What are the main causes of epididymitis. How can you recognize the symptoms of this condition. What treatment options are available for managing epididymitis.

What is Epididymitis? An Overview of the Condition

Epididymitis is a medical condition characterized by inflammation and swelling of the epididymis, a coiled tube located at the back of the testicles. This crucial structure plays a vital role in storing and transporting sperm, connecting to the ejaculatory duct via the vas deferens. When the epididymis becomes inflamed, it can cause significant discomfort and various symptoms that require attention.

There are two primary types of epididymitis:

• Acute epididymitis: This form develops suddenly, with pain and inflammation progressing rapidly. It typically lasts less than six weeks.
• Chronic epididymitis: This type develops more gradually, presenting with a duller pain. It persists for longer than six weeks and is considered a long-term issue.

In some cases, the inflammation may extend to the testicles, resulting in a condition known as epididymo-orchitis. It’s important to note that epididymitis can affect males of any age, making it a concern across various demographics.

Common Causes of Epididymitis: From Infections to Injuries

Understanding the underlying causes of epididymitis is crucial for proper diagnosis and treatment. The condition typically results from the spread of a bacterial infection, often originating in the urethra, prostate, or bladder. Two primary types of infections are associated with epididymitis:

Sexually Transmitted Infections (STIs)

Epididymitis caused by STIs, such as gonorrhea or chlamydia, is most prevalent among young, heterosexual men. This is particularly true for those engaging in sexual activities with multiple partners without using protection like condoms.

Urinary Tract Infections (UTIs)

UTI-induced epididymitis is more common in children, older men, and men who have sex with men. Several factors can contribute to UTIs in men, including:

• An enlarged prostate gland pressing on the bladder
• The insertion of a catheter into the penis
• Recent surgery on the groin, bladder, or prostate gland

While less common, epididymitis can also occur in children. In these cases, the bacterial infection typically spreads from the urethra or bladder. Inflammation in children may develop due to:

• Direct injury to the area
• Twisting of the epididymis
• Urine flowing back into the epididymis

Other Potential Causes

In addition to infections, several other factors can lead to epididymitis:

• Viral infections such as mumps
• Tuberculosis
• High doses of the heart medication amiodarone
• Groin injuries
• Structural problems in the urinary tract
• Behcet’s disease
• Congenital kidney and bladder issues

Recognizing the Symptoms: Key Indicators of Epididymitis

Identifying the symptoms of epididymitis is crucial for early detection and treatment. The primary symptom is pain in one or both testicles, accompanied by redness, swelling, and warmth in the affected area. If left untreated, these symptoms tend to worsen over time.

Other common symptoms include:

• Fever and chills
• A feeling of heaviness in the affected testicle
• Enlarged and sensitive testicle
• Pain in the abdomen or pelvis
• Frequent urge to urinate
• Burning sensation during urination
• Discharge from the penis
• Blood in urine
• Pain during ejaculation or sexual intercourse
• Fluid buildup around the testicle, which may feel like a lump

The specific symptoms experienced often depend on the underlying cause of epididymitis. For instance, penile discharge is more likely to be associated with an STI, while frequent urination may indicate a UTI.

Symptoms in Children

In children, the most common symptoms of epididymitis include:

• Discomfort in the lower abdomen or pelvis
• A red and tender area on the side of the scrotum
• Pain or burning during urination
• Discharge from the urethra
• Fever

Diagnostic Approaches: How Doctors Identify Epididymitis

Accurate diagnosis of epididymitis is essential for proper treatment. Doctors employ various methods to identify the condition and its underlying cause:

Physical Examination

A thorough physical examination is typically the first step. This may include a rectal exam to check for an enlarged prostate, which can be a contributing factor to epididymitis.

Laboratory Tests

Doctors often order urine and blood tests to detect signs of infection and inflammation. Specific tests for gonorrhea and chlamydia may be conducted if an STI is suspected.

Imaging Studies

Ultrasound scans are commonly used to visualize the affected area and rule out other conditions, such as testicular torsion, which can present with similar symptoms.

Medical History

A detailed medical history helps doctors identify potential risk factors and determine the most likely cause of the condition.

Treatment Options: Managing Epididymitis Effectively

The treatment approach for epididymitis depends on its cause and severity. In most cases, the condition can be effectively managed with appropriate care.

Acute Epididymitis Treatment

For acute cases, the primary treatment options include:

• Antibiotics to combat bacterial infections
• Bed rest to promote healing
• Pain relief medications such as ibuprofen
• Application of cold or warm compresses to reduce swelling and discomfort

With proper treatment, most cases of acute epididymitis resolve without long-term sexual or reproductive problems. However, the condition can recur, and some complications may arise.

Chronic Epididymitis Management

Chronic epididymitis requires a different approach, as inflammation occurs without an active infection. Treatment options may include:

• Frequent warm baths to alleviate discomfort
• Non-steroidal anti-inflammatory medications
• Muscle relaxants and nerve-altering medications
• Anesthetic or steroid injections into the scrotum
• Surgery to remove the affected epididymis in severe cases
• Stress management techniques to reduce overall tension

Potential Complications: Understanding the Risks of Epididymitis

While most cases of epididymitis resolve with proper treatment, some complications can occur:

• Abscess formation in the scrotum, which may require drainage
• Development of chronic epididymitis
• Formation of an opening on the skin of the scrotum
• Testicular infarction (death of testicular tissue due to lack of blood supply)
• Potential impact on fertility

These complications underscore the importance of prompt and appropriate treatment for epididymitis.

