Varicose veins of the spermatic cord (varicocele)

Varicose veins of the spermatic cord, or varicoceles, are a common problem in men aged 16 to 35 years. It most often develops on the left and is the most common anatomical change in men suffering from infertility. According to modern concepts, varicocele develops due to a violation of the outflow from the left ovarian vein, which flows into the renal vein at a right angle.

Secondary (symptomatic) varicocele may be a consequence of thrombosis or stergosis of the renal vein by a kidney tumor. Bilateral damage is caused by primary incompetence of the testicular vein valves and/or the presence of arteriovenous anastomoses. Increased pressure in the renal vein due to one reason or another leads to reverse flow of blood from the renal vein through the testicular vein into the pampiniform plexus of the testicle and then through the external spermatic vein into the common iliac vein.

The accumulation and stagnation of blood leads to an increase in temperature inside the scrotum and damages spermatogenesis. In women, by analogy with varicocele, the so-called ovarian varicocele can develop - varicose dilatation of the ovarian plexus, clinically manifested in the form of menstrual irregularities.

Symptoms of varicocele include a feeling of heaviness, pain in the testicle, scrotum, along the spermatic cord, which increases with physical activity and prolonged standing. Upon palpation of the scrotum, convoluted veins of the spermatic cord (“ball of worms”) and sometimes a small hydrocele on the affected side are determined.

The course of the disease is gradually progressive. With the normalization of sexual life, regression of symptoms is noted. The appearance of varicocele in old age is more typical for the symptomatic genesis of the disease.

Diagnosis of varicocele is simple due to the characteristic clinical signs. Clarification of the cause of varicocele is carried out using modern research methods, such as renal venography and arteriography, venotonometry.

In case of severe pain, surgical treatment is indicated: using an incision parallel to the inguinal canal, the testicular vein is isolated extraperitoneally and ligated in the lower third (Ivansevich’s operation). As a conservative measure, wearing compression garments is recommended, which helps reduce blood stagnation in the testicular area and improve blood circulation. Drugs that improve microcirculation and venous tone, as well as drugs that improve spermatogenesis, can also be prescribed.

In most cases, varicocele does not pose a threat to health and does not require treatment. However, if a varicocele leads to infertility or causes significant pain, then surgery may be required. In any case, it is recommended to consult a urologist or andrologist for consultation and prescribing appropriate treatment.