What is testicular torsion. How does it affect blood flow to the testicles. What are the main symptoms of testicular torsion. When should you seek emergency care for testicle pain. How is testicular torsion treated. What complications can arise from untreated testicular torsion. Who is most at risk for developing this condition.

Understanding Testicular Torsion: A Medical Emergency

Testicular torsion is a serious condition that occurs when a testicle rotates, twisting the spermatic cord that supplies blood to the scrotum. This rotation results in reduced blood flow, leading to sudden and often severe pain and swelling. While it can happen at any age, even before birth, testicular torsion is most common in adolescents between 12 and 18 years old.

The condition requires immediate medical attention, as prolonged lack of blood flow can cause permanent damage to the affected testicle. In cases where blood supply is cut off for an extended period, the testicle may become so severely damaged that surgical removal becomes necessary.

The Mechanism of Testicular Torsion

During testicular torsion, the testicle rotates within the scrotum, causing the spermatic cord to twist. This cord is crucial as it contains blood vessels that supply oxygen and nutrients to the testicle. When twisted, these vessels become constricted, limiting or completely blocking blood flow.

Recognizing the Symptoms of Testicular Torsion

Identifying the signs of testicular torsion quickly is crucial for preserving testicular function. The primary symptoms include:

• Sudden, severe pain in the scrotum
• Swelling of the scrotum
• Abdominal pain
• Nausea and vomiting
• A testicle positioned higher than normal or at an unusual angle
• Frequent urination
• Fever

It’s important to note that young boys experiencing testicular torsion often wake up due to scrotal pain in the middle of the night or early morning.

When to Seek Medical Help

Any sudden or severe testicle pain should be treated as a medical emergency. Prompt treatment can prevent severe damage or loss of the affected testicle. Even if the pain subsides on its own, medical attention is still necessary, as this could indicate intermittent torsion and detorsion, which may require surgery to prevent recurrence.

Causes and Risk Factors of Testicular Torsion

The exact cause of testicular torsion remains unclear. However, most males who experience this condition have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles, but not every male with the trait will develop testicular torsion.

Several factors may contribute to the occurrence of testicular torsion:

• Vigorous physical activity
• Minor injury to the testicles
• Sleeping
• Cold temperatures
• Rapid growth of the testicle during puberty

Who is at Risk?

While testicular torsion can occur at any age, certain factors increase the risk:

1. Age: The condition is most common between ages 12 and 18.
2. Previous testicular torsion: If you’ve experienced intermittent torsion and detorsion, you’re at higher risk for recurrence.
3. Family history: Testicular torsion can run in families.

Complications of Untreated Testicular Torsion

Failing to treat testicular torsion promptly can lead to severe complications:

Testicular Damage or Loss

When testicular torsion goes untreated for several hours, the blocked blood flow can cause permanent damage to the testicle. In severe cases, the testicle may need to be surgically removed.

Impact on Fertility

In some instances, damage or loss of a testicle due to torsion can affect a man’s ability to father children. The extent of this impact varies depending on the severity of the damage and whether one or both testicles are affected.

Diagnosis and Treatment of Testicular Torsion

Diagnosing testicular torsion typically involves a physical examination and may include imaging tests such as ultrasound. The primary treatment for testicular torsion is emergency surgery. During this procedure, the surgeon untwists the spermatic cord, restoring blood flow to the testicle. If the testicle is viable, it is then fixed in place to prevent future torsion.

The success of the surgery largely depends on how quickly it is performed after the onset of symptoms. If treated within 6 hours, the testicle can usually be saved. However, after 12 hours, the chances of saving the testicle decrease significantly.

Manual Detorsion

In some cases, a doctor may attempt to manually untwist the testicle. This procedure, known as manual detorsion, can temporarily restore blood flow and alleviate pain. However, it is not a definitive treatment, and surgery is still necessary to prevent recurrence.

Preventing Testicular Torsion

For males with the inherited trait that allows testicles to rotate freely in the scrotum, the only way to prevent testicular torsion is through surgery. This preventive procedure involves attaching both testicles to the inside of the scrotum, a technique known as orchiopexy.

