Varicocele in children
What is it?
This is an enlargement of the testicular veins.
There are three degrees of varicocele: the first is the mildest and the third is the most severe.
The testicular veins are responsible for carrying blood from the testicle to the larger veins in the abdomen. The veins are fitted with valves so that the blood does not flow back down under the force of gravity.
The scrotum is the “skin sac” that holds the testicle.
Causes and risk factors
It is rare in children under 10 years of age, and in late adolescence it appears in 15 out of 100 children.
There is still no agreement on the exact causes. The main hypotheses are:
- complete absence of valves in the testicular vein;
- defects in the function of the testicular vein valves;
- presence of an obstruction at the level of the testicular vein, which prevents the normal outflow of blood;
- presence of normally closed collateral veins around the testicle, which cause a local increase in blood flow.
Which are the symptoms?
It can manifest as a feeling of discomfort or heaviness in the scrotum due to the presence of dilated and swollen veins. When a person stands or tenses, these veins take on the appearance of a “bag of worms”.
In other cases, varicocele is completely asymptomatic and is suspected in adulthood if there are problems with infertility.
How is it diagnosed?
- specialist examination by a pediatric urologist, who assesses the possible presence of varicocele;
- ultrasound of the seminal veins to determine the exact degree of varicocele. This is a special form of ultrasound, which allows us to determine the true degree of blood reflux in the testicles;
- spermiogram: sperm analysis to assess whether varicocele has damaged sperm production and function. In fact, when venous blood stagnates in the testicle, causing testicular veins to dilate and subsequent testicular fever, sperm production can be impaired.
This examination should be performed from the age of 16-17.
How is it treated?
Degree I or II varicocele does not require corrective surgery if it does not cause scrotal discomfort or changes in the spermiogram.
Degree III varicocele requires corrective surgery to avoid possible future infertility problems. This involves exposing the testicular blood vessels and closing all dilated veins visible at the time of surgery.
A few hours after surgery, the boy is in good general condition and can be discharged.
In 30% of cases, varicocele may recur. For this reason, all patients are advised to repeat ultrasound of the seminal veins 6 months after surgery.
If the results of the examination are negative, the operation was successful. If degree III varicocele is still present, the operation should be repeated.
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