Varicocele is a hidden health problem that requires special attention. Description of the disease varicose veins of the spermatic cord

Varicocele is a change in the veins in the area of the spermatic cord, which is formed as a result of exposure to varicose veins and proceeds in combination with a violation of the outflow of venous blood from the testicle. Varicocele, the symptoms of which are manifested in the form of bursting and pulling pain, heaviness and discomfort localized in the scrotum, as well as visible venous expansion, often occurs due to inflammation and rupture to which varicose vessels are exposed, which is accompanied by hemorrhage in the scrotum.

Against the background of a progressive form of the disease, the affected testicle decreases in size, spermatogenesis is impaired, and early male menopause and infertility begin to develop.

general description

Regarding the disease under consideration, the World Health Organization has its own data, on the basis of which it follows that the incidence of varicocele among men is observed in about 17% of cases. Significant fluctuations in the incidence rate can be observed depending on the territorial location, as well as on the age of men. For example, in about 19.3% of cases, varicocele is present in adolescents, while military age indicates the presence of this disease in young men already in 5-7%.

Quite often, the course of the disease is characterized by the absence of symptoms, which is why, accordingly, men are in no hurry to provide them with appropriate medical care. An ultrasound scan determines the presence of signs of the disease in question in 35% of cases in those men who have reached puberty. In this case, the vast majority of cases indicate a left-sided form of varicocele, due to the anatomical differences that the venous systems have on the right and left sides. The development of the right-sided form of varicocele is relevant in 3-8% of cases, bilateral - in the range from 2 to 12%.

Classification of varicocele

In accordance with the above features of the disease, its corresponding classification is distinguished:

depending on the affected side:

varicocele left-sided;
right-sided varicocele;
bilateral varicocele.

depending on the characteristics of the etiology:

primary varicocele;
symptomatic varicocele;
functional varicocele (often defined as secondary varicocele).

depending on the characteristics of venous reflux:

in combination with renotesticular reflux;
in combination with ielotesticular reflux;
in combination with a mixed form of reflux.

depending on the degree (I, II, III);
depending on the combination of the disease in the renal vein with hypertension:

in combination with the syndrome of hypertension of the renal vein;
without the syndrome of hypertension of the renal vein.

depending on the definability of the disease through the use of physical methods:

subclinical;
clinical.

In accordance with the stages of expansion of the veins in the pampiniform plexus, in combination with the changes inherent in the trophism of the testicle, the following stages of the disease are distinguished:

I stage - manifestations of varicose veins are noted only by palpation, which is done by straining the patient in assuming a vertical position of the body;
II stage - dilated veins are determined visually, there are no changes in the consistency and size of the testicles;
III stage - dilatation in the pampiniform plexus of muscles has a pronounced character, the testicle decreases in size, and its consistency is also subject to changes.

In rare cases, there is a possibility of transition from one stage to another.

Causes of varicocele

The development of the disease we are considering occurs as a result of the fact that the valves in the veins that normally prevent the flow of blood in the opposite direction “fail” or function, but not well enough for proper results. As a result, there is an increase in pressure in the veins (for example, when the body takes a vertical position or as a result of physical stress), the pressure is transferred in the opposite direction, thereby provoking a gradual expansion in the volume of the venous vessel. Accordingly, the course of the pathological process in this form also leads to the expansion of the veins surrounding the spermatic cord.

As another cause of varicocele, there are also features of the anatomical relationships that form between the superior mesenteric artery and the renal vein, in which the aorto-mesenteric "tweezers" are formed.

Over time, exposure to increased pressure leads to an increase in the size of the veins, to their expansion and stretching. Based on the strength that the walls of the veins have in each person individually, and also based on the magnitude of the impact of venous pressure, stretching can reach various degrees.

The venous network surrounding the testicle becomes larger and larger in size, while the pronounced manifestations of the disease in some cases lead to the fact that the testicle becomes, as if immersed in a sponge consisting of venous vessels. Such a kind of "cushion" of the vessels surrounding the testicle leads to the loss of the thermoregulatory function of the scrotum, as a result of which the testicle does not cool. Thus, the reduced temperature required for the production of spermatozoa is absent, as a result of which the suppression of normal spermatogenesis is determined. Considering all the above features of the course of the disease, it can be noted that varicocele, according to experts, is one of the main factors provoking infertility in men.

