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Varicocele

  Varicocele refers to the tortuous expansion of veins within the spermatic cord due to obstructed return. It is a common disease among young and middle-aged adults, referring to the expansion, tortuosity, and elongation of the varicose veins in the spermatic plexus (venous vascular plexus) due to blood stasis in the spermatic cord blood flow. The incidence rate among male populations is 10-15%, accounting for 15-20% in male infertility. This condition often occurs on the left side, but it is not uncommon for both sides to be affected, and the incidence can reach about 20%.

  Varicocele can be accompanied by testicular atrophy and sperm production disorders, leading to male infertility. Varicocele can also be caused by renal tumors or other retroperitoneal tumors, and varicocele caused by compression is called symptomatic or secondary varicocele.

  There are many cases of varicocele with male infertility. Varicocele can cause pathological changes in the testicles, affecting sperm production, leading to decreased sperm motility, immature sperm cell morphology, and an increase in the number of acrosome heads, thus leading to male infertility.

Table of Contents

1. What are the causes of varicocele?
2. What complications can varicocele easily lead to?
3. What are the typical symptoms of varicocele?
4. How to prevent varicocele?
5. What laboratory tests are needed for varicocele?
6. Diet taboos for varicocele patients
7. The conventional methods of Western medicine for treating varicocele

1. What are the causes of varicocele?

  Varicocele refers to the obstruction of venous return in the spermatic cord, valve failure, and blood reflux, leading to blood stasis, resulting in the expansion, elongation, and curvature of the varicose veins. Most people believe that varicocele can affect sperm production and semen quality, leading to infertility. Some individuals can recover their fertility after surgical treatment.

  One, common triggering factors of varicocele

  1. Physiological factors

  The sexual function of young people is generally strong, and the blood supply to the contents of the scrotum is very abundant. In addition, long-term standing increases abdominal pressure, which is also one of the risk factors for the disease.

  2. Anatomical factors

  The veins inside the left spermatic cord near the left renal vein generally have no valves, so blood can easily reflux. The internal veins of the left spermatic cord are too long and enter the renal vein at a right angle, causing certain resistance to blood flow.

  3. Other factors

  Renal tumors, retroperitoneal tumors, renal hydrops, and other factors can compress the veins inside the spermatic cord, causing symptomatic or secondary varicocele of the spermatic cord.

  Two, the pathological etiology of varicocele

  1. Primary varicocele

  The main cause of varicocele is the stasis of spermatic vein blood flow. Due to the influence of human upright posture, the venous return of the spermatic veins is affected. The venous wall and its surrounding connective tissue are weak or the cremaster muscle is underdeveloped, the venous valve is defective or incomplete, so varicocele is prone to occur. Recently, it has been reported that varicocele is closely related to masturbation. Pathological changes in the internal spermatic veins and blood flow disorders are intercausal and mutually influential, forming a vicious cycle. Both left and right spermatic veins can occur separately or simultaneously, but the incidence of left varicocele is higher, the reason being: the left spermatic vein is about 8-10 cm longer than the right, and it enters the renal vein at a right angle, resulting in high venous pressure. The left spermatic vein may be compressed by the colon, and the left renal vein may be compressed between the aorta and mesenteric artery, affecting the venous return of the spermatic veins, forming the so-called proximal 'clamp' phenomenon. The right common iliac artery may compress the left common iliac vein, causing the left spermatic vein to be blocked, forming the so-called distal 'clamp' phenomenon.

  2. Symptomatic varicocele

  Renal tumors with renal vein, inferior vena cava thrombus formation, retroperitoneal tumor compression, renal hydrops, or ectopic blood vessels can all cause symptomatic varicocele of the spermatic cord.

  Three, why varicocele can cause male infertility

  There are many cases of varicocele combined with male infertility. Varicocele causes pathological changes in the testicles, affecting spermatogenesis, causing a decrease in sperm motility, an increase in the number of immature sperm cells, and an increase in the number of acrosome heads. To date, there is no reliable evidence to clarify the mechanism of infertility, but it is believed to be related to the following factors:

  1. The retention of blood in varicose veins causes the local temperature of the testicles to increase, affecting spermatogenesis.

  2. The retention of blood affects the blood circulation of the testicles, leading to a lack of necessary nutritional supply and oxygenation, which affects spermatogenesis.

  3. The reflux of blood in the internal spermatic veins on the left side brings metabolic products secreted by the adrenal glands and kidneys, such as steroids, catecholamines, serotonin, and others, to the testicles. Steroids can inhibit spermatogenesis, catecholamines can cause chronic intoxication of the testicles, serotonin can cause vasoconstriction, leading to premature shedding of immature sperm, and can cause male infertility.

  4. The above factors can also affect the endocrine function of the testicular interstitium, interfere with spermatogenesis.