While this surgery is typically performed after an episode of torsion, it may be recommended for individuals with a family history of the condition or those who have experienced intermittent torsion.

Importance of Self-Examination

Regular self-examination of the testicles can help in early detection of any abnormalities. While it may not prevent torsion, it can lead to quicker recognition of symptoms and prompt medical attention.

Living with the Risk of Testicular Torsion

For those at higher risk of testicular torsion, being aware of the symptoms and knowing when to seek medical help is crucial. It’s important to educate adolescent boys about this condition, as they are in the primary risk group.

Psychological Impact

The possibility of testicular torsion can cause anxiety in some individuals. It’s important to address these concerns with a healthcare provider, who can provide reassurance and guidance on managing the risk.

Advances in Testicular Torsion Research and Treatment

Medical research continues to explore new ways to diagnose and treat testicular torsion more effectively. Some areas of ongoing research include:

• Improved imaging techniques for faster and more accurate diagnosis
• Development of biomarkers to assess testicular damage
• Exploration of protective measures to reduce tissue damage during torsion
• Investigation of genetic factors that may predispose individuals to testicular torsion

These advancements aim to improve outcomes for patients and potentially reduce the need for emergency surgery in some cases.

Telemedicine and Testicular Torsion

The rise of telemedicine has introduced new possibilities for rapid initial assessment of testicular pain. While a physical examination is crucial for definitive diagnosis, telemedicine consultations can help patients quickly determine whether they need to seek emergency care, potentially saving crucial time in cases of testicular torsion.

The Role of Education in Managing Testicular Torsion Risk

Education plays a vital role in managing the risk of testicular torsion. Schools, healthcare providers, and parents should work together to ensure that young males are informed about this condition. Key educational points include:

• Understanding the symptoms of testicular torsion
• Recognizing the urgency of seeking medical care for sudden testicular pain
• Learning proper techniques for testicular self-examination
• Awareness of personal risk factors, such as family history

By promoting awareness and understanding of testicular torsion, we can improve early detection and treatment, potentially saving many testicles from permanent damage or loss.

The Importance of Open Communication

Encouraging open communication about testicular health can help overcome the embarrassment or reluctance that some males may feel about discussing these issues. Creating a supportive environment where concerns can be freely expressed is crucial for timely intervention in cases of testicular torsion.

Long-term Outlook for Testicular Torsion Survivors

The long-term prognosis for individuals who have experienced testicular torsion varies depending on several factors, including the speed of treatment and the extent of damage to the affected testicle. In cases where the testicle is saved, most men go on to have normal testicular function and fertility.

However, even with successful treatment, there may be some long-term considerations:

• Increased vigilance for symptoms of recurrence
• Potential need for hormonal monitoring
• Possible impact on fertility, particularly if both testicles were affected
• Psychological effects, such as anxiety about future episodes

Regular follow-up with a urologist is often recommended to monitor testicular health and address any ongoing concerns.

Support for Testicular Torsion Survivors

For those who have experienced testicular torsion, especially if it resulted in the loss of a testicle, psychological support can be beneficial. This may include counseling to address body image concerns, anxiety about future health issues, or fertility worries. Support groups, either in-person or online, can also provide a valuable network for sharing experiences and coping strategies.

The Global Perspective on Testicular Torsion

While testicular torsion occurs worldwide, its incidence and management can vary across different regions and healthcare systems. In some parts of the world, lack of awareness or limited access to emergency medical care can lead to delays in treatment and poorer outcomes.

Global health initiatives are working to:

• Improve awareness of testicular torsion in underserved regions
• Enhance training for healthcare providers in recognizing and treating the condition
• Develop strategies for faster referral to surgical care in rural or remote areas
• Implement telemedicine solutions to provide expert consultation in areas with limited specialist access

These efforts aim to reduce the global burden of testicular torsion and improve outcomes for affected individuals regardless of their geographical location.

