Varikotsele in adolescents - modern methods of treatment

Pathological expansion affects not only the blood vessels of the lower limbs, but also the veins of the spermatic cord. This form of varicose veins is common in the puberty period, especially at the very onset of adolescent puberty . Without adequate therapy, the disease can lead to irreversible effects.

Varikotsele - reasons

Urologists do not know exactly what provokes the problem described. The main factor causing varicose veins of the testicle is heredity. If relatives have similar vascular disorders, flat feet or heart failure, the risk of developing the disease in the child is significantly increased. Other suspected causes of varicocele in adolescents:

• hormonal disorders in combination with venous wall insufficiency;
• intensive physical activity;
• disruptions in exchange processes;
• overweight ;
• high blood pressure in the pelvic area.

Varicocele - degree

4 stages of progression of the examined pathology are determined. At the zero or subclinical stage, the veins are dilated slightly. During this period varicocele in children can not be found on examination with a specialist, but the altered blood vessels are noticeable when performing phlebography or ultrasound. Subclinical form of the disease is not accompanied by any symptoms, so it is rarely diagnosed.

Varicocele 1 degree in adolescents

An easy stage of the disease is characterized by a non-constant expansion of the veins of the spermatic cord. At 1 degree of testicular varicocele, the adolescent has no signs of vascular changes, but the problem can be diagnosed on examination of the urologist. For this, a special test has been developed, during which intra-abdominal pressure is artificially increased. The initial stage of progression of varicocele in adolescents is well marked during hardware research. Swollen veins are distinguished by ultrasound imaging and the results of phlebography.

Varicocele 2 degrees

The average severity of varicose is more pronounced, the damaged vessels are palpated even without tension of the abdomen and increased abdominal pressure. This form of varicocele in adolescence is often diagnosed with routine preventive consultations of a specialist. The venous lumen on stage 2 of the disease has not yet been greatly expanded, but the vascular walls are already subject to stretching. The boy can feel the early symptoms of the pathology.

Varicocele 3 degrees

Expressed type of disease is easy to see and self-examination. Damaged veins are clearly visible without medical equipment and laboratory tests. Teenage varicocele at 3 stages is combined with atrophy of the testicle. Changes are often experienced on both sides of the scrotum, even if varicose veins have affected only one testicle (mostly on the left). Severe varicocele in adolescents is accompanied by obvious clinical manifestations of the disease. Boys feel:

• discomfort, feeling of heaviness while walking or standing;
• pain in the scrotum;
• sinuous subcutaneous formations in the testicle;
• swelling or swelling of damaged areas;
• increased pain during physical exertion;
• asymmetry of the testicles;
• decrease in volume and density of testicles.

What is dangerous varikotsele?

There are suggestions that varicose veins in the testicles can provoke the extinction of their functions (the production of sperm) and atrophy. So far only in adult men has been proven the connection of infertility and varicocele - the consequences of the disease in adolescence are not thoroughly studied. Difficulties in the studies are due to the difficulty of obtaining sperm in boys before the final puberty. Even in the presence of biological material, it can not be reliably estimated according to standard criteria, because physiological indices in the pubertal period are too variable.

How to identify varicocele?

Confirm the described pathology in the early stages is difficult because of the lack of specific symptoms and visual manifestations of the disease. With the help of laboratory methods, too, it is impossible to identify varicocele - the diagnosis of blood testing for hormones is not informative. Varicose veins in the scrotum rarely cause an endocrine imbalance and this occurs only in the late stages.

To determine varicocele in adolescents the following techniques are used:

1. The Valsalva test. The boy is asked to hold his breath and strongly strain. This method provokes an increase in intra-abdominal pressure and swelling of dilated vessels.
2. Ultrasonography. This technology provides a reliable assessment of the condition of veins and reflects the state of the scrotum in 3 planes.
3. Testiculometry. With the help of a special device (orchidometer), the exact size of the testicles is determined.
4. Dopplerography . The apparatus technique of research, reflecting the state of blood vessels, their walls.
5. CT scan. This technology is used rarely, it is necessary for the differentiation of varicose veins from tumors in the retroperitoneal zone and thrombosis of the vena cava.
6. Phlebography. The study is mainly used for adult men. A teenager is assigned only if the information of the previous options is low.

How to treat varicocele?

The difficulty of treating the problem under consideration in boys of transitional age is the danger of subsequent relapses. During puberty, the filling of the veins and the pressure inside the abdominal space is constantly and sharply changing, so it is better to postpone the treatment until the young man is 12 years old (unless there are specific symptoms of varicose veins).

