Post Date April, 15 2023
Varicocele (VC) refers to the abnormal expansion, elongation and circuitous varicosity of the tendril venous plexus in the spermatic cord caused by the obstruction of venous return or the injury of venous valve due to various reasons. VC is a common andrology disease, accompanied by growth and development disorders, pain and discomfort of the lateral testicles, which can cause infertility. It is mostly seen in young adults. The incidence rate accounts for 10%~15% of normal male population and 19%~41% of male infertility. The left side of the disease is more common, and the bilateral side or the right side is single.
Main performance
The varicocele is usually asymptomatic. Usually, the painless worm-like mass of scrotum is found during physical examination, or it is found during infertility treatment. Some patients may have swelling of the scrotum when standing, local swelling and pain, and may radiate from the lower abdomen, groin area or back waist. The symptoms may worsen after tiredness, long standing and walking, and may be relieved or disappear after lying flat. It can be complicated with varicose veins, hemorrhoids and other diseases.
In patients with varicocele, semen examination showed that the number and vitality of sperm decreased, the number of abnormal sperm with pointed or irregular shape increased, and the number of immature sperm and germ cells shed from the convoluted tubules increased. The presence of immature sperm cells in semen is considered to be a characteristic change in patients with varicocele.
Relationship between varicocele and infertility
There is a close relationship between varicocele and male infertility, but the pathophysiology of testicular dysfunction caused by varicocele is still unclear, and the theory of male infertility caused by varicocele cannot be explained. VC may be related to testicular hypoxia caused by testicular temperature rise, affecting testicular sperm production ability, inhibiting gonadal hormone, damaging testicular immune barrier, reflux of renal and adrenal metabolites and other reasons.
However, not all patients with VC have infertility or fertility decline, and most varicocele can have a smooth birth. There are also literature reports that surgical treatment of VC has no exact effect on male infertility; In addition, excessive treatment in adolescence is harmful. Many young patients with this disease have no problem in their future life and reproduction.
In modern medicine, male infertility caused by VC is mainly treated by surgical ligation of internal spermatic vein, but there is no uniform standard for surgical indication of VC in various diagnosis and treatment guidelines. Evidence-based medicine also shows that the severity of VC can not reflect the damage of male semen quality. At present, early surgical treatment is proposed for male infertility patients with VC at home and abroad to avoid further damage to male fertility, and varicocele surgery should be considered, such as oligospermia, infertility with a course of more than 2 years, and idiopathic male infertility. However, surgical treatment cannot improve the semen quality of all VC patients, so there are also patients who do not want to receive surgical treatment.