Cultural Considerations in Testicular Torsion Management

Cultural factors can significantly influence how testicular torsion is perceived and managed in different societies. In some cultures, discussions about reproductive health may be taboo, leading to delays in seeking medical care. Healthcare providers and public health officials must be sensitive to these cultural nuances when developing education and treatment strategies for testicular torsion.

Future Directions in Testicular Torsion Care

As medical science advances, new approaches to preventing and treating testicular torsion are on the horizon. Some promising areas of research and development include:

• Genetic screening to identify individuals at high risk for testicular torsion
• Development of non-invasive treatments to restore blood flow without surgery
• Advanced imaging techniques for more precise diagnosis and treatment planning
• Tissue engineering approaches to potentially regenerate damaged testicular tissue
• Artificial intelligence algorithms to assist in rapid diagnosis and triage of testicular pain

These innovations hold the potential to revolutionize the management of testicular torsion, potentially reducing the need for emergency surgery and improving long-term outcomes for patients.

The Role of Patient Advocacy

Patient advocacy groups play a crucial role in advancing care for testicular torsion. These organizations work to:

• Raise public awareness about the condition
• Lobby for increased research funding
• Provide support and resources for affected individuals and their families
• Collaborate with medical professionals to improve treatment protocols

By amplifying the voices of those affected by testicular torsion, these groups help drive progress in both medical care and public health policies related to the condition.

Testicular torsion – Symptoms & causes

Overview

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion

During testicular torsion a testicle rotates, twisting the spermatic cord that brings blood to the scrotum, the loose bag of skin under the penis that contains the testicles. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth.

Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.

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Symptoms

Signs and symptoms of testicular torsion include:

• Sudden, severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
• Swelling of the scrotum
• Abdominal pain
• Nausea and vomiting
• A testicle that’s positioned higher than normal or at an unusual angle
• Frequent urination
• Fever

Young boys who have testicular torsion typically wake up due to scrotal pain in the middle of the night or early in the morning.

When to see a doctor

Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion.

You also need to seek prompt medical help if you’ve had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from happening again.

Causes

Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

It’s not clear why testicular torsion occurs. Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion.

Testicular torsion often occurs several hours after vigorous activity, after a minor injury to the testicles or while sleeping. Cold temperature or rapid growth of the testicle during puberty also might play a role.

Risk factors

• Age. Testicular torsion is most common between ages 12 and 18.
• Previous testicular torsion. If you’ve had testicular pain that went away without treatment (intermittent torsion and detorsion), it’s likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage.
• Family history of testicular torsion. The condition can run in families.

Complications

Testicular torsion can cause the following complications:

• Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage to the testicle. If the testicle is badly damaged, it has to be surgically removed.
• Inability to father children. In some cases, damage or loss of a testicle affects a man’s ability to father children.

Prevention

Having testicles that can rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.

Testicular torsion – Symptoms & causes

Overview

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion

During testicular torsion a testicle rotates, twisting the spermatic cord that brings blood to the scrotum, the loose bag of skin under the penis that contains the testicles. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth.

Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.

Products & Services

Symptoms

Signs and symptoms of testicular torsion include:

• Sudden, severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
• Swelling of the scrotum
• Abdominal pain
• Nausea and vomiting
• A testicle that’s positioned higher than normal or at an unusual angle
• Frequent urination
• Fever

Young boys who have testicular torsion typically wake up due to scrotal pain in the middle of the night or early in the morning.

When to see a doctor

Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion.

You also need to seek prompt medical help if you’ve had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from happening again.

Causes

Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

It’s not clear why testicular torsion occurs. Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion.

Testicular torsion often occurs several hours after vigorous activity, after a minor injury to the testicles or while sleeping. Cold temperature or rapid growth of the testicle during puberty also might play a role.

Risk factors

• Age. Testicular torsion is most common between ages 12 and 18.
• Previous testicular torsion. If you’ve had testicular pain that went away without treatment (intermittent torsion and detorsion), it’s likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage.
• Family history of testicular torsion. The condition can run in families.