Many parents are interested in whether the varicocele itself can pass from the adolescent. Urologists answer this question negatively, the described disease at any stage of development does not disappear. The only way to effectively combat it is surgical removal of varicocele in adolescents - treatment without surgery has not yet been developed. Neither medicines nor folk recipes produce a proper therapeutic effect. Their independent use can lead to irreversible complications, including infertility.

Varikotsele in adolescents - operation

Before the appointment of a surgical intervention, a thorough examination and carrying out of instrumental or instrumental diagnostics is carried out. This helps determine the extent and severity of varicocele in adolescents - whether the operation is decided solely by the urologist based on the results obtained, subjective symptoms and the age of the boy. If the patient is too young to perform the procedure, varicose veins are at an easy or first stage of progression, surgical therapy can be postponed. In such cases, they are limited to regular monitoring and control of the testes.

Modern surgical treatment of varicocele in adolescents is carried out in several ways:

• laparoscopy;
• the Marmara method;
• endovascular intervention;
• procedure Ivanissevich.

Varicocele - laparoscopic operation

Presented type of surgical intervention is minimally invasive. The procedure is performed under general anesthesia, but does not require long-term rehabilitation. After laparoscopic therapy varicocele in adolescents you can go home the next day. The full course of recovery is up to 4 weeks maximum, but most young patients need only 12-15 days. How is the operation of varicocele in a teenager:

1. The abdominal cavity is filled with carbon dioxide to facilitate access to the veins.
2. A 10-mm tube (trocar) is installed in the navel area. A microscopic video camera is inserted through it.
3. On the sides are inserted 5-millimeter trocars, which serve as "tunnels" for medical equipment.
4. Special clips are placed on the enlarged veins.
5. The shell of the spermatic cord is sutured.
6. Trocars are extracted. Wounds from their implementation are sutured.

Varikotsele - the operation of Marmara

This procedure is considered the most painless, effective and safe. Microsurgical varicocelectomy has important advantages over other methods of eliminating varicocele - Marmara procedure is extremely rarely associated with complications and relapses (less than 4% of cases), tissues are minimally traumatized, hospitalization is not needed. Procedure:

1. At the exit of the spermatic cord under local anesthesia, a small incision is made (up to 3 cm).
2. Using a microscope or binocular loupe, the doctor detects damaged veins and binds them.
3. The incision is sutured.

Endovascular surgery - varicocele

Another name for the surgical procedure under consideration is embolization of the vein. Such treatment varicocele in children and adolescents is rarely prescribed because of the features of physical development and the width of blood vessels. For the endovascular procedure, a puncture of a large femoral vein is made. Through it, a flexible catheter is inserted, which alternately penetrates into the following vessels:

• inferior vena cava;
• renal vein;
• the vein of the testicle.

All manipulation takes place under the control of the X-ray apparatus. When the medical equipment reaches the target, the blood flow is blocked (embolization) by installing a special plug. This treatment option is more suitable for combating varicocele in adults and adolescents over 16-17 years of age. At this age, the width of the blood vessels corresponds to the size of the surgical catheter.

Operation Ivanissevich at varikotsele

The described type of procedure by the method of execution resembles the excision of an inflamed appendix. Operation Ivanissevich - equipment:

1. In the iliac zone, an oblique incision of about 5 cm in length is made.
2. Through it, the surgeon gets access to the retroperitoneal region, where he finds a damaged vein.
3. The expanded vessel and the adjacent branches are bandaged.
4. The surgical wound is sutured, a sterile bandage is applied from above.

Manipulation is carried out under local anesthesia, but the boy will have to spend several days in the ward of the hospital. On the scrotum it is necessary to wear a special supporting corset (3-5 days), which provides a reduction in the strain of the spermatic cord and a decrease in the severity of the pain syndrome. Seams are removed after 8-9 days after surgery.

Varicocele - complications

Very rarely, the presented variants of surgical interventions are combined with negative consequences:

• edema of the testicle (hydrocele);
• hematoma;
• bacterial infection;
• damage to the artery and vas deferens;
• testicular atrophy;
• chronic pain;
• thrombophlebitis;
• bleeding and others.

The main danger after surgical treatment varicocele - a relapse. The probability of its occurrence depends on the chosen method of surgical intervention. The most preferable options are:

• Marmara operation;
• embolization of the vein;
• laparoscopic ligation.