Hemodynamics of varicocele: from pathogenesis to treatment

Abstract

Introduction. Varicocele is a common clinical problem associated with pain and heaviness in the scrotum, testicular atrophy, and decreased fertility. Following a brief historical overview, this article examines the anatomical and hemodynamic features of the disease, treatment indications, treatment options, and potential complications associated with varicocele. Aim. Consider the etiology of varicocele and describe its clinical manifestations. Describe venous hemodynamics in the development of varicocele and its changes in different types of surgery. Summarize outdated and modern treatment options for varicocele. Justify the importance of coordination between urologists andrologists, angiosurgeons and functional diagnosticians to improve long-term treatment outcomes in patients with varicocele. Materials and methods. The study includes a review of the literature describing the pathogenesis, anatomical options in patients with varicocele, hemodynamic preconditions for the pathology and the use of modern treatments to ensure maximum impact on the anatomical and pathogenetic link of development and progression of varicocele. Results. According to the analysis of the literature, it can be argued that the most radical and minimally invasive are modern endovascular treatments, which include the use of intravascular coils and endovenous laser coagulation in combination with foam scleroobliteration. Conclusions. For a long time, surgical treatment of varicocele involved a purely isolated approach to the intervention on the scrotum, without considering the features of venous pathology of the pelvis and abdomen. However, taking into account the described features of the formation of this pathology, for successful treatment it is necessary to conduct ultrasound with functional tests of the veins of the scrotum, pelvis, renal and gonadal veins, in some cases CT and phlebography. Cooperation of endovascular surgeons, urologists and functional diagnosticians is necessary to determine the indications and choose the optimal method of surgical treatment. Selective phlebography allows you to visualize all possible paths of pathological reflux into the veins of the scrotum, and endovasal technology provides their complete obliteration, which eliminates recurrence.