Prevention Strategies: Reducing the Risk of Epididymitis

While not all cases of epididymitis can be prevented, several strategies can help reduce the risk of developing this condition:

• Practicing safe sex by using condoms and limiting sexual partners
• Getting regular STI screenings if sexually active
• Maintaining good hygiene, especially in the genital area
• Staying hydrated to promote regular urination and flush out bacteria
• Seeking prompt treatment for any urinary tract infections or STIs
• Avoiding activities that may cause trauma to the groin area

By implementing these preventive measures, individuals can significantly reduce their risk of developing epididymitis and its associated complications.

Living with Epididymitis: Coping Strategies and Long-term Outlook

For those diagnosed with epididymitis, particularly chronic cases, developing effective coping strategies is crucial for maintaining quality of life. Some helpful approaches include:

• Adhering to prescribed treatment plans and follow-up appointments
• Engaging in stress-reduction techniques such as meditation or yoga
• Wearing supportive underwear to minimize discomfort
• Avoiding activities that exacerbate symptoms
• Joining support groups or seeking counseling to address emotional impacts

The long-term outlook for individuals with epididymitis is generally positive, especially with proper management and treatment. Most acute cases resolve completely within a few weeks, while chronic cases may require ongoing management. Regular check-ups and open communication with healthcare providers are essential for monitoring the condition and adjusting treatment as needed.

Is epididymitis a serious condition? While epididymitis can cause significant discomfort and potential complications if left untreated, it is generally not considered a life-threatening condition. However, prompt medical attention is crucial to prevent potential long-term issues and ensure proper treatment.

Can epididymitis affect fertility? In most cases, properly treated epididymitis does not have long-term effects on fertility. However, severe or recurrent cases may potentially impact sperm production or transport. Men concerned about their fertility should discuss this with their healthcare provider.

How long does it take for epididymitis to heal? The healing time for epididymitis varies depending on the severity and cause of the condition. Acute cases typically improve within a few days of starting antibiotics, with complete resolution often occurring within 4-6 weeks. Chronic cases may require longer-term management and treatment.

By understanding the causes, symptoms, and treatment options for epididymitis, individuals can take proactive steps to manage their health and seek appropriate care when needed. Regular communication with healthcare providers and adherence to recommended treatments are key to effectively managing this condition and minimizing its impact on daily life.

Epididymitis: Causes, symptoms, and treatment

In the back of the testicles, there is a coiled tube called the epididymis. This tube stores and carries sperm and is linked to the ejaculatory duct by another tube called the vas deferens.

Epididymitis is when this tube becomes painful, swollen, and inflamed.

There are two types of epididymitis. Acute epididymitis comes on suddenly, and pain and inflammation develop quickly. This kind of epididymitis lasts less than 6 weeks.

Chronic epididymitis develops slowly and has a duller pain. It is a long-term problem that lasts for longer than 6 weeks. Males of any age can be affected by the condition.

If the testicles also become inflamed and painful, then this is known as epididymo-orchitis.

Share on PinterestThe epididymis stores and carries sperm, and may become swollen and inflamed due to a bacterial infection.

The spread of a bacterial infection usually causes epididymitis. This infection will often start in the urethra, prostate, or bladder.

Two main types of infection cause epididymitis:

Sexually transmitted infection (STI)

Epididymitis caused by an STI, such as gonorrhea or chlamydia, is most common in young, heterosexual men; particularly those who have sex with multiple partners and do not use a condom.

Cases of epididymitis that are not caused by an STI are less common.

Urinary tract infection (UTI)

Epididymitis caused by a UTI occurs in children, older men, and men who have sex with men. The following factors often cause UTIs in men:

• enlarged prostate pressing on the bladder
• insertion of a catheter into the penis
• surgery on the groin, bladder, or prostate gland

Children

While cases of epididymitis in children are rare, they do occur. Often the bacterial infection will spread from the urethra or bladder.

Inflammation will usually develop due to one of the following:

• direct injury to the area
• twisting of the epididymis
• urine flowing back into the epididymis

Other causes

There are also some more unusual causes of epididymitis:

• mumps
• tuberculosis
• high doses of a medication called amiodarone, usually taken for heart rhythm problems
• groin injury
• structural problems in the urinary tract
• Behcet’s disease
• congenital kidney and bladder problems

Share on PinterestFever or chills are common symptoms of epididymitis.

Epididymitis will cause pain in one or both testicles. The affected area will also be red, swollen, and warm to touch. If it is left untreated, it will worsen over time.

Other symptoms include:

• fever
• chills
• heaviness in the affected testicle
• enlarged testicle
• affected testicle sensitive to touch
• pain in the abdomen or pelvis
• frequent urge to urinate
• burning sensation when urinating
• discharge from the end of the penis
• blood in urine
• pain when ejaculating or having sex
• fluid buildup around the testicle which may feel like a lump

Symptoms will usually depend on the cause of the epididymitis. For example, discharge from the penis is likely to be due to an STI, while the urge to urinate probably results from a UTI.

