Varicocele
| Classification according to ICD-10 | |
|---|---|
| I86.1 | Scrotum varices varicocele |
| ICD-10 online (WHO version 2019) | |
A varicocele , varicocele testis ( Latin varix - varicose vein ; Greek kele - fracture) or a varicose vein hernia is a varicose vein formation in the area of the pampiniform plexus formed by the testicular veins, a plexus in the spermatic cord . In 75 to 90 percent of cases, the varicocele occurs on the left side. As a rule, the varicocele does not require any therapy. Untreated varicoceles are a common cause of male infertility.
frequency
The varicocele is the most common blood vessel disease of the male genital organ. The occurrence of the varicocele is between 8 and 10 percent. During growth , the proportion of those affected is higher (5–25%), which is caused by the increased hydrostatic pressure in the testicular vein. A varicocele can be seen as the cause in 25 to 40 percent of infertile men.
classification
Varicoceles are divided into different degrees of severity. A distinction is made between the following degrees of severity:
- Grade 0 (subclinical) - The varicocele cannot be seen or felt, but can be made visible by Doppler sonography (ultrasound)
- Grade I - varicocele palpable but not visible during Valsalva maneuvers
- Grade II - Varicocele palpable but not visible under resting conditions
- Grade III - Varicocele easily palpable and clearly visible even under resting conditions
Symptoms
The symptoms of a varicocele can vary greatly from case to case. Some patients have mild to no symptoms, while others complain of a variety of symptoms. This can be due, for example, to the fact that the person affected has different causes and risk factors for the development of the varicocele. On the other hand, the physical condition, the individual lifestyle and the current severity, as well as the number of countermeasures taken in everyday life, play a very important role for the number and severity of the symptoms.
Physical symptoms
- Pain
- Worm-like swellings in the scrotum
- Sagging of the scrotum
- Testicular atrophy
- Decreased release of male sex hormone
- Elevated levels of estrogen
- Decreased libido
- Gynecomastia
- Decreased muscle tension
- Heaviness
- Feeling of overheating
- Enlarged prostate
- Decreased fertility
- infertility
Mental symptoms
- fear
- stress
- Feelings of shame
- Erectile dysfunction
- Little motivation
Diagnosis
Low-grade varicoceles can often be felt with the fingers and can be made visible by the urologist using Doppler sonography (ultrasound) on the screen. An examination of the varicocele should be carried out with the patient standing as well as lying down. If the suspicion is confirmed by the "touch test", the veins are usually examined more closely on the screen.
In order to make the exact course of the damaged vein visible, it should be ensured that not only the varicocele itself is x-rayed, but also the surrounding areas of the abdomen and kidneys. In the further course of the examination, a semenogram of the person concerned is made to determine the current status of his / her fertility. Control visits to the urologist and annual evaluations of the spermogram are generally recommended for all varicoceles patients. Especially if the person concerned wants to have children.
causes
The cause of left-sided varicoceles is most likely the unfavorable inflow path of the left testicular vein (testicular vein) into the left renal vein (renal vein), which meets the renal vein at an angle of about 90 degrees. This results in higher venous pressure on the left side, which favors the development of the varicocele. In rare cases symptomatic varicoceles, for example caused by a kidney tumor, occur.
Nutcracker Syndrome
The nutcracker syndrome is a clinically manifest variant of a nutcracker phenomenon caused by pinching the left renal vein between the main artery ( arteria mesenterica superior ) and the abdominal artery ( aorta abdominalis ). This can lead to a venous outflow disturbance of the testicular vein and the formation of varicose veins (varicoceles). Occasionally there is pain in the abdomen or left flank. In men, pain in the testicles and disorders of sperm formation ( spermatogenesis ) can occur as a result of the varicocele . This should be clarified by a urologist in connection with the examinations of the varicocele.
Venous valve insufficiency
In a healthy person, the venous valves ensure that the blood from the muscles and organs flows back to the heart properly. In varicose veins, these valves are often defective or negatively affected. This can be caused by years of bad habits and behavior patterns, among other things. However, age can also play a role here as a trigger. Anyone who has an office job and spends most of their time sitting is just as damaging to the veins as someone who has to stand all day. The weakness begins when the venous valves no longer close properly. These valves usually allow blood to flow back to the heart properly.
consequences
The increase in pressure and the varicose vein-like bulging ( ectasia ) of the venous complex in the testicle can damage the surrounding tissue. The backlog of blood in the scrotum (scrotum) causes overheating of the testis (testicles), which can lead to infertility . Untreated varicoceles are a common cause of male infertility and can also cause pain. In some cases, varicocele therapy can improve fertility. The volume of the testicle is reduced on average in men with varicocele.
therapy
Therapy takes place for the following reasons:
- decreased semen quality (pathogenic semen analysis )
- Pain symptoms
- Impairment of the hormonal balance
- right and bilateral varicocele
- Eliminate the cause of the symptomatic varicocele
- possibly cosmetic reasons in the case of highly pronounced forms
On the other hand, treatment can be dispensed with if the (left-sided) varicocele does not cause any impairment.
There are numerous surgical procedures that principally aim to ligate the testicular vein (at different heights depending on the procedure). Options for this are the obliteration of the veins ( Tauber method ) or a laparoscopy.
In adolescents with a reduced testicular volume, therapy often has a normalizing effect on this. In the majority of the studies it was found that the treatment of a varicocele has a positive effect on sperm quality. So it can increase male fertility again.
In addition to thrombosis , embolism and wound infections , the operation can in a few cases damage the urinary and spermatic ducts or nerves. The accumulation of fluid in the testicular sheaths ( hydrocele ), the removal of which is not absolutely necessary, is also rare . Sometimes there is heavy bleeding that needs surgery.
Web links
- Varicocele at surgery portal
- M. Becker, Ch.Börgermann, H. Sperling, H. Rübben: Varicocele and male infertility (PDF file; 967 kB). In: Blickpunkt der Mann. 2006, 4 (2), pp. 26-29.
- Treatment of a varicocele Federal Center for Health Education (BZgA)
- Varicocele at the Techniker Krankenkasse
Individual evidence
- ↑ a b M. Becker, Ch. Börgermann Ch, H. Sperling, H. Rübben: Varicocele and male infertility. (PDF file; 967 kB). In: Blickpunkt der Mann. 2006, 4 (2), p. 26.
- ↑ Focus on the man. 2006, 4 (2), p. 27.
- ↑ a b c Guidelines for Treatment of Varicocele . LKH Leoben, Urological Department, April 2004.