  5. Left-sided varicocele can also affect the function of the right testicle, as there are abundant anastomoses between the venous vessels of the two testicles. The toxins in the left venous blood can reach the right side and affect the spermatogenesis of the right testicle.

2. What complications can varicocele easily lead to?

  Varicocele can be accompanied by testicular atrophy, inguinal hernia, varicose veins in the lower limbs, and hydrocele, and even lead to male infertility.

  Currently, the treatment of moderate to severe varicocele still focuses on surgery, and some people have tried non-surgical ligation and adopted venous embolization therapy, but due to the high failure rate, it cannot replace surgery. From the initial use of magnifying glasses to later microscopic surgery, and finally the use of laparoscopic surgery in modern times, it has already been recognized by the medical community as the most effective surgical method, but having good tools does not necessarily mean good results. How to control surgical complications has always been an important research topic in the medical community.

  Urology experts tell us that scrotal edema and hydrocele of the tunica vaginalis are the most common complications after surgery, with an incidence rate between 3% and 40%. Severe edema can cause hydrocele of the tunica vaginalis or edema of the testicle (substantia). In the published medical literature, based on the clinical data cited in the literature, most believe that there is a difference in the incidence of edema between minimally invasive surgery and open surgery, with minimally invasive surgery being able to significantly reduce the incidence of edema. Some literature also points out that modified minimally invasive surgery can reduce the incidence of edema to zero.

3. What are the typical symptoms of varicocele?

  Varicocele of the spermatic cord is more common in young males and is usually asymptomatic, often discovered during routine physical examinations or when self-examining and finding painless, earthworm-like masses in the scrotum, or when seeking medical attention for infertility. If symptoms do occur, they usually include a sense of坠痛 in the scrotum after prolonged standing, which can be severe enough to radiate to the lower abdomen or the inner side of the thigh. This symptom disappears after lying down. It can be associated with diseases such as varicose veins in the lower limbs and hemorrhoids. In recent years, there have been reports that varicocele can lead to a decrease in sperm count, affecting fertility. After surgical treatment, fertility can be restored. In addition, some patients may experience symptoms such as restlessness, anxiety, insomnia, general weakness, and impotence. Severe varicocele can cause atrophy of the testicle on the affected side, leading patients to seek medical attention due to a small testicle.

  Varicocele of the spermatic cord occurs in 95% of cases on the left side. During examination, the patient is asked to stand. The scrotum on the affected side is visibly hanging, and the skin surface sometimes has curved veins. The veins inside the scrotum are twisted into a mass, resembling a bag of roundworms. Palpation reveals soft, compressible nodules within the spermatic cord above the testicle, and occasionally, small nodules indicative of thrombosis can be felt. Similarly, nodules of the same nature can be felt in the lower posterior part of the testicle. After the patient lies down, the nodules quickly disappear. If they do not disappear after lying down, secondary varicocele should be considered, and appropriate examinations should be conducted.

  Symptomatic varicocele may have a history of primary diseases such as renal tumor, renal积水, etc. Primary varicocele may have a history of male infertility. The patient's scrotum swells when standing, with a feeling of weight and distension, which can radiate to the lower abdomen, inguinal region, or waist, and it worsens during walking and labor, but improves after lying flat and resting. The degree of varicocele may not be consistent with the symptoms, and sometimes there may be symptoms of neurasthenia or sexual dysfunction. The primary disease symptoms that cause symptomatic varicocele include abdominal pain, anemia, hematuria, pelvic mass, etc.

  According to the degree of varicocele, it can be divided into three degrees: mild, moderate, and severe. In the mild stage, there is no visible varicocele veins locally, palpation is not obvious, and the degree of varicocele increases during the Valsalva test, and the varicocele veins disappear immediately after lying flat. In the moderate stage, varicocele veins in the scrotum can be felt when standing, but they gradually disappear when lying flat. In the severe stage, worm-like or mass-like varicocele veins can be felt in the scrotum, and the varicocele veins disappear slowly after lying flat. In recent years, China has increasingly attached importance to the research of subclinical varicocele. These patients cannot be found to have varicocele during physical examination, and the Valsalva test is also negative, but very slight varicocele can be found by ultrasound, radionuclide scanning, or color Doppler examination. These patients are often found in infertility examination. There is no unified diagnostic criteria for subclinical varicocele, and it is generally believed that a venous vessel diameter exceeding 2mm is subclinical varicocele, and exceeding 5mm is clinical varicocele.

  If the varicocele mass in the scrotum cannot be reduced or disappear after lying flat, the patient has bilateral varicocele, and secondary varicocele should be considered, and further examination should be carried out for a clear diagnosis.

4. How to prevent varicocele

  Varicocele is a common disease in urology. Generally, the symptoms are not obvious, but severe varicocele can affect sperm quality and lead to male infertility, which requires surgical treatment. Therefore, it is very important to prevent varicocele in daily life.