Symptoms of epididymitis can also be similar to those of testicular torsion, a condition that sees the testicle twist and cut off the blood supply and which requires emergency surgical treatment.

As a result, if a person experiences any of these symptoms they should see a doctor straight away.

In children, the most common symptoms are:

• discomfort in lower abdomen or pelvis
• a red and tender area on the side of the scrotum
• pain or burning when urinating
• discharge from the urethra
• fever

It can often be hard to tell the difference between epididymitis and testicular torsion, particularly in younger men.

Sometimes epididymitis and testicular torsion can occur at the same time.

Doctors may perform some other tests to find the cause. These include:

• rectal exam, where a doctor inserts a finger into the anus to check for an enlarged prostate
• urine and blood tests
• urine samples to test for gonorrhea and chlamydia
• ultrasound scans, to identify testicular torsion
• medical history

Share on PinterestPain and swelling can be reduced with ibuprofen.

In most cases, epididymitis clears up with antibiotics and bed rest, and there are no long-term sexual or reproductive problems.

However, the condition can return, and some complications can occur:

• abscess in the scrotum, which may require draining
• chronic epididymitis
• opening on the skin of the scrotum
• the death of testicular tissue due to a lack of blood, known as testicular infarction
• infertility

Chronic epididymitis

In the case of chronic epididymitis, doctors will not prescribe antibiotics as inflammation occurs without an infection.

Treatment includes:

• frequent warm baths
• anti-inflammatory medication that does not contain steroids
• medication to relax muscles and alter nerve messages
• anesthetic of steroid injections into the scrotum
• surgery to remove affected epididymis
• stress management techniques

Epididymitis: Causes, symptoms, and treatment

In the back of the testicles, there is a coiled tube called the epididymis. This tube stores and carries sperm and is linked to the ejaculatory duct by another tube called the vas deferens.

Epididymitis is when this tube becomes painful, swollen, and inflamed.

There are two types of epididymitis. Acute epididymitis comes on suddenly, and pain and inflammation develop quickly. This kind of epididymitis lasts less than 6 weeks.

Chronic epididymitis develops slowly and has a duller pain. It is a long-term problem that lasts for longer than 6 weeks. Males of any age can be affected by the condition.

If the testicles also become inflamed and painful, then this is known as epididymo-orchitis.

Share on PinterestThe epididymis stores and carries sperm, and may become swollen and inflamed due to a bacterial infection.

The spread of a bacterial infection usually causes epididymitis. This infection will often start in the urethra, prostate, or bladder.

Two main types of infection cause epididymitis:

Sexually transmitted infection (STI)

Epididymitis caused by an STI, such as gonorrhea or chlamydia, is most common in young, heterosexual men; particularly those who have sex with multiple partners and do not use a condom.

Cases of epididymitis that are not caused by an STI are less common.

Urinary tract infection (UTI)

Epididymitis caused by a UTI occurs in children, older men, and men who have sex with men. The following factors often cause UTIs in men:

• enlarged prostate pressing on the bladder
• insertion of a catheter into the penis
• surgery on the groin, bladder, or prostate gland

Children

While cases of epididymitis in children are rare, they do occur. Often the bacterial infection will spread from the urethra or bladder.

Inflammation will usually develop due to one of the following:

• direct injury to the area
• twisting of the epididymis
• urine flowing back into the epididymis

Other causes

There are also some more unusual causes of epididymitis:

• mumps
• tuberculosis
• high doses of a medication called amiodarone, usually taken for heart rhythm problems
• groin injury
• structural problems in the urinary tract
• Behcet’s disease
• congenital kidney and bladder problems

Share on PinterestFever or chills are common symptoms of epididymitis.

Epididymitis will cause pain in one or both testicles. The affected area will also be red, swollen, and warm to touch. If it is left untreated, it will worsen over time.

Other symptoms include:

• fever
• chills
• heaviness in the affected testicle
• enlarged testicle
• affected testicle sensitive to touch
• pain in the abdomen or pelvis
• frequent urge to urinate
• burning sensation when urinating
• discharge from the end of the penis
• blood in urine
• pain when ejaculating or having sex
• fluid buildup around the testicle which may feel like a lump

Symptoms will usually depend on the cause of the epididymitis. For example, discharge from the penis is likely to be due to an STI, while the urge to urinate probably results from a UTI.

Symptoms of epididymitis can also be similar to those of testicular torsion, a condition that sees the testicle twist and cut off the blood supply and which requires emergency surgical treatment.

As a result, if a person experiences any of these symptoms they should see a doctor straight away.

In children, the most common symptoms are:

• discomfort in lower abdomen or pelvis
• a red and tender area on the side of the scrotum
• pain or burning when urinating
• discharge from the urethra
• fever

It can often be hard to tell the difference between epididymitis and testicular torsion, particularly in younger men.

Sometimes epididymitis and testicular torsion can occur at the same time.