Among the factors provoking, thus, there are:

An increase in testicular temperature to body temperature (in a normal state, the testicles are characterized by a lower temperature than body temperature, which determines, thereby, normal indicators for the course of spermatogenesis);
Testicular hypoxia (that is, its oxygen starvation, ischemia);
Throwing in the opposite direction from the kidneys and adrenal glands of biologically active components;
The accumulation of free radicals in the tissues of the testicle, which act as the strongest cellular poisons and, accordingly, damage it.

In addition to the listed influencing factors, varicocele can also appear as a result of congenital weakness, which characterizes the vascular wall as a whole, while the congenital form of the disease manifests itself mainly for this reason. It is noteworthy that almost always one of the patient's relatives is faced with varicose veins of the extremities, with heart valve defects, and other types of manifestations, indicating a deficiency inherent in the connective tissue. Often these diseases are associated with each other.

Varicocele: symptoms

As for the symptoms characteristic of varicocele, it is determined based on the degree of expansion that the veins have undergone. Stage I is characterized by the absence of any symptoms, the definition of varicose veins is made randomly during a physical examination.

As for the features of stage II, it is characterized by the presence of complaints from patients about pain localized in the scrotum, while the severity of their manifestations can vary significantly. In some cases, discomfort during walking is noted, and sometimes sharp pains may occur, and their nature makes them more similar to neuralgic pains.

There may be increased sweating, a burning sensation may occur in the scrotum. Often, patients diagnosed with varicocele experience sexual dysfunction. Physical examination reveals dilated veins that reach the lower pole, descending from the testicle below. In the affected area, the testicle descends, which leads to asymmetry of the affected half of the scrotum and to its sagging.

Stage III disease is characterized by a loss of association between exercise and pain. In this case, the pain becomes a constant phenomenon for the patient, and this manifestation does not disappear even during sleep. External examination determines the presence of multiple clusters of veins. In addition, the actual phenomenon is an increase in the size of the scrotum, the severity of its characteristic asymmetry in the disease.

Diagnosis of varicocele

Diagnosis of varicocele often occurs only on the basis of examination in combination with palpation of the pampiniform plexus (which has the appearance corresponding to the name) when the patient takes a standing position. Palpation at a more distinct level is carried out using the Valsalva test (that is, a test with straining, which implies an increase in pressure through the abdominal cavity, resulting in increased blood filling of the testicular veins).

With a significant increase in veins and there is no doubt about the diagnosis, there is no need for additional examinations.

With a slight degree of severity of the disease in question, it is required, in this case, to conduct either its Dopplerography. These examination methods are necessarily carried out both in the prone position and in the standing position, otherwise there is simply no point in it.

In addition to the above, the diagnosis of varicocele also requires a spermogram, and it is done at least twice, with an interval between procedures of 4-12 weeks. Sexual abstinence for spermogram is necessary for a period of 2-7 days.

Varicocele: treatment

Similarly, in which the localization of the pathology is concentrated in the legs, with a varicocele, the only effective way is an operation that can be performed in any of the existing forms.

Given the fact that the disease itself is not dangerous, and, as a rule, the symptoms during its course do not bother the patient, the expedient solution is to eliminate the need for surgical intervention when a varicocele is detected in an adult male.

An operation becomes mandatory in the following cases:

in the presence of severe pain in the testicles;
with infertility on the male side, which arose against the background of a decrease in mobility, quality and quantity of spermatozoa;
with an aesthetic defect formed against the background of the disease in the scrotum;
there is a stop in the growth of the testicle affected by the disease, which is particularly important during the puberty of the patient.

In general, it can be noted that the issue of the close connection between varicocele and infertility is quite controversial today, as, in fact, the need for surgical intervention is disputed.

A number of specialists in this regard are of the opinion that, as a preventive measure for subsequent infertility, surgical intervention in case of morbidity in children / adolescents is necessary regardless of the situation and stage of development of the disease, because blood buildup in the testicles leads to irreversible damage to the spermatogenic epithelium, which in according to this feature, under no conditions and treatment is not restored, thereby causing certain problems in the reproductive sphere.

Meanwhile, there are statements regarding the fact that varicocele is not the cause of infertility, moreover, surgical intervention in this disease is required only when a pronounced pain syndrome appears and when the testicle is underdeveloped on the side of the lesion, that is, with specific indications for surgery

A more detailed consideration of the disease in the context of possible infertility, we can highlight an interesting point. In particular, the issue of changes in spermatogenesis, which was in a depressed state before surgery, is being considered.

