Know the Problem of Varicocele
Knowing the Disease Better
The male reproductive system consists of the testicles and epididymis located inside the scrotum (skin sac), as well as the accessory gonads.
Varicocele is characterized by an enlargement of the veins of the testicles, which not only causes swelling in the scrotum (the sac that houses the testicles) and discomfort, but is in many cases a major cause of male infertility.
Varicose veins are found in approximately 15-20% of men and in 35-40% of men with primary infertility and up to 80% of men with secondary infertility. It gradually increases with age reaching 14% in ages 15-19 and escalates by approximately 10% for each decade of life in men over 30 years of age. Varicose veins therefore tend to develop in adolescence.
Despite its frequent appearance on the left side, bilateral varicocele is seen in 50% of men with the problem. Varicose veins only on the right side are rare and require immediate investigation, as they may be associated with other pathological conditions, even tumors.
The etiology of varicocele is considered multifactorial. First, the anatomical arrangement of the left testicular vein, where the drainage angle to the renal vein is 90 degrees, is thought to contribute to an increase in hydrostatic pressure within the venous plexus.
Second, compression of the left renal vein between the superior mesenteric artery and the abdominal aorta, known as the “nutcracker syndrome,” is recognized as another contributing factor to blood flow in the left testicular vein.
These anatomic factors may explain the predominance of left varicocele.
Apart from the above anatomical reasons, it is clear that the condition is due to genetically insufficient valves in the veins of the testicles. To make it easier to understand, varicose veins are practically like varicose veins in the legs, only here it concerns the veins of the testicles and is observed at young ages. It is an enlargement of the veins within the loose sac of skin that holds the testicles, the scrotum.
The veins carry the used blood (after oxygen has been taken up) from the testicles. Varicose veins occur when blood pools in the veins or backs up into the testicles (reflux) instead of going up, out of the scrotum.
The inability of the valves to close, preventing the return of used venous blood to the testicles, is the main cause of both pathological dilatation of the venous plexus and damage to the testicles. The inability to remove venous blood from the testicles results in the inability to enter the arterial blood necessary for the testicles to function. Thus, in the presence of a varicocele, the arterial blood does not reach the testicles, therefore sperm production is affected, and over time there is a decrease in the volume of the testicles due to atrophy and, of course, further deterioration of the parameters of the spermogram.
Subsequently, these changes lead to an altered testicular microenvironment and accumulation of oxygen free radicals (ROS), abnormal changes in testicular temperature, and the accumulation of toxic metabolites, leading among others to sperm DNA fragmentation. In other words, it is a cascade of events that determines male fertility and you have to catch up. Thus, in boys going through puberty, varicocele can inhibit testicular growth, hormone production, and other factors related to testicular health and proper functioning.
Prevention
The chart shows simple tips to prevent male fertility.
Patients with asymptomatic varicocele and fertile sperm should follow two important tips:
- Using a scrotum protection cup that holds the testicles up, especially when working out
- Repeat spermogram every year and clinical re-evaluation.
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