Doctors may perform some other tests to find the cause. These include:

• rectal exam, where a doctor inserts a finger into the anus to check for an enlarged prostate
• urine and blood tests
• urine samples to test for gonorrhea and chlamydia
• ultrasound scans, to identify testicular torsion
• medical history

Share on PinterestPain and swelling can be reduced with ibuprofen.

In most cases, epididymitis clears up with antibiotics and bed rest, and there are no long-term sexual or reproductive problems.

However, the condition can return, and some complications can occur:

• abscess in the scrotum, which may require draining
• chronic epididymitis
• opening on the skin of the scrotum
• the death of testicular tissue due to a lack of blood, known as testicular infarction
• infertility

Chronic epididymitis

In the case of chronic epididymitis, doctors will not prescribe antibiotics as inflammation occurs without an infection.

Treatment includes:

• frequent warm baths
• anti-inflammatory medication that does not contain steroids
• medication to relax muscles and alter nerve messages
• anesthetic of steroid injections into the scrotum
• surgery to remove affected epididymis
• stress management techniques

Pain in the urethra – General information, Causes. Tomsk

General information

Urethra (urethra) is an organ of the urinary system, due to which urine is removed from the bladder to the outside. The walls of the urethra consist of an internal mucous membrane and external – muscular and connective tissue, that is, the urethra is a tube 18-20 cm long in men and 3-4 cm in women and 6-7 mm in diameter.

The male urethra starts at the bladder, passes through the prostate and corpus spongiosum of the penis, and opens outwards at the glans. It is customary to distinguish between several departments:

• prostatic;

• membranous;

• spongy.

The prostatic section passes through the prostate gland, on the back wall of which is located the seminal protrusion. During intercourse, this tubercle becomes erect and prevents the reflux of sperm into the bladder. Considering that in men the urethra performs two functions:

It is in this section of the canal that the vas deferens and prostate ducts open.

The membranous region is the narrowest part of the canal that passes through the muscular diaphragm of the pelvis. Next, the spongy part begins (the longest – about 15 cm), which is surrounded by the cavernous body and goes to the external opening.

The female urethra is significantly shorter than the male. It starts from the bladder, goes through the bottom of the pelvis and opens on the eve of the vagina. The posterior wall of the urethra is connected to the anterior wall of the vagina. Along the canal are located periurethral glands that produce a secret, the volume of which increases with sexual arousal. This organ performs the function of not only excreting urine, but also its retention, which occurs due to the external and internal sphincters.

Pain in the urethra

Pain in the urethra may be described as dysuria or burning during urination and be constant or intermittent. Patients with inflammatory processes of the urethra feel pain in the urethra mainly during urination and during sexual arousal.

In most cases, there is a purulent discharge from the urethra. In the case when the stone has descended from the upper urinary tract and stuck in the opening of the urethra, the patient feels a sudden pain in the urethra. It manifests itself during urination, when the stone passes along with the stream of urine into the urethra.

Simultaneously with the onset of pain, the flow of urine is interrupted. Palpation of the urethra usually makes it possible to determine the location and size of the stone. In men, it most often stops in the navicular fossa. Pain in periurstral and paraurethral abscesses is localized according to their location.

Causes of pain in the urethra

Pain in the urethra in men and women is a symptom of such inflammatory diseases of the genitourinary system as: urethritis, acute and chronic prostatitis, prostate stones, tumor diseases of the genitourinary tract; cystitis; some venereal diseases.

Basically, pain in the urethra in men and women occurs with the following diseases:

Chlamydia is classified as a venereal disease. This is an infectious disease in which chlamydia damage the genitals and urinary tract of a person. The danger of chlamydia lies in the fact that long-term existence, it leads to complications, which most often force the patient to consult a doctor. So, often, a symptom that makes you see a doctor is infertility. Treatment of chlamydia must be carried out for all partners. At the end of the course, control tests are carried out. If chlamydia is not detected, then the tests are carried out again in a month (in women – before menstruation). Only after that it will be possible to talk about the effectiveness of the treatment.

Gonorrhea is a sexually transmitted infectious disease caused by gonococci of the genus Neisseria. Gonorrhea affects the genitourinary organs lined with columnar and transitional epithelium; urethra, cervix, lower third of the rectum, conjunctiva.

In the treatment of gonorrhea, antibiotics, which have a bactericidal and bacteriostatic effect on gonococci, are of primary importance. In acute fresh gonorrhea, etiotropic treatment is sufficient to obtain a therapeutic effect. Patients with complicated, torpid and chronic forms of gonorrhea are shown complex etiological and pathogenetic therapy. Treatment of gonorrhea should be carried out strictly under the supervision of a physician.

Urolithiasis

Urolithiasis is a disease manifested by the formation of stones in any part of the genitourinary system . The disease occurs in people of all ages, from children to the elderly. So with stones in the bladder, pain occurs in the lower abdomen, which can be given to the perineum, genitals.

Pain in the urethra occurs when moving and when urinating. Another manifestation of bladder stones is frequent urination. Sharp causeless urges appear when walking, shaking, physical activity. In severe cases, with very large stone sizes, patients can only urinate while lying down. Treatment of urolithiasis can be conservative, instrumental and operational.

