Varicocele

Classification N. Lopatkina (1978) , mainly used at present) - is more simplified and takes into account the severity of varicocele and changes in trophic testis:

• I degree - varicose veins are detected only by palpation when straining the patient in an upright position of the body;
• II degree - expanded veins are visually determined, the size and consistency of the testicle is not changed;
• III degree - pronounced dilation of the veins of the plexiform plexus, a decrease in the testicle and a change in its consistency ^[4] .

Isakov Y. F.'s classification (1977) - has become firmly established in pediatric surgical practice; In addition to the severity of varicocele, it assesses its effect on trophic testis.

• I degree - varicocele imperceptibly visually, but clearly defined by palpation, especially with tension;
• II degree - varicose nodes are clearly determined visually, but the size and consistency of the testicle are not changed;
• III degree - against the background of severe varicose veins there is a decrease and testability of the testicle ^[4] .

BL Coolsaet Classification (1980) - Contains hemodynamic criteria for spermatic cord vein dilation.

• Type 1 - reflux from the renal vein to the testicular;
• Type 2 - reflux from the iliac vein into the testicular;
• Type 3 - a combination of the first two types ^[4] .

Classification L. Dubin and R. Amelar (1978) - varicocele is divided into three degrees:

• I degree - varicose veins are determined only during the Valsalva test ;
• II degree - veins are not visible during an external examination of the scrotum, but are palpated without a stress test;
• III degree - varicose veins are visible during examination.

WHO classification :

• I degree : dilated veins in the scrotum are not visible and are not palpable, with the exception of their expansion during the Valsalva test;
• II degree : dilated veins in the scrotum are not visible, but are easily palpated;
• III degree : dilated vein plexuses protrude through the skin of the scrotum and are easily palpated ^[4] .

Varicocele may or may not cause subjective sensations in patients. More often they are expressed as various pain, testicular atrophy can occur ^[3] .

Long stagnation of venous blood leads to ischemia, the development of sclerotic changes in the testicle and impaired differentiation of spermatogenic epithelium, the hematotesticular barrier is damaged. Autoimmune aggression develops, which in the future can be manifested by a decrease in general spermatogenesis and the development of infertility ^[5] .

The diagnosis is not difficult. The expansion of the veins is usually determined on the basis of the clinical picture, ultrasound or dopplerography (lying and standing), palpation of the cluster (pinnacle) plexus, Valsalva test. They also conduct a study of the level of sex hormones in the blood. Before proceeding with treatment, the doctor, based on the spermogram, determines the severity of the disease.

Operation Ivanissevich

During the operation of Ivanissevich, ligation and intersection of varicose veins (or veins) of the spermatic cord is performed. Then the reverse outflow of venous blood down the testicular vein stops. The operation is performed under general anesthesia. The operation is as follows. An approximately 5 cm incision is made in the iliac region (usually on the left) just above and parallel to the inguinal canal. The skin, subcutaneous tissue and fascia are dissected in layers. Next, the aponeurosis is cut - the wall of the inguinal canal. In the inguinal canal in men, the spermatic cord passes, among the elements of which are the veins of the vaginal plexus. These veins are ligated and intersected. Further, all tissues are sutured in layers.

Microsurgery Marmara

The method of operation is similar to Ivanissevich’s operation, but it is less invasive, as the length of the incision is only 2 cm and therefore much less tissue is injured. The terms of rehabilitation and the number of complications are significantly less compared to the method described above. The number of relapses is only 2-5%. The incision is made in the inguinal region. The spermatic cord is pulled out, and each enlarged wreath is carefully separated and nipped. Self-absorbable sutures are applied to the skin.

The possibility of conscription in the army with a diagnosis of varicocele is determined based on the degree of the disease and the presence of functional disorders. The category of fitness for military service is approved on the basis of article 45 of the Schedule of Diseases (Appendix to the Regulation on Military Medical Examination) ^[6] . In accordance with the document, conscripts with a single manifestation of a varicocele of the II degree are recognized as fit for military service with the category "B-3".

Citizens having:

• recurrent expansion of the veins of the spermatic cord of the II degree (the fitness category "B" is set when the young man refuses treatment);
• varicose veins of the spermatic cord III degree.

The category of fitness for military service is approved based on the results of a medical examination and confirmation of the diagnosis with the help of an additional examination.

• Lopatkin N.A., Morozov A.V. and Zhitnikova L.N. Stenosis of the renal vein, M., 1984.
• Urology, ed. N.A. Lopatkina, p. 438, M., 1982.
• Small medical encyclopedia. - M.: Medical Encyclopedia. 1991–96
• First aid. - M .: Big Russian Encyclopedia. 1994
• Encyclopedic dictionary of medical terms. In 3 volumes / Editor-in-Chief B.V. Petrovsky . - Moscow: Soviet Encyclopedia , 1982 . - 1424 s. - 100,000 copies.
• Grebenshchikov G.S., Extension of the veins of the spermatic cord. Seminal cyst, in the book: Multi-volume guide to surgery, ed. B.V. Petrovsky, T. 9, M., 1959.

• Varicocele: treatment, operation
• Microsurgical subingual varicocelectomy by Marmar and Goldstein
• A detailed description of the disease and methods for its treatment
• Article about Varicocele in the Medical Encyclopedia