In this regard, a study was once conducted that lasted about 2 years, when considering 986 cases of the disease, accompanied by problems with fertility. We analyzed the results after the operation in the indicated number of patients with a diagnosis of varicocele. As it turned out, after it, about 70% of the quality characteristics of sperm were improved, while in 53% of cases, the wives of the test men became pregnant. It is also known that men with varicocele who refuse surgery become fathers only in 10-15% of cases.

As for the surgical methods of therapy used today, they include open surgery and surgery with mini-access, endoscopic surgery, as well as microsurgical revascularization of the testicle.

When examined by a specialist, the main thing is to determine the causes that provoked varicocele, because in some cases the appearance of the disease is caused by a kidney tumor. In the presence of symptoms characteristic of varicocele, it is necessary to consult a urologist and phlebologist.

Varicocele is an enlargement of the veins of the spermatic cord. Occurs during the period and the greatest sexual potency, i.e., during the period of the greatest rush of blood to the genitals. It is localized in 95% of cases on the left, where the conditions for outflow of blood from the scrotum are worse than on the right. This is explained by the peculiarities of the internal spermatic, which flows into the inferior vena cava on the right at an acute angle, and on the left into the renal vein at a right angle. Prolonged standing, prolonged sexual arousal, weight lifting, etc. contribute to the occurrence of varicocele. The diagnosis is established by examining the patient in a standing position. The scrotum on the side of the lesion sags; along the cord, convoluted, dilated, easily compressible veins are palpated. In the position of the patient lying down, the outflow of blood is facilitated and the varicocele disappears. Rarely, a varicocele is a symptom of a retroperitoneal tumor that is compressing a vein. In this case, in the position of the patient lying down, the varicocele does not disappear.

Patients are concerned about pain in the scrotum or, especially in the evening.

Quite often with the age the disease is spontaneously compensated. In case of progression, testicles may occur. Maybe .

Dilation of the veins of the spermatic cord (varicocele)

Varicocele means not only expansion, but also elongation and excessive tortuosity of 4-5 venous trunks that form the plexus pampiniformis and are part of the spermatic cord. After passing through the inguinal canal, the veins merge into a common trunk v. spermaticae internae.

The expansion of the veins of the spermatic cord is characteristic mainly of people aged 17-30 years and is quite common; Thus, among conscripts, varicocele occurs in 1-2% of cases. After 40 years, varicocele is rare.

Frequent flushes of blood to the genitals during the period of the most intense sexual function play a known role in the pathogenesis of varicocele. However, the main reason is the weakness of the coronal walls, the low position of the scrotum, the narrow lumen of the veins, and the small number of venous valves.

In 90% of cases, varicocele occurs on the left. The reason is the less favorable conditions of the venous outflow on the left than on the right: 1) the left spermatic vein flows into the renal vein at a right angle, and the right one into the inferior vena cava at an acute angle; 2) left v. spermatica passes through a narrow gap between the aorta and a. mesenterica superior; 3) left to v. spermatica exerts pressure on the sigmoid colon, especially in constipation.

For the idiopathic form of varicocele, it is characteristic that it is observed only with a vertical position of the body, with long walking. In the supine position, the varicocele disappears or sharply decreases. A varicocele that does not disappear when the patient is in a horizontal position is suspicious for germination or compression of the renal vein by a malignant tumor originating from the kidney.

With an idiopathic varicocele, the corresponding half of the scrotum hangs down, its skin is stretched, flabby. On palpation, a tangle of soft, dilated, highly tortuous veins located along the spermatic cord is determined.

Often varicocele is asymptomatic. Sometimes patients complain of pulling pains, a burning sensation in the testicle or along the spermatic cord during walking, standing and physical exertion.

Treatment of varicocele is conservative and symptomatic; it must be assumed that the disease mostly disappears by the age of 40, and surgical methods of treatment cannot eliminate its causes. A well-fitted suspensorium, cold rubbing of the scrotum, elimination of constipation relieve pain and a feeling of heaviness in the scrotum. Patients are advised to avoid prolonged walking and standing.

Only in rare cases can one resort to one of the many surgical aids offered for the treatment of varicocele. The main goals of these operations are as follows: 1) creating more favorable conditions for venous outflow from the testicle by moving it upward; 2) creation of a supporting connective tissue or muscle case around the dilated veins. For these purposes, resection of the lower part of the corresponding half of the scrotum, fixation of the testicle to the inguinal ring or pubic bone, excision of varicose veins, wrapping the spermatic cord with a flap from the shells of the testicle or cremaster are used. These operations give a high percentage of relapses, cause complications in the form of thrombosis, suppuration, and sometimes testicular atrophy due to damage to a. spermaticae internae or testicular nerves.