Urethritis

Urethritis is an inflammation of the urethra, the main manifestation of which is discharge from it and pain during urination. Urethritis occurs in both men and women. Pain in the urethra may occur intermittently or continuously. Constant pain in the urethra is often a symptom of colliculitis (a type of urethritis). In acute urethritis, the pains are sharp and painful, in chronic they are less strong and are perceived as a burning sensation.

Any symptom of urethritis is a good reason to urgently consult a doctor: the infection from the urethra moves up, involving other organs in the inflammatory process.

In the worst case, untreated urethritis can eventually develop into prostatitis, and, in women, cause inflammation of the female genital organs. Treatment of urethritis is prescribed strictly individually.

Prostatitis

Prostatitis is inflammation of the prostate tissue , swelling. This is the most common urological disease in men. An important role in the development of prostatitis is played by previously transferred or currently existing infections. Clinically significant are:

To date, antibiotic therapy for chronic prostatitis remains relevant. The specialist must take into account the individual characteristics of the course of the disease, the presence of infection, the state of the immune system.

Successfully used in the treatment of prostatitis physiotherapeutic methods of treatment: ​

Other diseases

Trichomoniasis is a disease caused by Trichomonas. Their main habitat in the male body is the prostate gland and seminal vesicles, in the female – the vagina. However, when they first enter the body, Trichomonas always cause urethritis, and, as a result, pain in the urethra.

Infection occurs sexually through contact with a sick or carrier of the infection. In women trichomoniasis is manifested by inflammation of the vagina (colpitis), cervix (cervicitis) and glands that secrete the lubricant necessary for sexual intercourse. In men, the urethra (urethritis) and the prostate gland (prostatitis) most often become inflamed. Treatment must be carried out for all partners, regardless of the results of laboratory tests. Course of treatment with antibacterial drugs averages 10 days.

Cystitis is an inflammation of the bladder. Cystitis is one of the most common inflammatory diseases of the urinary tract. Mostly women suffer from cystitis. If you suspect that you have cystitis – do not try to treat it yourself, and even more so do not start the disease. Incorrectly treated or undertreated cystitis can turn into a chronic process, which then will have to be treated for a lifetime. If you have been diagnosed with symptoms of cystitis, then you should contact a urologist as soon as possible or gynecologist.

Pain in the urethra may be due to chemical, traumatic or infectious factors . Cramping and pain in the urethra during urination are not always associated with inflammation in the urethra. They can be observed with uric acid diathesis and urolithiasis (during the passage of sand and (or) stones through the urethra).

Pain in the urethra when sitting and walking is characteristic of a posterior urethral stone. This is confirmed by secondary developing urethritis. Pain at female urethra often accompanies caruncles – bluish growths that bleed easily and are painful during sexual intercourse.

Treatment

Pain in the urethra in men and women can have quite unpleasant consequences, so it is best not to self-medicate, but to consult a urologist. Mandatory components of the treatment regimen should be broad-spectrum antibiotics : amoxiclav, norfloxacin, ciprofloxacin, pefloxacin, nolicin, azithromycin, doxycycline.

An indispensable condition for effective antibacterial therapy is the isolation of the pathogen (after taking a smear from the urethral mucosa) and the determination of its sensitivity to drugs. Local treatment – sitz baths with solutions of pharmacy antiseptics (potassium permanganate) or decoctions of medicinal herbs (calendula, chamomile, knotweed).

Physiotherapeutic procedures – warming applications, electrophoresis on the area of ​​the sacrum and pubis; intravaginal introduction of tampons with medicinal ointments and solutions; installations into the urethra of uroseptic solutions – protargol, collargoal, miramistin, chlorhexidine. The doctor prescribes immunostimulants, multivitamin-mineral complexes.

A special diet becomes an obligatory component of the treatment of urethritis – salty and spicy foods, marinades and smoked meats are excluded from the diet, abundant drinking and adherence to a dairy-vegetarian diet during the acute stage (exacerbation of chronic inflammation) are indicated.

For the period of treatment it is important to reduce physical activity, exclude alcoholic beverages, smoking and hypothermia, limit sexual contacts. The criterion for the success of treatment is the normalization of the condition and laboratory parameters (bacteria smear from the urethral mucosa).

Varicocele in adolescents – Clinic Zdorovye 365 Yekaterinburg

Varicocele is usually detected as early as in adolescence . Patients usually turn to the urologist when varicose veins of the scrotum appear (many patients describe it as a “bag of earthworms”). Also, during a routine examination, the surgeon can detect a difference in the size of the testicles. In most cases, varicocele is asymptomatic, but testicular pain or heaviness in the scrotum may be disturbing. Although varicocele can be bilateral, it is most often unilateral, and in 90% occurs on the left side.

In the case of only a right-sided varicocele, it is imperative to exclude a large retroperitoneal process, such as a tumor that causes compression of the right internal spermatic vein. Also, patients with unilateral right-sided varicocele should be diagnosed for thrombosis or occlusion (blockage) of the inferior vena cava. These patients should undergo x-ray studies, such as computed tomography. The reverse arrangement of organs (a developmental anomaly in which all organs are mirrored in relation to the normal arrangement of internal organs) is another cause of right-sided varicocele.