  1. Understanding the disease

  Preventing varicocele starts with a correct understanding of the disease. It is important not to make children and adolescents patients ashamed to ask for medical advice and treatment, which may lead to many patients not receiving timely treatment and exacerbating their condition, even causing serious consequences such as male infertility. Therefore, it is very important to have a correct understanding of the disease. The testicle is a cord-like tissue with two on each side of the male scrotum, and the varicocele veins exist within the testicle. Due to the special anatomical structure and many reasons such as male physiological development, once the varicocele veins are stimulated by something bad and become dilated and blood stasis, a worm-like varicocele mass will form, which is varicocele.

  2. Early prevention

  According to the survey, varicocele is a disease that starts from childhood and adolescence, and can onset as early as 6 years old, reaching a peak during the androgenic stage from 11 to 17 years old, and the incidence of varicocele in children and adolescents can be as high as 20%, much higher than the 12% incidence of varicocele in adults. Therefore, the prevention of varicocele should start as early as possible. It is noteworthy that the lower incidence of varicocele in adults than in adolescence is partly related to the spontaneous recovery of some adolescent patients after they become adults.

  3. Pay attention to diet

  Adolescents should pay attention to dietary adjustment, avoid spicy and stimulating foods. At the same time, eat more foods rich in vitamin E. Vitamin E has certain functions for vascular recovery, and regular consumption can have certain effects on the prevention and treatment of varicocele. Common foods rich in vitamin E include peanut oil, sesame oil, lettuce leaves, and cabbage, etc.

  4. Control frequent sexual desire

  During adolescence, sexual desire is strong, and varicocele is related to strong sexual desire and frequent excessive congestion of the sexual organs. Therefore, controlling frequent sexual desire is also an important link in preventing varicocele in adolescents.

  5. Pay attention to personal hygiene

  Adolescents should pay attention to personal hygiene, change their underwear frequently, and prevent skin itching and eczema from occurring due to prolonged contact with sweat-absorbent and difficult-to-dry cotton underwear. At the same time, do not wear tight underwear, and wear cotton underwear with a higher degree of tightness, which is conducive to heat dissipation and perspiration, thereby reducing the local temperature of the scrotum and alleviating gravity.

  6. Avoid prolonged standing

  Try to avoid prolonged standing. If it is necessary to stand for a long time due to work, it is best to alternate between two feet, that is, slightly bend one foot, allowing the body's weight to be on the other foot, or to move and shake the two legs alternately, and find opportunities to walk around.

  7. Change bad habits

  Abstain from smoking and alcohol, and avoid spicy and刺激性 food. Drink plenty of water, eat more fresh vegetables and fruits, which are very helpful in preventing varicocele.

  8. Treat reproductive diseases

  Timely treatment of urogenital system infections such as prostatitis and urethritis can reduce the opportunity for inflammation to occur, which is also an important means of preventing the occurrence of varicocele.

  9. Support the scrotum

  For those without symptoms or with mild symptoms, which do not affect daily life, and whose semen routine examination is normal, only a scrotal support or tight underwear can be used to support the scrotum, promoting venous blood return.

  10. Early treatment

  For patients with severe symptoms and abnormal semen routine examination, as well as adolescents with varicocele, high ligation of the spermatic vein should be performed for treatment. In addition, if male infertility after marriage is found to have abnormal semen, surgery should also be performed as soon as possible to improve semen quality and increase the chances of conception.

5. What laboratory tests need to be done for varicocele

  The general symptoms of varicocele are not obvious, and the diagnosis of varicocele requires auxiliary examinations. Below, I will introduce the examinations that varicocele patients should do:

  1. Semen Analysis

  It can be seen that the number of sperm is reduced, the activity of sperm is reduced, the morphology is immature, and the number of acrosome heads is increased. If a testicular biopsy is performed, it can be seen that the spermatogenic cells are poorly developed.

  2. Doppler Ultrasound Examination

  Can determine the blood flow of the testicle and measure the volume of the testicle.

  3. Spermatic Vein Angiography

  Using the Seldinger method, a catheter is inserted into the internal spermatic vein through the femoral vein, a contrast agent is injected, and the degree of reflux of the contrast agent is observed. When the length of reflux of the contrast agent in the spermatic vein reaches 5 cm, it is mild; when it refluxes to the level of L1-5, it is moderate; when it refluxes to the scrotum, it is severe.

  4. Examination for secondary varicocele

  For secondary varicocele, attention should be paid to the examination of the abdomen, and venography should be performed to exclude kidney tumors.

6. Dietary taboos for varicocele patients

  For patients with varicocele, in addition to general treatment, symptoms can also be relieved through dietary adjustment, or quickly recover through diet after varicocele surgery.

