The so-called varicocele refers to the backflow and stasis of blood in the scrotum caused by valve failure or insufficiency in the spermatic vein around the testicle and above the testicle in the scrotum, causing the veins in the scrotum to tortuously expand. The testicles on the varicose side are often lower, and tortuous thick veins can be vaguely seen through the scrotal skin. If you touch it with your hands, it looks like a mess of thick wool or like an earthworm. Varicocele is a condition in which the venous return of the spermatic cord is blocked or the valve fails, causing blood reflux to cause blood stasis, leading to tortuous expansion of the pampiniform venous plexus. The incidence rate is 10% to 15% in the male population, and it is more common in young adults. It accounts for 15% to 20% of male infertile people. The patient\’s scrotum is distended when standing, with a feeling of heaviness and swelling, which can radiate to the lower abdomen, groin or waist. The symptoms are aggravated when walking and working, and are relieved after lying down and resting. The degree and symptoms of varicose veins may be inconsistent, and sometimes there are symptoms of neurasthenia.
The testicular and epididymal veins converge into the pampiniform venous plexus, which refluxes through three paths:
① Convergence into the internal spermatic vein in the inguinal canal, ascending retroperitoneally, and the left spermatic vein The intracordal vein enters the left renal vein at a right angle, and the right side enters the inferior vena cava at an acute angle about 5 cm below the right renal vein. Only 5% to 10% directly enter the right renal vein;
② Meridian The vas deferens vein enters the internal iliac vein;
③ passes through the cremaster muscle vein to the inferior epigastric vein and joins the external iliac vein.
The reasons for the high incidence of left varicocele are:
① People’s upright posture affects the spermatic venous return;
②The vein wall and its surrounding connective tissue are weak or the cremaster muscle is underdeveloped;
③The venous valve is defective or insufficient;
④The left internal spermatic vein has a long course, And enters the renal vein at a right angle, with high venous pressure;
⑤ The left internal spermatic vein may be compressed by the sigmoid colon;
⑥ The left renal vein may be compressed between the aorta and superior mesenteric artery pressure, affecting the return of the spermatic vein, forming the so-called proximal clamping phenomenon;
⑦ The right common iliac artery can compress the left common iliac vein, blocking the venous return of the left vas deferens, forming the so-called distal clamping phenomenon.
Because the first three factors mentioned above affect the internal spermatic veins on both sides at the same time, part of the right internal spermatic vein directly enters the right renal vein, and there are communicating branches between the pampiniform plexuses on both sides. In fact, the right internal spermatic vein The incidence of varicocele is also low. Renal tumors forming tumor thrombi in the renal vein and inferior vena cava, or retroperitoneal tumor compression, hydronephrosis or ectopic blood vessels can cause spermatorrhea.Varicocele, known as symptomatic or secondary varicocele.
Why does varicocele cause male infertility? It is generally believed that one of the reasons is that due to the reverse flow of blood flow in the testicle on the varicose side, some metabolites from the adrenal gland, such as catecholamines, are brought to the blood vessels around the testicle, causing them to shrink, so that the testicle cannot receive sufficient blood exchange. As a result The testicles receive less oxygen and nutrients; the accumulation of carbon dioxide and other metabolites increases. Due to poor nutrition, the testicles\’ seminiferous tubules atrophy to varying degrees, causing this sperm-producing \”factory\” to reduce production, stop production, and produce defective products. products, resulting in reduced fertility until the loss of fertility. Another reason is that the temperature of the scrotum on the varicose side will be 1 to 2°C higher than before, and the production of sperm by the testicles may be interfered with or inhibited by the increase in temperature in the scrotum. This is why working under high temperature conditions for a long time or wearing tight pants for a long time is not conducive to scrotal heat dissipation and can lead to male infertility.
Although those with varicocele may not necessarily cause infertility, those who have caused infertility should be treated in time.
This article is provided by Baidu Reading. It is excerpted from \”The Clear \”Conception\” Plan\” Author: Sun Jianqiu and Xie Yingbiao