The venous vessels of the testis have many anastomoses (communications with each other) in the scrotum and inguinal canal, which are collectively referred to as the pampiniform plexus. A varicocele results from an abnormal expansion of this venous network. Violation of the blood supply due to the expansion of the veins of the pampiniform plexus of the veins of the testicle leads to the depletion of the testicle and a violation of its internal structure.

The initial detection of the disease usually occurs during puberty. Varicocele is extremely rare in children younger than 9years. The prevalence of varicocele in adolescents aged 10-19 years is about 15%, which is similar to the incidence in adults. However, due to the fact that most cases of varicocele in children are asymptomatic, the true incidence among adolescents is likely to be higher. Varicocele is cited as one of the main causes of male factor infertility and is found in adult males with primary infertility in 35%-40% of cases.

In the presence of a varicocele, in many cases, the testicle on the same side is reduced in size compared to the testicle on the other side. Histological studies have shown that in such testicles in the seminiferous tubules, sclerosis, degenerative changes in blood vessels and changes in Leydig cells, Sertoli and spermatogonia are found (Spermatogonia are cells that produce spermatozoa. Sertoli cells provide normal nutrition for germ cells in the process of their development. Cells Leydig produce the male sex hormone testosterone).

These changes are recorded in patients as early as 12 years of age. The influence of varicocele on spermogram parameters has been studied in detail in adults. At the same time, there was a decrease in the total number of spermatozoa and their motility, an increase in the number of abnormal forms of spermatozoa. A small number of studies conducted in adolescents with varicocele have also shown changes in the composition of semen.

The reasons for changes in testicular size, sperm composition, and morphological (cellular) changes in testicular tissues are not fully understood. Researchers suggest the following mechanisms for the development of pathological processes:

• Filling the dilated veins with venous blood leads to enlargement of the scrotum and an increase in testicular temperature. This could theoretically alter DNA synthesis in testicular tissue, leading to morphological (cellular) changes in sperm and testicular tissues.
• Since the left spermatic vein does not have valves, but flows directly into the left renal vein, reflux (reverse reflux) of metabolites (waste products), kidneys and adrenal glands, can cause damage to testicular tissue. When the structure of the testis changes, the production of hormones can be disrupted, which leads to disruption of spermatogenesis.
• Blood poor in oxygen stagnates in dilated veins. Low oxygen content in the testicle leads to local hypoxia (lack of oxygen) of the tissues. This can affect both the structure of testicular tissues and their production of sperm.
• A hormonal imbalance in the testis due to any of the above mechanisms can lead to further impairment of testicular function.

These pathological processes can be stopped, after surgical treatment there is an increase in the size of the testicle, normalization of its structure, restoration of the sperm composition

Symptoms of varicocele in adolescents

The vast majority of cases of varicocele in adolescent patients are asymptomatic. The diagnosis is made on the basis of palpation (palpation) of the scrotum during a thorough medical examination in an upright position. With varicocele, dilated veins are visible on the lateral surface of the scrotum. The testicles, spermatic cord and scrotum are palpated, the size of the testicles is estimated according to the age of the teenager.

Mild varicocele is manifested by thickening of the spermatic cord. A severe varicocele, as mentioned above, is usually described by the patient himself as a “bag of earthworms.” The doctor should ask the patient to perform a Valsalva maneuver where the patient holds his breath and simultaneously pushes. At the same time, the veins of the pampiniform plexus further expand and become visible even to moderately dilated vessels.

Next, the doctor must continue the examination of the patient in the supine position. The expansion of the veins lying down should decrease. If this does not happen, then compression of the renal and seminal veins may be the cause of the varicocele. In such cases, the doctor will prescribe additional diagnostic procedures, such as computed tomography of the abdominal cavity.

Normally, a patient’s testicles should be symmetrical in volume and density. A size difference of more than 3 cm ³ is considered significant. The average testicular volume in men is 23 ± 3 cm ³ . Using the Prader testiculometer and testicular ultrasound, you can accurately measure the volume of the testicle.

Adolescent stage

Age (years)

Average dimensions of the left testicle

Average dimensions of the right testicle

l

7-10

4.76 ±2.76 cm ³

5.20 ±3.86 cm ³

II

12-14

6.40 ±3.16 cm ³

7. 08 ±3.89 cm ³

III

13-15

14.58 ±6.54 cm ³

14.77 ±6.1 cm ³

IV

14-16

19.80 ±6.17 cm ³

20.45 ±6.79 cm ³

V

16-18

28.31 ±8.52 cm ³

30.25 ±9.64 cm ³

Varicocele grades are assessed on the basis of physical examination data and classified as follows:

• Subclinical (grade 0) – slightly advanced veins are not detected during the examination, but are visible on ultrasound or phlebography.
• Mild (1 degree) – varicose veins are not permanent. It is detected only with an increase in intra-abdominal pressure, which prevents the outflow of blood from the testicles and leads to swelling of the veins (a special Valsalva test is performed when the patient holds his breath and strains at the same time).
• Medium (grade 2) – veins are detected by palpation (without a Valsalva test).
• Severe (grade 3) – dilated veins of the scrotum are visible during normal examination.