A disease like varicose veins of the spermatic cord(or varicocele) is most often observed in men who have reached the age of twenty to thirty years. The disease is localized, as a rule, on the left testicle, since the testicular vein in this place connects to the renal vein, and also because the left testicle is located somewhat lower. Secondary varicose veins of the spermatic cord are sometimes the result of deposits on the renal vein (stenosis) due to a kidney tumor. In the case of bilateral vein damage, the cause may be the malfunction of the valves of the testicular vein.

Symptoms of varicose veins of the spermatic cord

Symptoms of varicose veins of the spermatic cord- this is pain in the scrotum, in the testicle, a feeling of heaviness in the groin, pain in the spermatic cord, especially strong during physical exertion or long standing in one place. The course of the disease tends to progress in the absence of a normal sexual life, with its normalization, the symptoms become less acute. The occurrence of varicocele in old age is possible against the background of other diseases.

Diagnosis of varicose veins of the spermatic cord

Diagnosis of varicose veins of the spermatic cord is possible by palpation of the scrotum. With this procedure, the so-called "ball of worms" is clearly defined - curled and swollen veins of the spermatic cord. Sometimes a small hydrocele (watery tumor) may appear at the site of the lesion.

Given the signs of varicose veins of the spermatic cord, doctors divide the disease into stages:

The first stage: there are no subjective sensations, the veins are dilated only within the spermatic cord.

The second stage: the expansion of the veins has reached the lower part of the testicle, pain and heaviness in the testicle, the spermatic cord is noticeably thickened.

Third stage: the veins are greatly dilated at the bottom of the scrotum, the testicle is atrophied; severe pain in the testicle, lower back, perineum.

Treatment of varicose veins of the spermatic cord is carried out depending on the stage of the disease. If the pain syndrome is pronounced, surgical intervention according to Dr. Ivanisevin is likely: an incision is made along the inguinal canal, the testicular vein is isolated and ligated. Conservative methods include wearing tight shorts, a suspensory (a special bag to support the scrotum), and normalizing sexual life. The prognosis for the disease is usually favorable.

Diagnosis of varicose veins of the spermatic cord possible by palpation of the scrotum. With this procedure, the so-called "ball of worms" is clearly defined - curled and swollen veins of the spermatic cord. Sometimes a small hydrocele (watery tumor) may appear at the site of the lesion.

Given the signs of varicose veins of the spermatic cord, doctors divide the disease into stages:

The first stage: there are no subjective sensations, the veins are dilated only within the spermatic cord.

The second stage: the expansion of the veins has reached the lower part of the testicle, pain and heaviness in the testicle, the spermatic cord is noticeably thickened.

Third stage: the veins are greatly dilated at the bottom of the scrotum, the testicle is atrophied; severe pain in the testicle, lower back, perineum.

Treatment of varicose veins of the spermatic cord

Treatment of varicose veins of the spermatic cord carried out depending on the stage of the disease. If the pain syndrome is pronounced, surgical intervention according to Dr. Ivanisevin is likely: an incision is made along the inguinal canal, the testicular vein is isolated and ligated. Conservative methods include wearing tight shorts, a suspensory (a special bag to support the scrotum), and normalizing sexual life. The prognosis for the disease is usually favorable.

Testicular varicocele is a special type of disease that occurs only in men. Signs of varicocele are characterized by an increased size of the veins in the groin and testicles. It occurs in 15% of men under certain circumstances. At first glance, a not so dangerous disease can cause sexual dysfunction in men, so it’s worth understanding its nature and treatment options, as well as learning the symptoms and consequences in order to know what needs to be done in such cases.

Diagnostics and defect detection

Varicocele in men occurs due to many factors. It is usually found when the disease progresses, and this is already stage 2-3. In this case, there may be a feeling of heaviness and pain in the groin area, as well as partial swelling of the veins. Before the start of the second stage, the pathology does not manifest itself in any way, so it is very difficult to diagnose testicular varicose veins in men in advance. In the early stages, only a doctor will notice signs of varicose veins during an examination. Changes can be felt to the touch - a partial increase in blood vessels and veins in the groin and testicles.
In most cases, a lesion of the left testicle is diagnosed, in more rare cases - both, the pathology of the right testicle is the least common.
It is extremely rare to independently identify varicose veins of the spermatic cord. If you do not seek medical help in time, varicocele goes from a harmless disease to a painful threat of infertility. How does this disease occur?

