What are the causes of right varicocele?

In medicine, the causes of varicocele mainly include two aspects, the first is primary varicocele, and the other is symptomatic varicocele. According to experts, right varicocele can be affected by many factors, such as testicular and sperm abnormalities. What are the specific causes of right varicocele?

1. Changes in the spermatic vein

Endothelial cells degenerate, large vacuoles appear, and myeloid bodies increase. In severe cases, endothelial cells are lost, smooth muscle cells proliferate, binuclear changes can be seen, myeloid bodies appear in the cytoplasm, there are a large number of collagen fibers between the muscles, and the media is obviously hyperplastic and thickened. Blood vessels proliferate and form multi-cavity vascular structures and valves, and the smooth muscle fibers and connective tissue of the valves proliferate. Among them, the multi-cavity vascular structure and valve organization are more characteristic.

2. Testicular changes

One-third of patients with second-degree varicose veins and more than one-half of patients with third-degree varicose veins have delayed testicular development on the same side as the lesion, and 80% of patients have further testicular development after surgery. Pathological changes: Thickening of the basement membrane of the seminiferous tubules, hyaline degeneration of the tubular wall, and contraction of the tubular lumen. The average diameter of the seminiferous tubules and the fertility index of the seminiferous tubules are significantly reduced. The seminiferous epithelium delaminates, and the spermatocytes and spermatids are disordered and progressively reduced. The capillary walls are thickened, the lumen is narrowed, and the interstitium is edematous. Some of the Leydig cells in the interstitium undergo dysplasia, while others proliferate, and the blood vessels undergo sclerotic changes. In severe cases, spermatogonia are lost, and only supporting cells remain, and multinucleated giant convoluted seminiferous tubules can be seen. Damage to supporting cells occurs earlier, and damage to spermatogenic cells occurs later. Abnormal changes occur in both tight junctions and semi-tight junctions.

3. Sperm abnormalities

Most scholars believe that the number of sperm in patients with varicocele is reduced, and the number of pointed sperm, amorphous sperm or immature sperm increases. The sperm quality is significantly lower than that of normal people. The sperm apicointment rate (PIA) and sperm hypoosmosis test (HOS) are significantly different from those of the normal control group, and are lower than those of the normal group. However, Zhou Chunwen et al. surveyed 3,000 male students aged 14-18 and found 32 cases of varicocele, and compared the semen quality with 32 randomly selected normal controls. Results: There was no significant difference in semen volume, sperm count, motility, deformity rate, etc. between the varicocele group and the normal control group (P>0.05); there was no significant difference in the above indicators between groups with different degrees of varicocele (P>0.05). It is believed that varicocele in adolescence has no obvious effect on semen quality.

4. Changes in testicle or blood chemicals

There was no significant difference between the levels of follicle stimulating hormone and luteinizing hormone in peripheral blood and normal controls; the levels of testosterone in peripheral blood, spermatic venous blood and testicular tissue were normal, but the testosterone level in blood may be reduced in patients with obvious varicocele; the partial pressure of O2 and CO2 and the concentration of cortisol in varicose veins were normal, but the levels of catecholamines, hydroxytryptamine, prostaglandin E and prostaglandin F were increased. The Cd content in spermatic venous blood and plasma was significantly higher than that in the control group, while the Zn content in the plasma was significantly lower than that in the control group. In addition, the Cd/Zn ratio in spermatic venous blood and plasma was also significantly different from that in the control group. The free radical level in the testicular tissue of the animal model of varicocele is increased. The free radical level in the peripheral blood and varicose vein of patients with varicocele is increased, while the superoxide dismutase activity is reduced.