The degree of testicular atrophy directly depends on the severity of varicocele. It was noted that testicular volume was reduced in 81% of patients with grade 3 varicocele and in 34% of patients with grade 2 varicocele. In patients with grade 1 varicocele, testicular atrophy is not detected. It has also been proven that with grade 3 varicocele in the testicle on the opposite side, atrophy also develops.

Diagnosis of varicocele in adolescents

Laboratory tests. There are no specific laboratory parameters that would be useful in the evaluation of adolescents with varicocele. Some centers use the gonadotropin-releasing hormone (GnRH) stimulation test. Adolescents in Tanner stages 4 and 5 (see table above) of grade 3 varicocele usually have a response increase in LH and FSH above normal after stimulation with gonadotropin-releasing hormone, but this does not occur in all cases. Initially, the levels of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in patients with varicocele are normal.

Instrumental methods of diagnostics

• Testiculometry. To determine the indications for surgery in adolescents, it is important to accurately determine the size of the testicles. With the help of ultrasound, the volume of the testicles can be determined more accurately than using an orchidometer. On ultrasound, an image of the testicles is obtained in 3 dimensions, and the volume is calculated using the ellipse formula (volume \u003d length x width x depth x 0. 53).
• Doppler in a vertical position without a Valsalva test and with its use can be performed in cases where the doctor suspects a varicocele in a patient, but when examining dilated veins is not visible, for example, in an obese adolescent.
• CT (computed tomography) is rarely used, mainly in isolated right-sided varicocele or in the absence of reduction in the varicocele in the patient’s supine position, to rule out an obstructive cause of the disease. In such cases, as a result of compression of the inferior vena cava or renal vein by the tumor, blood cannot flow freely from the testicle. If a right-sided varicocele is detected, tumors of the retroperitoneal space and thrombosis of the inferior vena cava should be excluded.
• Phlebography is a diagnostic tool for detecting subclinical varicocele in infertile adults, but is rarely used in adolescents. Adolescents with unexplained testicular atrophy and scrotal pain may have phlebography performed when scrotal ultrasonography and Doppler Valsalva testing are insufficient.
• Spermogram. Although semen analysis is not usually performed in younger adolescents, semen analysis in older adolescents may be advisable, as deviations from the normal values ​​allow an early decision on the need for surgery. But the norms of spermograms in adolescents have not been fully studied, so you should not completely rely on this test.
• Testicular biopsy. Testicular biopsy to assess damage to testicular structure is not usually done, as there are currently no specific histological criteria to predict the reversibility of testicular tissue changes in adolescents.

Medical treatment of varicocele in adolescents

There is currently no effective non-surgical treatment for varicocele. But annual examinations and assessment of the size of the testicle help to track the dynamics of the developmental process of a teenager and identify pathology in time.

Indications for surgical treatment in adolescents

To date, there are no strict diagnostic criteria that determine the indications for surgical intervention in adolescents. Each case is analyzed individually and discussed with the patient, parents and doctor in terms of the risk of surgery and the possibility of the impact of varicocele on childbearing function. Testicular growth retardation on the side of the varicose veins is the most common indication for surgery in adolescents. It is taken into account that the presence of a varicocele in a teenager and slow testicular growth later in adulthood can result in a violation of fertility (the ability to reproduce offspring).

The general principles used by pediatric urologists to determine indications for surgery typically include the presence of one or more of the following criteria:

• Reduction in testicular size on the side of the varicose veins. The generally accepted indication for surgery is a decrease in testicular volume by 20% compared to age norms
• Bilateral varicocele
• Varicocele with pain syndrome
• Sperm composition disorders (sperm concentration <20 million/ml, degree of motile spermatozoa <50% and number of normal-shaped spermatozoa <30%)

Other factors to consider when determining indications for surgery include: the presence of a grade 2 or 3 varicocele a significant difference in the consistency of the testicles, (softer on the side of the varicose veins).

If it is decided to postpone the operation, the patient should be monitored every 6-12 months to detect any consequences of the varicocele as early as possible.

Surgical treatment of varicocele in adolescents

Surgical ligation of the spermatic vein is used to treat varicocele. There are several methods that differ mainly in the ways of access to the vessels. These include retroperitoneal access (Palomo operation), inguinal (Ivanissevich operation) and subgroin accesses.

The purpose of surgery for varicocele is to identify and ligate dilated veins of the pampiniform plexus, which drains blood from the testicle, epididymis and vas deferens. The testicular artery, as a rule, is isolated from the surrounding tissues under the control of a microscope during inguinal access. With retroperitoneal access, the internal spermatic artery, as a rule, also crosses simultaneously with the veins. But ligation of the internal seminal artery in the retroperitoneal space usually does not cause testicular atrophy due to well-developed collateral ( bypass) blood circulation in the testicle.

