal estrogen receptor antagonist that competitively binds to estrogen receptors in the hypothalamus and pituitary, thereby reducing the negative feedback effect of normal estrogen in the body. The results showed that endogenous secretion of GnRH, FSH and LH increased, and then acted on Leydig cells, Sertoli cells and spermatogenic cells of testis to regulate and promote spermatogenic function. Clomiphene also increased the sensitivity of Leydig cells to LH and promoted T secretion. Clomiphene can affect the whole hypothalamic-pituitary-testicular axis and correct the hormone imbalance in the gonadal axis system.
  • Antioxidant drugs: such as vitamin E, can clear oxygen free radicals, protect the lipid peroxidation of sperm membrane, treatment of asthenospermia and sperm dysfunction.
  • Human chorionic gonadotropin: According to the literature, human chorionic gonadotropin can be used to treat infertility after varicocele operation. It can directly stimulate the Leydig cells of the testis to produce testosterone and affect the seminiferous epithelium of the seminiferous tubules of the testis, thus improving the spermatogenic function. Human chorionic gonadotropin can effectively restore the metabolism of testis and improve the quality of semen.
  • Botanical medicine and traditional Chinese medicine: studies have shown that botanical medicine and traditional Chinese medicine can improve semen quality to a certain extent, but there is still a lack of sufficient evidence of evidence-based medicine in this regard.

5. Cold compress.

Scrotal support can be used to elevate the scrotum, improve testicular distention discomfort, can also use some physical cooling methods, such as cold towel compress.

6. diet.

Eat lots of vitamin-rich fruits and vegetables. These methods are also effective in preventing varicocele.

7. Inspection.

Suggest 6 months go to a hospital to reexamine testicular color Doppler, the proposal that has birth requirement reexamines seminal fluid.

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