Complications

Testicular torsion can cause the following complications:

• Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage to the testicle. If the testicle is badly damaged, it has to be surgically removed.
• Inability to father children. In some cases, damage or loss of a testicle affects a man’s ability to father children.

Prevention

Having testicles that can rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.

stages, consequences, what is dangerous, how to treat

Varicocele is a varicose vein of the spermatic cord of the testis. Violations of blood flow lead to stagnation in tissues, their atrophy, in about 10% of cases it contributes to infertility. Varicocele in men is successfully treated by surgery, even at the most advanced stages.

What is a varicocele and why is it dangerous?

1. Why does testicular varicose veins occur?
2. Symptoms of testicular varicocele
   1. Is it possible to visually determine a varicocele
   2. What can hurt with varicocele
3. What are the stages of testicular varicose veins or varicose veins on the testicles
   1. Varicocele 1st degree
   2. Varicocele grade 2
   3. Varicocele grade 3
4. What is dangerous varicose veins of the spermatic cord
   1. How does varicocele affect sex life?
5. Treatment methods for testicular varicocele and which doctor to contact
6. Disease prevention

Why testicular varicose veins occur

Varicose veins of the spermatic cord are most often caused by a genetic predisposition (weakness of the vessel walls).

Let’s list other causes of varicose veins in men on the testicles:

• high venous pressure in the small pelvis;
• regular strenuous exercise, legwork, cycling;
• injuries of the scrotum and groin;
• tumors.

Important!

The risk of developing varicocele is significantly increased by past infections of the genitourinary system (urethritis, prostatitis). Sometimes the causes of varicocele lie in the transferred sexually transmitted diseases, for example, gonorrhea.

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Symptoms of testicular varicocele

At the initial stage of the disease, symptoms are virtually invisible. Later, it becomes more pronounced and is characterized by a deterioration in well-being. The patient may note minor pains that make themselves felt after physical exertion and pass while lying down.

We list other symptoms that testicular varicose veins in men have:

• drawing pains in the groin area, increasing with heavy physical exertion and in a state of sexual arousal;
• asymmetry of the scrotum;
• heaviness and pain in testicles;

Is it possible to visually identify varicocele? It is indicated by such signs revealed during visual self-examination and palpation:

• testicles lost elasticity;
• outwardly the veins become more pronounced, resemble a “ball of worms”;
• enlarged vessels are clearly visible when the man is standing or lying down.

What can hurt with varicocele

Running testicular varicose veins provokes unpleasant sensations, which are mostly dull, aching in nature, intensify after physical exertion and sexual intercourse. Most often, patients complain of pain in the scrotum and perineum. This indicates that the spermatic cord hurts.

Important!

The most pronounced and severe pain becomes in the evening and at night. At stage 2 of the disease, you can alleviate your condition by taking a horizontal position for several hours. But on 3 and 4 this is not enough: the pain syndrome almost does not go away after rest, pursuing the patient virtually around the clock. Therefore, it is not recommended to delay a visit to the doctor.

What are the stages of testicular varicose

Varicose veins of the spermatic cord has several stages, each of which is characterized by its own characteristics. As the disease progresses, the health and quality of a man’s sexual life worsens, and the risk of infertility increases.

Varicocele of the 1st degree

Characterized by mild symptoms and blurred clinical picture. A slight discomfort in the testicles is usually attributed to other causes. The following factors contribute to the exacerbation of the condition and the transition of the disease to stage 2:

• Injuries of the testicle and scrotum.
• Kidney problems causing impaired blood flow in the testicular vein.

Grade 1 varicocele can only be diagnosed during a special ultrasound examination.

Varicocele 2nd degree

Initially, pain and general symptoms do not actually increase. But the swelling of the veins, which is felt during self-examination and palpation, should alert. There may also be a slight increase in temperature, which makes it difficult for blood to flow to the testicles, which, in turn, leads to a slowdown in sperm growth.