• Interventional phlebography (percutaneous embolization) is also used for occlusion (blockage) of testicular veins. The course of the vessels of the testicle is determined by the pictures during phlebography. Then the femoral vein is punctured, a thin tube is inserted into it – a catheter to the level of the dilated testicular veins. Through this catheter, special balls, spirals or sclerosing agents are passed above the site of the varicocele, which block the lumen of the vessel. As a result of this manipulation, the dilated testicular veins collapse.
• Microsurgical subinguinal approach. An incision is made above the external inguinal ring, and an operating microscope is used to isolate the arteries and lymphatic vessels of the testis from the surrounding tissues.
• Laparoscopic testicular vein ligation. During this operation, special clips (small metal clips that remain in the patient’s body) are placed on the dilated veins. It is performed using a special laparoscope device, through three punctures in the patient’s skin. With this operation, the testicular artery is clearly visible during the operation and does not intersect along with the vein, as is the case with conventional surgical intervention. But as a result of this separation, the duration of the operation is lengthened, and the risk of recurrence (recurrence) of varicocele increases.

A varicocele is located in the upper part of the scrotum, above the testicle. The spermatic cord passes up into the groin area above the scrotum. The spermatic cord consists of the spermatic vein, vas deferens, and testicular arteries, including the internal spermatic artery (it may have several branches), the external spermatic artery. During surgical treatment, the spermatic vein is ligated. This can be done at various levels above the varicocele. Operations on the pampiniform plexus veins themselves are generally avoided due to the many anastomoses (junctions) of the branches of the venous system and the high risk of bleeding. The operation can be performed at the level of the upper scrotum, groin, or retroperitoneum.

There are no particular contraindications for ligation of a varicocele in a healthy patient, but different surgical approaches have different advantages and disadvantages. Therefore, the choice of treatment method should be approached taking into account all the features of the patient’s clinical situation. For example, as a result of a previous surgical intervention in a patient, the course of the vessels in this area may be changed.

If the patient has already had groin surgery, the second surgery will be more difficult and potentially dangerous to the testicular structures. As a result of the previous surgical treatment, one of the branches of the testicular artery could have been cut, which should also be taken into account. The testicle has a rich circulatory system and the intersection of one of the branches does not lead to its atrophy, since all branches anastomose (connect) to each other, but with a second operation it is better to choose the most sparing method.

Therefore, if a teenager develops a varicocele after previous surgery for an inguinal hernia, microsurgical varicelectomy is the best treatment. It allows you to isolate from the surrounding tissues and save the testicular artery. A retroperitoneal approach with ligation of the testicular artery is contraindicated in such cases, since during the first operation for a hernia, there is a possibility that the surgeon has accidentally damaged one of the branches of the testicular artery. In this case, ligation of the internal seminal artery can lead to testicular atrophy due to a violation of its blood supply.

After the operation

After the operation, the patient can go home from the hospital 3-4 days after the operation. There may be discomfort, slight soreness, swelling and slight bleeding in the area of ​​the postoperative wound and scrotum. You can take painkillers. Applying an ice pack to the wound area will help reduce swelling and pain. The wound should be kept dry and clean. The patient can return to school within 7-10 days.

The doctor will schedule visits after surgery to monitor the condition of the wound and then remove the sutures. In the first year after the operation, it is necessary to see a doctor several times in order to measure the density and volume of the testicles and scrotum, and in a timely manner to identify possible testicular atrophy or dropsy, recurrence of varicocele.

Complications

Complications of varicocelectomy, regardless of the method used, include: hydrocele formation, recurrent varicocele and, rarely, testicular atrophy. Hydrocele is the most common complication and most likely results from damage to the lymphatic vessels. The rate of complications varies depending on the surgical method used. Microscopic surgeries had the lowest complication rates (<1%). With inguinal, retroperitoneal laparoscopic ligation, the incidence of postoperative hydrocele is less than 10%; embolization very rarely causes hydrocele formation.

Less common complications include: testicular atrophy, hematoma formation, damage to the vas deferens, chronic testicular pain. With percutaneous embolization, the following are possible: an allergic reaction to a contrast agent for radiography, bleeding from damaged vessels, thrombophlebitis (inflammation of a vein), migration of the spiral and balls from the testicular vein to other veins of the body.

Result and prognosis

The frequency of recurrence (re-development) of varicocele differs depending on the surgical technique used. In microsurgical operations, relapses occur in less than 5% of cases, while in inguinal, retroperitoneal and laparoscopic approaches, this level reaches 13-16%. Embolization has 80-90% success rate and a recurrence rate of about 10-20%.

After surgery for varicocele, you should expect improvement in sperm parameters and an increase in testicular volume. However, it is important to remember that in adolescents and without surgical treatment, the testicle also gradually increases in size. A long period of observation of the adolescent before surgery is warranted even in those patients in whom there is a significant difference in testicular size (eg, > 20%).

In addition to testicular enlargement, other studies have shown that varicocelectomy not only improves sperm count and motility, but also reduces specific functional defects in sperm.

A meta-analysis of 22 studies involving 2989 patients with varicocele showed that 71% of patients had an improvement in sperm parameters in the postoperative period, and 37% of men conceived a child. However, there is still a lot of controversy around this topic. In a large controlled study, no significant difference in pregnancy rates (25.2% in the infertility operated group compared to 27.1% in the non-operated group) was noted during 1 year of follow-up. However, the concentration of sperm in patients of the first group increased significantly, while no significant changes in the composition of sperm in untreated patients occurred.