Paick Sunghyun, Choi Woo Suk
Department of Urology, Konkuk University School of Medicine, Seoul, Korea.
World J Mens Health. 2019 Jan;37(1):4-11. doi: 10.5534/wjmh.170010. Epub 2018 May 16.
Varicocele is the dilatation of the scrotal portion of pampiniform plexus and the internal spermatic venous system. About 15% of men suffer from scrotal varicocele and 2% to 10% of them complain of pain. The probable mechanisms for pain include compression of the surrounding neural fibers by the dilated venous complex, elevated testicular temperature, increased venous pressure, hypoxia, oxidative stress, hormonal imbalances, and the reflux of toxic metabolites of adrenal or renal origin. Testicular pain associated with varicoceles is typically described as a dull, aching, or throbbing pain in the testicle, scrotum, or groin; rarely, it can be acute, sharp, or stabbing. The management of testicular pain associated with varicocele starts with a conservative, non-surgical approach and a period of observation. Varicocelectomy in carefully selected candidates with clinically palpable varicocele resolves nearly 80% of all cases of testicular pain. Microsurgical techniques for varicocelectomy have gained popularity with minimal complication rates and favorable outcomes. The grade of varicocele, the nature and duration of pain, body mass index, prior conservative management, and the type of surgical method used, are predictors for the success of varicocelectomy.
精索静脉曲张是蔓状静脉丛阴囊段及精索内静脉系统的扩张。约15%的男性患有阴囊精索静脉曲张，其中2%至10%的人主诉疼痛。疼痛的可能机制包括扩张的静脉复合体压迫周围神经纤维、睾丸温度升高、静脉压升高、缺氧、氧化应激、激素失衡以及肾上腺或肾脏来源的有毒代谢产物反流。与精索静脉曲张相关的睾丸疼痛通常表现为睾丸、阴囊或腹股沟的钝痛、隐痛或搏动性疼痛；很少情况下，也可能是急性、尖锐或刺痛。与精索静脉曲张相关的睾丸疼痛的治疗首先采用保守的非手术方法并进行一段时间的观察。在精心挑选的临床可触及精索静脉曲张的患者中进行精索静脉结扎术，几乎可解决所有睾丸疼痛病例的80%。精索静脉结扎术的显微外科技术因并发症发生率极低且效果良好而受到欢迎。精索静脉曲张的分级、疼痛的性质和持续时间、体重指数、先前的保守治疗以及所采用的手术方法类型，都是精索静脉结扎术成功的预测因素。
