Varicocele in children and adolescents
Varicocele or varicose veins surrounding the spermatic cord is a purely male disease. About 90-95% of children have varicocele on the left, 2% of boys have varicocele on the right, and 8-10% of cases have 2-sided varicocele. Normally, the veins carry out the outflow of blood from the left testicle up through the veins of the aciniform plexus, then through the internal spermatic vein connected to the left renal vein.
There are three degrees of varicocele in children. The first degree does not bother with any symptoms, expressed by enlarged wreaths, palpable in a standing position.
The second degree gives pain in the scrotum, burning. The veins are visible, located below the testicle, there is an asymmetry of the scrotum. The third degree is easily determined even visually, veins in the form of clusters hang down in the scrotum, a decrease in the elasticity and size of the testicle, its lower location in the scrotum appears.
According to statistics, 5-6% of boys aged 10 years are diagnosed with varicocele with first-degree pathological changes, this is also typical for children from thirteen to seventeen years old, accounting for 10-15% of the surveyed. Varicocele of the second degree is observed in 10-12% of children, and the third degree occurs in 5% of young men at the time of puberty.
The expansion of the veins of the uviform plexus of the left testicle makes it difficult for the supply of nutrients and dangerous complications from the boy's reproductive function. Sperm formation should occur at a temperature several degrees lower than the body temperature; in this disease, the temperature of the scrotal organs rises, and spermatogenesis disorders occur, i.e. becoming an adult in the future, a man will be barren.
Varicocele causes
One of the reasons for the development of varicocele is the insufficiency of the valves of the internal spermatic vein and an increase in pressure in the left renal vein. In this case, there is a return flow of blood through the left internal spermatic vein (reflux) from the left renal vein. Another reason is the congenital lack of elasticity of the venous walls. Acquired varicocele is a consequence of sports, active games, there is a sharp increase in pressure in the abdomen and a violation of the valve function of the veins. This is one of the most common surgical pathologies in children. Based on the experience of treating childhood diseases, varicocele is detected mainly at the age of nine, the minimum is achieved in adolescents of 12-15 years.
Varicocele is congenital due to increased pressure in the lumen of the left renal vein. The acquired pathology that occurs during the period of intensive growth of the body does not manifest itself in any way until the onset of puberty.
Like many years ago, today this pathology is relevant and this is explained by its wide prevalence. If the disease is not treated at an early age, then after puberty, there will be a negative effect of circulatory testicular tissue hypoxia on spermatogenesis. In the future, it can lead to impaired reproductive capacity.
Varicocele symptoms
It should be borne in mind that varicocele may be asymptomatic. And it is often revealed by accident at a doctor's appointment. There is a course of the disease with complaints of pulling pains and discomfort in the left half of the scrotum during physical exertion. It is rarely diagnosed at an earlier stage and only because of the appearance (in rare cases) of cyanosis of the left half of the scrotum, which cannot be ignored. Adolescents usually find swelling of ectasized veins visible through the skin of the scrotum, especially when the abdomen is straining.
Diagnosis of varicose veins
During diagnostics, it is difficult to assess the functional state of the gonads in a developing organism for obvious reasons, therefore, during the initial examination, they are limited to determining the degree of the disease. Ultrasound of the kidneys, bladder, scrotum, testicles is performed, changes in size and structure are specified.
The diameter of the dilated veins of the groin-shaped plexus is visually examined during exercise and at rest. Re-examination is performed after 4-6 months, if the dynamics of development is negative - an increase in the diameter of the dilated veins, then the teenager is prepared for surgery.
Treatment and prevention of varicocele
The indication for surgical treatment is grade 2-3 varicocele. If the ultrasound results indicate an increase in stagnation and the progression of the pathological process, it is necessary to proceed to radical actions and perform surgical treatment in the traditional way or using surgical procedures such as embolization or endovascular sclerosis of the spermatic vein.
Prophylactic surgery with proven return of blood to the testicular vein can be performed without waiting for puberty. Be sure to consult a specialist in the postoperative period after 1 month, 6 months and after 1.5 years.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
