Varicocele - varicose veins grozdevidnogo (pampiniform) plexus - common in boys mostly after the age of 9-10 years with a frequency of up to 15%. There are idiopathic (primary) and symptomatic (secondary) varicocele. The development of secondary varicocele is due to compression of the blood outflow tract from the testis any volume retroperitoneal formation (tumor, enlarged lymph nodes, cysts). Primary varicocele formed usually on the left and has a rather complicated genesis.
As is known, the blood flows away from the eggs on three veins: testicular, cremasteric vein and the vas deferens. The last two fall into the internal iliac vein system. Right testieular Vienna falls into the inferior vena and the left - in the renal vein. The left kidney Vienna, going to the bottom of the hollow, is placed in the so-called aortomezenterialnom tweezers (between the aorta and superior mesenteric artery) and can be squeezed, leading to vennoy renal hypertension (the pressure in the renal vein) and the difficulty of outflow of blood through the testicular vein buy cialis online without prescription.
In prepubertal and early pubertal boys period intensively grow, which affects an additional increase in pressure in grozdevidnom plexus due to an increase orthostatic pressure. In the same period there has been increased about 4 times the inflow of arterial blood to the testicle. Increasing therefore blood flow pererastyagivaet testicular vein, pushing the valves and thus opening the way retrograde flow of blood from the renal vein crowded in testicular. Influenced greatly increased pressure develops varicose wall deformation testicular vein and grozdevidnogo plexus.
In the horizontal position of the patient aortomezenterialny "tweezers" opens, the pressure in the renal vein and the blood drops on the testicular vein is flowing freely from grozdevidnogo plexus to the kidney.
Another cause of varicocele is a congenital weakness of the testicular vein valves and the fact that it flows into the renal vein at right angles, creating difficult conditions hemodynamics.
Varicose veins testicular system launches some pathological mechanisms that disrupt the function of spermatogenesis (the process of sperm maturation) in the testis:
1.Hyperthermia (temperature increase) around the testicles. Note that knowingly nature testicles made from the inner space to the outside of the body. Cpermatozoidy normally ripen in a temperature range from 34 to 35 ° C. When varicoceles, as noted earlier, the testes temperature is raised to a temperature of 36-37 ° C (ie, body temperature), which leads to disturbances in the process of maturation of sperm.
2.Hypoxia (low oxygen supply) occurs in stagnant, varicose veins uviform plexus system. The lack of oxygen leads to tissue power failure, the cause of slow metabolism and eventually slows down maturation of sperm.
3.Autoimmune aggression. Prolonged stagnation of venous blood leads to ischemia, the development of sclerotic changes in the testis and disturbance of sperm maturation. It also damaged blood-testis barrier, which perform the function of testicular albuginea, basement membrane and Sertoli cells (sustentotsity). Emerging in the general line of blood circulating antibodies due to various reasons can overcome the blood-testis barrier right testicle and cause a violation of its morphology and function. In the future, this may appear a decrease in the overall development of spermatogenesis and infertility.
Very rarely, a varicocele is found in young (2-5 years) children. The history of such patients is usually possible to identify the factors that caused the prolonged violation of the outflow of blood from the testicle (trauma, inflammation, surgery). Sometimes varicose veins mark the right or on both sides. Varicocele just right often associated with abnormal flowing into the right testicular vein in the kidney. Children with varicocele, as a rule, do not complain and varicose veins revealed during preventive examinations in school, when viewed in the military. Only the older children sometimes notice a feeling of heaviness and a pain in the left half of the scrotum. The most terrible manifestation of infertility is a varicocele (up to 60% of patients with varicocele) as a result of the defeat of germ cells.
The diagnosis is established during the inspection of the scrotum, her tenderness, the sample with straining (Valsalva maneuver). Appointed by ultrasound of the scrotum, semen analysis (to determine the degree of destruction seminiferous epithelium and testing results of the forthcoming treatment). When varicoceles, does not fall down in a horizontal position, shown in research to detect the volume of retroperitoneal education (excretory urography, ultrasonography, tomography).
Laparoscopic method (endo-videohirurgichesky). In the laparoscopic version made three cuts to 1 cm, through which to put the instruments and a video camera (laparoscope). On the inner surface of the abdominal wall stands vascular bundle (Vienna, artery), which tie up or superimposed clips. As with the open method, the patient can go home the day of surgery.
The advantages of laparoscopic embodiment of intervention before the open method: less traumatic intervention, by increasing the video camera on the monitor screen can be more precise and sensitive technique. Just when laparoscopic treatment of abdominal organs examined. The disadvantage is the fact that laparoscopic surgery is a cavity, whereas in the open version of the abdominal cavity is not opened, and the fact that it is performed under endotracheal anesthesia ventilator.