Patient's question:
Hello, could you please tell me how many types of varicocele surgery there are? Also, regarding minimally invasive procedures, which one is the most ideal in terms of effectiveness, recurrence rate, and risk level?Additionally, could you explain the principle of this surgery? The doctor said it involves ligating the veins, but are the already varicose veins in the scrotum removed? Can it be cured? Will I be able to engage in strenuous exercise or heavy labor after the surgery? Thank you.
Doctor's answer:
Varicocele:I. Incidence
Varicocele refers to the dilatation, tortuosity, and elongation of the pampiniform plexus of veins in the spermatic cord. It is more common in young people, typically occurring between the ages of 16 and 25. The incidence rate is approximately 15%, with 99% occurring on the left side and about 1% being bilateral.
II. Etiology
(1) Anatomical factors: Blood from the testes and epididymis returns via the spermatic veins. The spermatic veins can be divided into three groups, which communicate with each other through collateral circulation at the external ring.
- Posterior group: External spermatic vein → Inguinal vein → Femoral vein → External iliac vein.
- Middle group: Vas deferens vein → Suprarenal vein → Internal iliac vein.
- Anterior group: Internal spermatic vein: The veins of the testes and epididymis primarily return via the pampiniform plexus. The plexus merges into 2–4 veins within the inguinal canal, which pass through the internal ring into the retroperitoneum to form a single vein called the internal spermatic vein. The right internal spermatic vein ascends obliquely to enter the inferior vena cava, while the left one enters the left renal vein at a right angle. The reason varicocele is more common on the left side is:
1. The left internal spermatic vein is longer and enters the renal vein at a right angle, resulting in some resistance to blood flow. The left internal spermatic vein near the left renal vein lacks valves, making it easier for blood to flow backward.
2. The left internal spermatic vein is located behind the sigmoid colon, making it susceptible to compression by fecal matter in the intestines, which affects blood.
(2) Physiological factors: Young and middle-aged individuals have more active sexual functions, leading to abundant blood supply to the contents of the scrotum. Therefore, some varicoceles may gradually disappear with age. Additionally, prolonged standing increases abdominal pressure, which is also a contributing factor.