  First, diet therapy for the relief of varicocele

  1. Golden Pomelo Root Stewed Pork Stomach

  30 grams of golden pomelo root, 100-150 grams of pork stomach, add water to 4 bowls, drink the soup and eat the meat. Suitable for varicocele with liver Qi stagnation.

  2. Cimicifuga, Sesame, and Fennel Stuffed Pig Intestine

  10 grams of cimicifuga, 60 grams of black sesame, 10 grams of fennel, a section of pig intestines, put the three herbs in the pig intestines, tie both ends tightly, add an appropriate amount of water, boil, remove fennel, cimicifuga, and sesame, season and drink the soup, eat the pig intestines. For those with constipation, black sesame can be eaten continuously. Suitable for varicocele with Qi deficiency and blood stasis.

  3. Codonopsis and Astragalus Double Kernel Porridge

  20 grams of astragalus, 30 grams of codonopsis, 15 grams of lychee kernel, 15 grams of mango kernel, 15 grams of glutinous rice, cook and eat porridge. Suitable for varicocele with Qi deficiency and blood stasis.

  4. Tangerine kernel, motherwort, and black bean syrup

  15 grams of tangerine kernel, 30 grams of motherwort, 60 grams of black beans, add water to 3 bowls, boil to one bowl, add an appropriate amount of brown sugar. Suitable for varicocele with blood stasis and channel blockage.

  What to eat for varicocele patients

  Vitamin E has certain functions in the recovery of blood vessels, so eating foods rich in vitamin E regularly can definitely have a certain effect on the prevention and recovery of varicocele.

  Common foods rich in vitamin E include corn oil, peanut oil, sesame oil, lettuce leaves, and orange peel, which also contain a lot of vitamin E. Almost all green leafy vegetables contain vitamin E, as do dairy products, eggs, fish liver oil, and other animal foods. The content of vitamin E in meats, fish, and other animal foods is relatively low. Lettuce, cabbage, and cauliflower are vegetables that contain more vitamin E.

  Vegetable oil is the best food source of vitamin E, and foods rich in vitamin E include sesame, walnuts, lean meat, milk, eggs, peanuts, lettuce, etc. In addition, soybeans, peanuts, walnuts, melon seeds, animal liver, egg yolk, butter, as well as corn and yellow-green vegetables are all rich in vitamin E.

7. Conventional methods of Western medicine treatment for varicocele

  Traditional Chinese medicine treatment of varicocele is through the regulation of the body's microcirculatory system and immune system with Chinese herbs, so that the body can recover and achieve self-healing, and repair function. In addition, with the coordination of attention to diet and rest, it can be cured.

  32. Venography can be taken to restore the smooth flow of blood in the veins, repair the damaged vascular wall, improve varicose veins, and gradually disperse the snake-like soft masses on the scrotum surface.

  31. For patients with kidney deficiency and liver depression, the treatment is mainly to regulate and tonify the liver, regulate Qi and treat blood.

  Prescription: Yishen Huoxue Prescription (Experience Prescription)

  Epimedium, Semen Prunus armeniaca, Cuscuta, Angelica Sinensis, Herba Epimedii, Safflower, Foeniculum vulgare, Evodia, Cynanchum wilfordii, Chuanxiong, Uncaria sinensis, Licorice.

  28. For patients with Qi deficiency and blood stasis, the treatment is mainly to invigorate Qi and promote blood circulation.

  Prescription: Bu Zhong Yi Qi Soup (Weishen Lun) with modification.

  Astragalus, Codonopsis, Atractylodes, Coptis, Angelica Sinensis, Chuanxiong, Akebia, Salvia Miltiorrhiza, Semen Prunus armeniaca, Corydalis, Evodia, Licorice.

  25. For the syndrome of Qi stasis and blood stasis, the treatment is mainly to promote blood circulation and remove blood stasis, regulate Qi and relieve pain.

  Prescription: Fennel Tangerine Kernel Pill (Jisheng Fang) with modification.

  Fennel, Melia toosendan, Costus, Corydalis, Tangerine Kernel, Lychee Kernel, Chuanxiong, Su Mu, Salvia Miltiorrhiza.

  22. Promote blood circulation and remove blood stasis, regulate Qi and relieve pain, use Bupleurum 15 grams, Angelica Sinensis 15 grams, Chuanxiong 15 grams, Yujin 15 grams, Peach Kernel 10 grams, Salvia Miltiorrhiza 10 grams, Safflower 10 grams, Bupleurum 10 grams, Oyster 15 grams, Atractylodes 15 grams, Poria 20 grams, Corydalis 15 grams, Melia toosendan 15 grams, this medicine dosage is large and should not be used for a long time, there will be uncomfortable pain after use, stop after one dose, and can be used again after the body recovers its tolerance.

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