Then the pain and discomfort become more and more distinct. Edema manifests itself especially clearly during the heat, in the evening, with a sedentary lifestyle.

Varicocele grade 3

This is the most advanced stage. It is characterized by pain and deterioration of well-being. The testicle undergoes strong visual changes, decreases in size. The scrotum, on the contrary, is getting larger due to constant edema. The veins are visible to the touch and visually. Pain can haunt the patient around the clock.

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What is the danger of varicose veins of the spermatic cord

The consequences of varicocele can be the most deplorable:

• Infertility. Due to the increase in temperature in the testicles, the level of oxygen in the scrotum decreases, so the maturation and production of sperm become impossible.
• Inability to play sports. The presence of a varicocele prohibits any sports activity associated with the tension of the abdominal muscles.

Aesthetic defect. If the pathology is not operated on, the scrotum sags over time, and a pronounced venous network appears on the testicles. Many men and adolescents with advanced varicocele experience discomfort due to these visual changes.

How varicocele affects sexual life

Contrary to popular stereotype, there is no direct connection between varicocele and impotence. But the quality of sexual life is deteriorating, because with the progression of the disease, the pain syndrome also increases. Its severity affects the duration of sexual intercourse and sexual desire.

Methods of treatment of testicular varicocele and which doctor to contact

Medical treatment of the disease is carried out by conservative and surgical methods. For help, you need to contact a urologist-andrologist. Conservative therapy is possible with normal spermogram parameters. To improve the patient’s condition, medication is prescribed to normalize blood pressure, massage and therapeutic exercises. You will also need to wear special corrective underwear.

But most often the only way to get rid of the pathology and avoid complications is surgery. The doctors of the Garvis clinic have a great positive experience in the elimination of varicocele through the Marmara operation. Indications for its implementation:

• severe pain syndrome;
• infertility;
• testicular atrophy.

During this intervention, a micro incision is made in the groin area. Then, using an ultramodern microscope, veins that have undergone pathological changes are detected. They are tied up and excised to free the arteries. The operation lasts about an hour, and the restoration of health after the intervention takes several weeks. The risk of recurrence is virtually zero.

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Prevention of the disease

Prevention of varicocele consists in regular examination by a urologist. Don’t wait for testicular varicose veins to jeopardize your fertility and quality of sex life. Sign up for a consultation at the Garvis clinic now, and we will definitely help you get rid of the pathology as soon as possible!

The role of the venous system of the testicles in the regulation of the level of sex hormones in normal and with varicocele

The venous blood supply system of the testicles is unique among the endocrine glands, primarily due to its length and capacity (Fig. 1). The main type of structure of the testicular vein. None of the endocrine glands (thyroid gland, adrenal glands, etc.) has such extended sections of the venous bloodstream, which in the testicle can be compared with the length of the veins of the forearm, lower leg. the venous system of the left testicle is even longer than that of the right one [1]. The incidence and progression of varicocele correspond to the age dynamics of the level of sex hormones in the blood of men [2].

In angiology studies in recent decades, data have been obtained on the effect of sex hormones on the vascular wall, including the wall of the venous vessel. Experimental studies on various models of angiogenesis in animals reveal a noticeable effect of the action of both male and female sex hormones both on the morphology of the vascular wall and on angiogenesis and vascular tone [3].

No less interesting is the effect of sex hormones as vasodilators. The vasodilatory effect is noted in experimental studies of both testosterone and female sex hormones. Both the wall of the artery and the lumen of the venous vessel are affected by sex hormones [4].

One of the mechanisms for realizing the effect of sex hormones on the venous wall is their interaction with the corresponding receptors detected by histochemical methods [5].

A model of the effect of sex hormones, primarily estradiol and progesterone, on the venous wall can be considered the onset of pregnancy, in which varicose veins of the lower extremities, pelvic plexus, and chronic hemorrhoids often appear [6, 7].

The pathogenetic mechanisms of varicocele development traditionally described in the scientific literature are mainly reduced to impaired venous outflow through the left renal vein and to valvular venous insufficiency.

