What is the cause of epitesticular varicocele?

Varicose veins at night can have adverse effects on male fertility and reproductive health, so the understanding of the causes should focus on the most common factors, including anatomical factors, physiological factors and other factors. If the patient, especially young people, has strong sexual function, strong blood supply to the scrotal contents, and long-term standing increases abdominal pressure, these may be the cause of the disease.

1. Reasons

(I) Anatomical factors: The blood of the testicle and epididymis flows back through the spermatic vein, which can be divided into three groups. They have collateral circulations at the external ring and communicate with each other. The rear group: external spermatic vein → inferior epigastric vein → femoral vein → external iliac vein. The middle group: vas deferens vein → superior vesical vein → internal iliac vein. Front group: Internal spermatic vein: The veins of the testis and epididymis mainly return through the spermatic vein plexus. The plexus merges into 2 to 4 veins in the inguinal canal, passes through the internal ring to the retroperitoneum and merges into a vein called the internal spermatic vein. The right internal spermatic vein runs obliquely upward into the inferior vena cava; the left one enters the left renal vein at a right angle.

(ii) Physiological factors: Young men have stronger sexual functions and the blood supply to the scrotal contents is strong. Therefore, some varicocele may gradually disappear with age. In addition, standing for a long time and increasing abdominal pressure are also factors that cause the disease.

(III) Other factors: Retroperitoneal tumors, kidney tumors, hydronephrosis, etc. compress the spermatic vein and may cause symptomatic or secondary varicocele. The primary varicocele disappears quickly when lying down, while the secondary varicocele often does not disappear or disappears very slowly.

2. Patients

The chance of middle-aged and older men getting varicocele is not very high, and it mainly occurs in young men. The incidence rate is 10-15% in the male population, and 15-20% in male infertility. This symptom mostly occurs on the left side, but it is not uncommon for patients to have bilateral varicocele, which can be as high as about 20%.