Varicocele is the most common “killer” of male infertility and sexual dysfunction

Author: Li Chuangui, deputy chief physician of Baoding First Central Hospital

Reviewer: Wang Yaxuan, Chief Physician, The Second Hospital of Hebei Medical University

A 19-year-old college student from a sports college was troubled by a dull "pain in the balls" and soreness and discomfort in the thigh area after each training session, which seriously affected his training and study. He recently came to the hospital for treatment, and a urologist diagnosed him with varicocele.

1. What is varicocele?

Varicocele is a vascular disease in the scrotum, which refers to the abnormal expansion, elongation and tortuosity of the spermatic venous plexus. Its prevalence in men is about 15%, and 30% to 40% of male infertility is related to varicocele.

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However, it is still not very clear how varicocele comes about. There are both congenital and acquired factors. For example, frequent running or physical labor are important causes of varicocele.

2. What discomforts may indicate varicocele?

If you have any of the following conditions, you may have varicocele.

1. The scrotum swells and there is a feeling of local heaviness and pain.

2. The blood vessels on the surface of the scrotum can be seen to be dilated and tortuous, and a soft, earthworm-like mass can be felt.

3. Symptoms worsen after fatigue or prolonged standing, and are alleviated or disappear after lying down or resting.

What should you do if these situations occur? There is no need to panic. If it is occasional or mild discomfort, it means that the condition is not serious. Only when you feel uncomfortable or the blood vessels are obviously dilated, you need to pay attention to it. Going to the hospital for a color Doppler ultrasound can make a clear diagnosis.

3. What are the dangers of varicocele?

Varicocele can cause blood congestion in the spermatic vein, obstructed blood flow, and accumulation of some harmful toxins in the testicles, endangering the health of male friends. The following are some common ones.

1. A small number of patients with varicocele who are not treated for a long time will experience sexual dysfunction such as loss of libido, impotence, and premature ejaculation; severe cases will cause a progressive decline in testicular function and even testicular shrinkage.

2. Varicocele is one of the most common causes of infertility. It affects the development of sperm, leading to asthenospermia and oligospermia in men, affecting family happiness and harmony.

3. Patients with varicocele, especially those with moderate to severe varicocele, cannot pass the conscription physical examination, resulting in some aspiring young men being unable to join the army and serve the motherland.

Therefore, we ordinary people, especially male friends, should not underestimate the harm of this disease.

4. How to treat varicocele?

1. For milder varicocele, you can adjust it yourself to prevent the condition from getting worse.

(1) Adjustment of lifestyle and diet: control smoking and drinking, eat a light diet, and avoid exercises that increase abdominal pressure, such as sit-ups, running, etc.

(2) Physical therapy: including cooling therapy and use of scrotal support belt.

(3) Drug treatment: Sodium aescinate tablets or Maizhiling tablets (which have anti-inflammatory, anti-exudative and microcirculation improving effects) are taken orally twice a day, 1 to 2 tablets each time, for a course of 20 days.

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2. If the condition cannot be relieved after self-adjustment, you don’t need to worry too much. You just need to go to the urology department of a regular hospital and do a color ultrasound to determine the severity of the condition. Some relatively mild patients can be treated with medication.

5. How severe is varicocele that requires surgical treatment?

For patients with more serious conditions, there is no need to panic. There are many minimally invasive technologies that can cure such diseases. Patients with varicocele need to consider surgical treatment if they have the following conditions.

1. Abnormal semen quality leads to infertility.

2. Those who have no fertility requirements for the time being, but abnormal semen quality is found during examination.

3. Symptoms (such as swelling and pain in the perineum or testicles) are severe and affect normal life.

4. Patients with grade II or III varicocele and decreased androgen levels.

There are two surgical methods: laparoscopic surgery and microscopic surgery. ① Laparoscopic surgery: a relatively minimally invasive treatment method that requires three "holes" to achieve the purpose of radical cure. ② Microscopic surgery: more minimally invasive than laparoscopy, only a small incision (1.5 cm incision) is required. Compared with traditional open surgery (3-4 cm incision) and laparoscopic surgery, microscopic varicocele ligation can better identify arteries, veins, and lymphatic vessels. It has the advantages of thorough treatment of varicose veins, protection of arterial safety, less trauma, faster recovery, fewer complications, and low postoperative recurrence rate. It is considered the "gold standard" for the treatment of varicocele.

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6. Postoperative precautions

1. Keep the incision dry and clean within 1 week after surgery and disinfect it with iodine.

2. Avoid strenuous exercise within 1 month after surgery and gradually increase the amount of exercise.

3. Take sodium aescinate tablets or Maizhiling tablets orally within 1 to 3 months after surgery to reduce edema, relieve the discomfort of scrotal swelling and promote the shrinkage of the varicocele.

7. Surgical Effects

1. After the operation, the swelling, pain and discomfort in the perineum, thigh root or testicles are significantly reduced or disappear in about 80% of patients.

2. Sperm concentration, sperm motility and androgen levels all improved after the operation, and the more severe the condition, the more obvious the improvement.

References

【1】Deng Chunhua, Shang Xuejun. Guidelines for diagnosis and treatment of men's diseases[M]. Beijing: Chinese Medical Electronic Audio-visual Publishing House, 2022.