Symptoms and causes

Symptoms of varicocele - swelling of the veins in the first stage, pain and discomfort in the groin area, severe pain during sex in the second and third. At the same time, there are factors that cause the disease, and can also accelerate its course:

Click on the picture to enlarge

testicular vein defect;
kidney disease - renal vein thrombosis or cancer;
congenital features;
diseases of the intestinal tract - constipation or diarrhea;
excessive physical activity.

With defects and congenital features, varicocele in men can be observed even at an early age, during puberty. During this period, it is easiest to identify it, since frequent examinations are carried out by doctors.
Kidney disease causes problems not only with the urinary system, but also with the reproductive system. The worst thing in this case is a cancerous tumor, in which there is a possibility of metastases from the kidneys to the inguinal region.

Problems with the intestinal tract are no joke. In addition to discomfort due to one disease, another, no less serious, may arise. With prolonged exertion, the intestines contract intensively, affecting the nearest organs and the circulatory system. If such loads are prolonged and regular, this can cause deformation of the walls of the veins.
Last on the list, exercise is the most common cause of testicular varicose veins in adult men. The reason is the same as with the intestines, only this time the abdominal muscles are to blame. Excessive muscle tissue pressure has an incredibly detrimental effect on the circulatory system in the groin area. Therefore, this disease is often found in weightlifters.

Treatment Methods

After the onset of symptoms, you should immediately consult a doctor for advice. If the diagnosis is confirmed by ultrasound and thermal analysis, there are several solutions. With the help of surgical intervention, the pathology is eliminated. In most cases, veins are removed for treatment, the affected areas are removed and the circulatory system in the groin area is restored. In this case, sexual dysfunction can become a complication.
For treatment, several types of operations are used:

Ivanissevich's technique;
operation Marmara;
microsurgical revascularization.

The first method is the cheapest, but very unreliable. When using it, the affected veins are removed, and this can cause a relapse, since the surgeon is not always able to notice all the defective areas.
The Marmar technique is used at stages 1-2 of development. Defective zones in this case are bandaged and separated, which in most cases leads to male sexual dysfunction. Relapse was observed in about 10 patients out of 100.
The most expensive, but the surest third operation allows you to restore normal blood circulation in the groin area. With the help of microsurgical intervention, the testicular vein is removed, and the epigastric vein is connected instead. No relapses were observed with this treatment.

Prevention

Signs of varicocele very often frighten men, since it will be necessary to undergo a rather complicated and dangerous treatment in order to get rid of the defect.

But there are ways to avoid the further development of the disease and its appearance:

in the first stages, heavy physical exertion should be abandoned;
good nutrition will reduce the burden on the intestines;
bad habits - smoking, drinking alcohol and drugs, negatively affect the integrity of the blood tract, so you should give them up;
good vacation;
active sex life.

Most of the preventive measures are aimed at preventing blood stasis. There is no guarantee that the symptom of varicocele will disappear, but the progress of the disease will slow down. More detailed instructions can be obtained from the doctor after the examination.

Final word

Varicocele is a very dangerous disease that has rather deplorable consequences. If it is detected, do not panic, but as soon as possible consult a doctor for advice and confirmation of the diagnosis. In the case of correct normalized loads and an active lifestyle, it will be possible to avoid terrible consequences and the need for surgery. In extreme cases, there are several options for dealing with the disease even in its advanced stages. But in no case should this disease be ignored.

Varicocele varicose veins of the spermatic cord diagnosis treatment surgery laparoscopy symptoms prevalence

Definition of varicocele

To determine the stage of varicorcele and indications for surgery, as well as to choose the right tactics for surgical treatment, you need to send me a personal e-mail [email protected] [email protected] copy a complete description of the ultrasound of the kidneys and scrotum, and after 25 years, spermogram data, indicate the age and main complaints. Then I can give a more accurate answer for your situation.