A number of authors [8] involved in the study of varicocele, including in young people, in children and adolescents, note the relative rarity of organic lesions of the renal and testicular veins in the total mass of patients with varicocele.

E.B. Mazo et al. [9] pointed to the role of the left adrenal gland in the formation of hormonal imbalance in varicocele. In their opinion, the change in the direction of blood flow in the venous system of the left adrenal gland during varicocele causes catecholamines to enter in high concentrations from the adrenal medulla and prostaglandin E ₂ of the left kidney into the vasculature of the adrenal cortex. The stimulating effect of catecholamines and prostaglandin E ₂ on the cells of the adrenal cortex causes activation of steroidogenesis in them. As a result, steroid hormones of the left adrenal gland in increased quantities enter the systemic circulation. Due to their pronounced antiandrogenic action, damage to steroidogenesis develops both in the left and in the right testicle.

The direct cause of the development of varicocele is also considered to be an increased inflow of arterial blood to the genital organs, which begins during puberty, which reveals the inconsistency of the wall tone of the testicular vein and leads to dilatation of the pampiniform plexus [8, 10].

The role of connective tissue dysplasia is no less important in the pathogenesis of varicose veins, regardless of their location, which is confirmed by morphological, phlebographic studies [11].

The purpose of the work is to determine the role of the venous system of the testicles as a regulator of the content of sex hormones.

Material and methods

Differences in the level of sex hormones in the peripheral blood and blood from the veins of the pampiniform plexus in a group of men operated on for varicocele on the left were studied.

Surgical treatment of varicocele was carried out in the city outpatient surgical center of Vladivostok. The age of the patients ranged from 15 to 54 years. All patients were admitted for surgical correction of varicocele after consultation with a urologist-andrologist, ultrasound examination of the scrotum organs and spermatogenesis examination. In addition to the routine examination (determination of the degree of varicocele, cremaster reflex, orchioptosis, Valsalva maneuver, etc. ), duplex scanning of the venous system of the testicles with the identification of blood flow characteristics was mandatory. To increase the representativeness of the study, patients with severe hemodynamic refluxes of both the first and second types were excluded from the sample, in which the imposition of intervenous vascular anastomoses is indicated; examined patients with primary, “idiopathic” varicocele II and III degree. Patients with bilateral and right-sided varicocele were also excluded from the study.

A comparative study of the level of hormones in the blood flowing through the vessels of the left testicle was carried out in 36 patients with varicocele (test group). Including 22 patients were operated according to the Marmar method (microsurgical varicocelectomy), 14 – according to the extended version of subinguinal varicocelectomy in Goldstein’s modification (Marmar-Goldstein operation). The control group consisted of patients (n=25) who were operated on the scrotum both on the right side and on the left for dropsy of the testicular membranes, spermatocele, inguinal hernia, and other testicular pathology not associated with varicocele. Sex hormones were determined on the basis of the Tafi-diagnostics laboratory using the Elecsis2010 apparatus using the electrochemiluminescence method. The method of determination was as follows: during the operation for varicocele according to the Marmar method, blood for the study of hormones was taken simultaneously from the cubital vein and the veins of the spermatic cord.

For statistical analysis of the reliability of the results of the study, the Mann-Whitney test was used to compare two independent samples, which was evaluated using the Statistica 7.0 data analysis computer program. Correlation analysis of the data was carried out using Spearman’s rank correlation test (r).

The morphological part of the study was as follows. During the surgical intervention, veins isolated under optical magnification from the lymphatic and arterial vessels were resected for 1.5-2 cm. Thus, we compared the morphological changes in the veins in the same patient on the side of the lesion from all venous pools of the testis involved in the pathological process. It should be noted that the morphological differences in the veins of different basins were already visible intraoperatively, with a fourfold optical magnification. Data on external changes in veins are presented in Fig. 2. Figure 2. Dilated and tortuous veins of the cremaster basin with varicocele.

Results and discussion

The results of the study of sex hormones in patients with varicocele are presented in Table. 1.

