АНАТОМИЯ СОСУДОВ МОШОНКИ И ИХ ПАТОЛОГИЧЕСКИЕ ИЗМЕНЕНИЯ КАК ОСНОВА КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ ВАРИКОЦЕЛЕ

Abstract

Varicocele is found in 8–40% of young men between the ages of 15 and 40. In 25.4% of cases, it is combined with a violation of rep- roductive function and in 40% of cases it causes pain syndrome in the scrotum. The etiology and pathogenesis of the disease are associated with various disorders in venous hemodynamics of the upstream vascular network. The peculiarity of venous blood outflow from the organs of the scrotum is the presence of a developed network of anastomoses and collaterals at the level of the scrotum, the inguinal region and the retroperitoneal space. The causes of varicocele are divided into three groups: primary, secondary hypertensive and secondary symptomatic. Primary causes include congenital disorders of the testicular vein vascular wall and its valve apparatus, which are detected in about 40–60% of cases. Secondary or hypertensive causes include upper- and lower- level arteriovenous conflicts, which occur in 40–50% of cases. There is also a group of secondary symptomatic causes that are related not to vascular pathology, but to the compression of the testicular vein from the outside. The basis of pathophysiological and pathomorphological changes in the scrotal veins and testicular tissues is the reflux of venous blood from the higher departments of the vascular network. Three types of varicocele are identified by the reflux type. The first type is renotesticular, occurring in 74.5–80.6% of cases. The second type is ileotes- ticular, observed in 7.2–14.6% of cases. The third type is mixed. It is a combi- nation of the first and second types and occurs in 4.8–18.1% of cases. The type of hemodynamic reflux determines the clinical symptoms developing in patients with varicocele. Diagnostic activities include: physical examination with Valsalva and Ivanissevich, laboratory examination of blood and urine, ultrasound examination of scrotum organs, Doppler mapping of renal vessels and testicular vein, retrograde or antegrade phlebography. The most sensitive to diagnosis of varicocele is Doppler-graphical mapping of the renal vessels and the testicular vein. X-ray endovascular methods are mandatory for diagnosis of varicocele relapses and have a high sensitivity. Physical research methods play an important role. Thus, diagnosis of the disease is aimed at identifying the cause and type of pathological reflux and eliminating secondary symptomatic varicocele. Clarification of the type of venous hemodynamics violation is of great practical importance for determining the type of surgical treatment.