Varicocele (varicocele) - varicose veins of the spermatic cord. Just like with varicose veins in the legs, this disease develops when the valves in the veins do not function properly, which leads to a reverse flow of blood. Due to the asymmetry of the confluence of the veins of the spermatic cord on the left and right sides, as well as the anatomical features of the left and right spermatic cord, vein dilatation is most often observed on the left (in 80-90% of cases). Less commonly, it occurs on the right side and even more rarely it is bilateral. With the scarcity of manifestations, varicose veins of the spermatic cord are fraught with a great danger of male infertility. When examining patients with varicocele in 40-80% of cases, a violation of the spermatogenic function of the testicles is detected.

Prevalence and frequency of occurrence of varicocele

Varicocele is a widespread disease found in 16.2% of the examined patients. During conscription, varicocele is detected in 1-7% of young people. The highest frequency of varicocele (15-19.3%) occurs at 14-15 years of age. In children under 10 years of age, this disease occurs in 0.7-5.7% of cases. In 30-40% of men examined for infertility, varicocele is found.

Clinical manifestations and classification of forms of varicocele

By itself, varicose veins of the spermatic cord are not a big problem, the patient's life is not threatened, and you can live with him calmly all your life without much concern. The key problem with varicose veins of the spermatic cord may be the main complication of this disease - male infertility.

"Manual suture in endoscopic surgery", K. V. Puchkov, D. S. Rodichenko

The main stages of varicocele:

There are the following stages of varicose veins of the spermatic cord of the disease:

I stage- varicose veins of the spermatic cord are detected only by palpation when straining the patient in a vertical position of the body;
II stage- the dilated veins of the spermatic cord are visually determined, the size and consistency of the testis are not changed;
III stage- pronounced dilatation of the veins of the pampiniform plexus, a decrease in size and a change in the consistency of the testicle.

The manifestations of the disease are directly dependent on the magnitude of the expansion of the veins.

At stage I of the disease usually no manifestations of varicose veins are noted. Often, the diagnosis of varicocele at this stage is first established during routine preventive examinations in the teenage office of the children's clinic and (if, of course, the surgeon or urologist examines the patient properly). In the vertical position of the patient, you can feel the dilated veins of the spermatic cord. When moving to a horizontal position, the veins of the spermatic cord collapse and become invisible.
With stage II varicose veins, which can be a completely natural consequence of the lack of treatment of stage I, the veins expand to a greater extent. They descend in clusters below the upper pole of the testis. Examination reveals asymmetry. The testicle on the side of the lesion descends, as a result of which the corresponding half of the scrotum sags. The patient complains of pain, which can be of varying intensity - from awkwardness when walking to acute pain such as neuralgia. Some patients have a burning sensation in the scrotum, as well as increased sweating. Not uncommon - a decrease in sexual function.
Stage III varicocele the pain is constant and worries outside of physical activity - at rest, at night. The scrotum is enlarged by numerous "clusters" of veins that descend well below the lower pole of the testis. Many studies have shown that irreversible atrophic changes occur in the testicle in this condition.

Diagnosis of varicocele as varicose veins of the spermatic cord

When examining a patient with suspected varicocele, pay attention to the side of the lesion, note the expansion of the veins of the pampiniform plexus in the left half of the scrotum or on both sides. Palpation of the scrotum determines the degree of expansion of the veins of the pampiniform plexus, the size and consistency of the testicles. The nature of the varicocele is noted - orthostatic or with constant filling of the veins. The presence of a permanent varicocele in ortho- and clinostasis may indicate an organic lesion of the venous system, thrombosis of the renal veins, compression of the venous lines by the neoplasm, etc. From special laboratory studies, an analysis of the ejaculate (in adults) is necessary for dynamic observation. Doppleroscopy with ultrasound can diagnose the so-called subclinical forms of varicocele, especially in children of preschool and early school age.

Treatment of varicocele (varicose veins of the spermatic cord)

Varicocele can only be removed by surgery. Conservative methods of treatment of varicose veins of the spermatic cord do not exist.

The most common method of surgical treatment of varicocele is the Ivanissevich operation. This is a classic operation performed by open access, which is performed through an incision in the left iliac region. Next comes the mobilization, ligation and intersection of the left seminal vein. With the widespread introduction of endoscopic methods into clinical practice in recent years, ligation (clipping) of the internal testicular vein is performed by the laparoscopic method.

A feature of my method of minimally invasive treatment of varicocele - laparoscopic excision and ligation of the vein, is the individual planning of the place of blocking the blood flow during the operation in a particular patient and its implementation in just two 5 mm punctures. Individual planning of the operation is based on preoperative color Doppler mapping of the patient's venous bed. These techniques allow us to make our technique virtually relapse-free (less than 1 percent).

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