Varikotsele in adolescents: causes, treatment, consequences

Varicose tortuosity of the veins of the spermatic cord is one of the most common pathologies in men. The peak of varicocele diagnosis falls on 14-15 years. In general, 15-30 years is exactly the age when pathology occurs most often. Most of this disease is observed in athletes and people engaged in manual labor. Therefore, it can be confidently asserted that muscular load plays an important role in the expansion of the veins of the spermatic cord.

This pathology has a significant effect on male reproductive function. And given that varicocele suffers up to 30% of the male population, the urgency of the problem becomes obvious.

What is varicocele?

In addition to other elements, the spermatic cord includes a lobate venous plexus. It is this that affects the varicocele. The veins of the spermatic cord change pathologically, become enlarged and convoluted.

Why is this happening? This disease occurs due to the violation of venous outflow, resulting in blood accumulating in the venous plexus, stretching and deforming the walls of the vessels.

Etiology of varicocele

Vessels belonging to the system of the inferior vena cava are equipped with special valves, because the blood flows from the bottom upwards. Without this adaptation, most of the blood simply would not reach the heart; However, the presence of the valve apparatus is very effective in combating blood stasis and retrograde (in the opposite direction) its movement.

The main cause of varicocele in adolescents is the failure of the valves of the testicle vein. Normally, blood from the lobate plexus enters the renal veins system or directly into the lower vena cava itself through the testicular veins. It is the problems with the valves at the level of the latter that are the main cause of the development of the disease.

Insufficiency of the valve apparatus can be primary (as a result of congenital pathology of the testicular veins, weakness of the muscular layer of the latter or connective tissue dysplasia) and secondary (arising as a result of increased pressure in the system of the inferior vena cava or renal veins). The reasons for secondary valve failure include all the pathological processes that squeeze the spermatic cord, the testicles, the renal veins or the directly lower vena cava, making it difficult for the blood to flow through them: neoplasms of the abdominal cavity, hernia, adhesions, etc. Somehow the situation arises when the blood begins Stagnate in the vessels of the spermatic cord.

Classification of varicocele

WHO recommends the following classification of the disease:

1. The veins of the lobate plexus are not only well defined by the touch, but also visible visually. The egg is wrinkled.
2. The veins can be palpated, although they are invisible.
3. Positive test of Valsalva. Neither to see, nor to palpate veins outside of the specified sample it is impossible.

However, in our country the classification of Yu. F. Isakov is most often used. It, like the previous one, distinguishes three stages, although the severity of the disease is indicated in the reverse order. It looks like this:

1. The veins are invisible, not determined by touch. To suspect varicocele it is possible only on Valsalva's sample.
2. The veins are well palpated, but invisible.
3. The veins are visible and palpable. The testicle is modified.

By the way! The Valsalva test is performed as follows. The patient in standing position is asked to cough. As a result, the pressure in the abdominal cavity increases, and the veins of the lobate plexus swell. Often, for comparison, this test is also carried out in the supine position. In this case, the test will be negative.

Clinical picture

Usually varicocele in adolescents proceeds without any subjective sensations. Rarely, some patients complain of a feeling of heaviness or pain in the scrotum after physical exertion. However, these symptoms should be treated with caution, because often they are the first signs of inflammatory processes of the testes and their membranes (orchitis and orchitis epididymitis).

What is dangerous varikotsele?

Eggs in men - the place where the formation of spermatozoa, sex cells, fertilizing the egg. These organs are extremely important in terms of their participation in the reproductive function.

When varicocele due to the accumulation of a large amount of blood in the venous plexus, there is a local increase in temperature, which adversely affects spermatogenesis. In addition, with varicocele, the supply of tissues and testicular cells with oxygen deteriorates, hypoxia occurs; The hematotestick barrier is broken, which can cause the development of antibodies that destroy spermatozoa in the body (after all, they are perceived by the immune system as hostile agents). Varicocele is often accompanied by hormonal failures, which also has a bad effect on the process of spermatogenesis.

Eggs in men are extremely sensitive to all these processes, so any of them can easily lead to a violation of the formation of sperm and sperm.

It should be noted, however, that the role of varicocele in infertility is still being studied. Not everyone believes that the above mechanisms are the basis of the pathogenesis of varicocele in adolescents. Therefore, the role of the expansion of the veins of the spermatic cord in male infertility remains to some extent controversial.

What to do?

The most commonly diagnosed varicocele in adolescents. Treatment, respectively, is performed during adolescence. It is known to be of two types: conservative and surgical. If we talk about varicocele in adolescents, the first item at once can be ruled out. Conservative treatment of this pathology does not exist. But the number of operations used to rid patients of this ailment is great.

Types of surgical interventions for varicocele

All operations on the testicles can be divided into several groups:

1. Surgical interventions based on excision of the veins of the spermatic cord. At present, they are no longer used, since after their use in 90% of cases, testicular atrophy was noted.

2. Operations that fix the testicle to the elements of the inguinal canal or to the muscular aponeurosis. Now they are not used, as they are accompanied by testicular atrophy (20-70% of cases).

3. Resection of a part of the scrotum with external fixation of the testicle. Recurrence of varicocele occurs in 100% of cases, therefore this operation is ineffective and is not currently applied.

4. Bandage of the testicle vein above the inguinal fold. This type of operation leads to the termination of the retrograde blood flow and gives the smallest percentage of relapses. However, the conducted studies have shown that varicocele is not always an independent pathology. This disease can only be a symptom that indicates the presence of a problem leading to venous hypertension. In this case, this operation can aggravate the situation.

5. Operations to create vascular anastomoses. Their essence lies in the fact that venous reflux is preserved, but due to the creation of an anastomosis, excess blood is discharged, and the expansion of the veins decreases.

Currently, in the treatment of varicocele in adolescents, surgery is not always extensive intervention with the opening of the abdominal cavity. There are also minimally invasive methods of treatment.

Surgical intervention from the mini-access

The most common operation for treating varicocele is Marmara. It is performed under local anesthesia. In the inguinal region, from the side where the pathological process has developed, a 2-3 cm long incision is made. From this access, the elements of the spermatic cord are prepared, the vein is excreted, the ligature is traced and intersected. The wound is sewn layer by layer.

As follows from the description, the operation is not cavitary and can be performed even on an outpatient basis. Sutures are removed on the 8th day.

In the postoperative period during the first week, the fixation of the scrotum is important (it is achieved due to the wearing of swimming trunks). In the first month should be abandoned sexual activity.

Laparoscopic clipping

Another method with a good cosmetic effect. Through the puncture in the anterior abdominal wall with the help of special tools, the testicular veins are extracted, clipped and crossed.

Compared with open surgery, this method has several advantages:

1. Short postoperative period due to almost complete absence of injury, because surgical intervention is carried out through a puncture, and not a cut.
2. There is no danger of a postoperative hernia.
3. Good cosmetic effect.
4. Slight chance of postoperative complications.

Endovascular phlebosclerosis

This method is an alternative to the operation. The essence of it is that a sclerosing substance is injected into the testicular vein, which contributes to the formation of a thrombus and the cessation of blood flow through the vein. Performed only if there is no reason to assume secondary valve failure and venous hypertension.

The main thing that should be understood for patients suffering varicocele - the timing of the operation is extremely important. It is proved that timely treatment significantly reduces the risk of developing spermatogenesis and infertility.