The level of sex hormones in the blood from the vein of the elbow was within the reference values, i.e. normal. While the indicators of hormones in the blood from the pampiniform plexus vein on the left, taken at the same time interval, significantly exceeded the norm. The multiplicity of excess in this case was approximately the same for estradiol and testosterone (more than 150 times), while for progesterone this multiplicity ranged from 11 to 15 times.

Analysis of testosterone concentration indicators revealed a high level of significance according to the Mann-Whitney test, the concentration of sex hormones in the blood from the cubital vein in the control group was significantly higher than in the experimental group (Table 2).

An inverse correlation weak relationship has been established between the level of progesterone in the blood from the cubital vein and the multiplicity of the testosterone index. A low level of progesterone in the blood from the cubital vein causes an increase in the multiplicity of testosterone levels. The older the patient’s age, the higher the level of estradiol in the blood from the veins of the pampiniform plexus, which confirms the age-related dynamics of the production of sex hormones in men (Table 3).

When studying the level of follicle-stimulating and luteinizing hormones (FSH, LH) in the blood flowing from the testicle, a slight decrease was noted, apparently due to consumption in the tissues of the gonad (consumption hormone). The study of the level of cortisol in the blood from the veins of the pampiniform plexus did not show its significant excess (an increase of 1.88 times).

In the control group, there was also a significant difference between the level of hormones in the peripheral blood and the blood flowing from the testicle through the pampiniform plexus veins. Nevertheless, it did not reach such proportions as with varicocele – an excess of 78.3 ± 13.9times.

A direct proportional dependence of the level of testosterone and estradiol on the severity of varicocele has also been established, and if the multiplicity of the excess of the level of these hormones in the blood from the veins of the pampiniform plexus ranges from 50 to 100 times, this corresponds to the II degree of severity of the varicocele, if more than 100 times – we are talking about the III degree of varicocele. Thus, the determination of the level of sex hormones in the blood from the pampiniform plexus veins can become an additional criterion for the severity of varicocele, along with clinical criteria and ultrasound data. Comparison of indicators of the level of sex hormones in a patient in a healthy vein and the affected one allowed us to find a new system for assessing the degree of varicocele (RF patent No. 2403871 dated June 15, 2009G.).

The left renal vein is longer than the right one, anatomically located in such a way that in the distal section it passes between the aorta and the superior mesenteric artery for 1. 5-2 cm and can be compressed by the transmission pulsation of these vascular formations. Another factor in the deposition of blood in the testicular vein system is the very structure of the venous wall of the testicular vein and pampiniform plexus. The results of a morphometric comparative study of the veins of the left testicle (pampiniform plexus and cremasteric plexus) show the predominance of veins with a moderately developed and highly developed type of structure of the muscular membrane, in contrast to the veins of the pampiniform plexus, which, with a relatively large lumen, had a thinner muscle layer and a number of irreversible changes in the venous wall, characterized by its uneven thinning, significant and persistent expansion of the lumen of the veins of the pampiniform plexus . The testicular veins are embryologically different compared to the system of cremaster vessels of the scrotum, they belong to the veins with a “weak” type of development of the muscular membrane. Due to this structure, veins can greatly expand and perform a deposition function [12].

Conclusion

The venous system of the testicles is an important factor in the regulation of the level of sex hormones produced in the testicle. In the presence of varicocele in a patient, the level of sex hormones in the blood from the veins of the pampiniform plexus can increase by tens and hundreds of times, which can serve as an objective criterion for the severity of varicocele.

Stagnation of venous blood in the pampiniform plexus and an increase in the level of sex hormones, especially estrogen and progesterone, causes a state of hormone-dependent phlebopathy at the first stage of varicocele development, which can undergo reverse development as the level of sex hormones stabilizes and decreases.

In patients with connective tissue dysplasia, phlebopathy passes into the stage of irreversible changes in the venous wall with a significant and persistent expansion of the lumen of the pampiniform plexus veins.

No conflict of interest .