The development of varicocele in adolescence is a frequent occurrence. However, in most cases this condition does not manifest itself in any way and is often first discovered only during planned physical examinations, for example, at the draft commission.
In this case, they speak exactly about the teenage form of the disease, in contrast to the congenital pathology associated with increased pressure in the left renal vein.
- 1 Statistics
- 2 Symptoms
- 3 Diagnosis
- 4 Degrees of disease
- 5 Causes of occurrence of
- 6 Is it dangerous? What should I look for?
- 9 Conclusion
Adolescent varicocele is formed during puberty, during a rapid growth, which is almost always characterized by an imbalance in the development of certain body structures.
In this disease, the extends the testicular veins of .These veins form a dense network called a groinlike plexus, where individual vessels have many messages to each other.
When the veins are greatly expanded, they become convoluted and swell , which can be seen with the naked eye. The teenager himself can pay attention to the unusual appearance of the scrotum. Visible signs are observed at the third degree of the disease.
Fortunately, in most cases diagnoses 1-2 degrees of , which are characterized by mild and moderate impairment of venous outflow.
Symptoms in most cases are absent. Occasionally the child complains of the sensation of heaviness in the scrotum and even the pain of .Unpleasant sensations can be provoked by increased physical exertion.
If you suspect a varicocele in a teenager, you should contact a pediatric urologist or surgeon who will determine the extent of the illness and the treatment tactics. First of all, the doctor conducts a manual examination, also the ultrasound of the testicles is assigned. Laboratory tests are not indicative.
The examination is carried out first in the standing position, and then lying on the couch. The doctor gently palpates the scrotum, testicles and spermatic cord. He evaluates the appearance of the scrotum, the consistency, the condition of the veins, compares the size of the right and left testicle .
Then the adolescent is asked to perform the Valsawa sample: hold your breath and strain the abdominal muscles. During the test, palpation is repeated. With straining the abdomen, the ovarian veins become more noticeable.
More accurate information about the size of the testicles and the condition of the veins is obtained with the help of ultrasound. The results are compared with the age norms of : from the moment of the onset of puberty to 16-18 years, the testes on average increase from 5 to 20-35 cm3.Normally, the right and left are almost identical, the permissible difference in volume is not more than 3 cm3.
Degrees of the disease
When varicocele in children and adolescents distinguish 1( light), 2( medium) and 3( pronounced) degree of .Separately, a zero( subclinical) degree is distinguished, when small changes in veins are visible only on ultrasound. An easy degree is characterized by swelling of the veins only during the exertion, a thickening of the spermatic cord is possible.
With an average degree of change, the veins are detected with normal palpation. At the last, third degree, pathological changes are visible even when examined.
Reasons for the occurrence of
There is no consensus on the reasons. Among the prerequisites for varicose veins are called , increased pressure in the veins, insufficiency of the valve apparatus .
The development of pathology to the left is facilitated by the anatomical location of the left renal vein between the aorta and the superior fibula, which causes renal vein to be compressed by , and the venous outflow from the scrotum deteriorates.
Is it dangerous?
Severe varicose leads to a circulatory disturbance in the testicle, as a result of tissue nutrition and oxygen supply to the worsens. According to a number of studies, over time there is a change in tissues at the cellular level. Due to structural changes, there may be a disruption in the production of sex hormones.
The main danger is considered a violation of sperm production, that in the future can lead to male infertility ( about a third of adult infertility men have varicocele).
However, large-scale studies of sperm quality in adolescents with varicocele have not been conducted. This is due both to the difficulty of obtaining sperm in children, and the lack of clear evaluation criteria, since in adolescence, physiological indices are very variable. Immediate connection with infertility is not proved.
There is an assumption that increased blood supply to the testes results in an undesirable increase in the local temperature of - a known cause of deterioration in the quality of sperm.
In mild cases, treatment is not required. Severe disorders are effectively treated only surgically by .Carry out a bandaging or sclerotherapy of pathologically altered veins, after which the blood flow is distributed to other vessels.
After the operation the teenager is in the hospital for 3-4 days, and after a week can attend the school .The most frequent complications after surgery are a dropsy caused by damage to the lymphatic vessels and a relapse of the disease.
The decision on the operation is taken after careful weighing and discussion with the teenager and his parents of all the pros and cons. Clear criteria for the need for surgery for today are absent. The question about the operation is put:
- With a significant decrease in the size of the affected testicle compared with the norm;
- For pain in the testicle and scrotum;
- With bilateral defeat.
What should I look for?
Varicocele in adolescents, as in adults, in 90% of cases occurs in the left testicle .This is due to anatomical features: the left ovarian vein is normally longer than the right one, and the pressure in it is greater. If the right testicle is affected, a thorough examination is necessary.
The simplest explanation is the transposition( mirror location) of the internal organs of , which occurs in 1 person out of 10,000. With normal organ arrangement, more serious pathologies are excluded.
A right varicocele can develop due to the tumor process in the peritoneum , which results in compression of the right internal seed vein.
Another possible cause is , a blood flow disorder in the inferior vena cava , for example, due to a thrombus. To exclude these dangerous conditions, the doctor prescribes ultrasound, CT or X-ray examination.
Despite the great interest in the problem, the causes the disease in adolescents not established .Accordingly, preventive measures have not been developed. The question of the tactics of treatment remains open. Most doctors agree that if there is an easy intervention, it is not required, but if there are significant changes, opinions differ.
Is it worthwhile to operate the disease specifically in childhood, see the video:
Is it necessary to have a varicocele surgery for a teenager or can it be postponed leaving the patient under supervision? If the connection of infertility and veins in the testicles is confirmed, this will become an important argument in favor of surgical treatment.