Varicocele refers to the spermatic cord in the veins due to flow obstruction, and the emergence of coiled expansion. Young adult is a common disease, is the result of the spermatic vein blood flow caused by deposition spermatic plexus racemosum ( venous blood tube bundle) vasodilation, tortuous and long.
The incidence of the male population is 10-15%, in male infertility accounts for 15-20% of. This disease occurs mostly on the left side, but it is not uncommon for both sides to develop, which can be as high as 20%. Varicocele may be associated with testicular atrophy and spermatogenesis disorders, resulting in male infertility. Varicocele can also be caused by a kidney tumor or other retroperitoneal tumor. The varicocele caused by compression is called symptomatic or secondary varicocele.
(1) Anatomical factors:
1. The left spermatic vein is long and enters the renal vein at a right angle, and the blood flow is subject to certain resistance. The left internal spermatic vein near the left renal vein has no valve, so the blood is easy to reverse.
2. The left internal spermatic vein is located behind the sigmoid colon and is susceptible to intestinal fecal compression, which affects blood return.
(2) Physiological factors : The young and middle-aged functions are more vigorous, and the blood supply of the contents of the scrotum is strong. In addition, standing for a long time, increasing abdominal pressure is also a disease.
(C) other factors: retroperitoneal tumors, renal tumors, hydronephrosis and other pressures of the internal spermatic vein can cause symptomatic or secondary varicocele. The original person disappears quickly when lying down, and the secondary person often does not disappear or disappear very slowly.
There are more varicocele combined with male infertility. Varicocele the testis occurred pathologicalchanges affect spermatogenesis , resulting in decreased sperm motility, sperm cells increase in the number of immature sperm morphology and tip. So far there is no reliable evidence to clarify the mechanism of infertility , but it is considered to be related to the following factors: 1. Blood retention in varicose veins, causing local temperature increase in testes and affecting spermatogenesis.
2. Blood retention affects the blood circulation of the testicles, causing the testicles to lack the necessary nutrient supply and oxygen supply to affect spermatogenesis. Venous backflow of blood in the left spermatic cord 3, the adrenal gland and kidney secretion of metabolic products such as steroids , catecholamines , 5- HT and the like to the testis, steroids inhibit spermatogenesis, testis catecholamines can chronic poisoning , 5- Serotonin can cause vasoconstriction , causing premature detachment of immature sperm, causing male infertility.
4. The above factors can also affect the endocrine function of the testicular stroma and interfere with spermatogenesis.
5. Left varicocele also affects the function of the right testis. There are abundant anastomoses in the testicular veins on both sides . The toxins in the left blood can go to the right side and affect the spermatogenesis of the right testicle.
The veins of the testes and epididymis form a spreading plexus in the spermatic cord, and ascend to the inguinal canal to synthesize several branches of the spermatic vein and the external spermatic vein. About 60% of the people have a spermatic vein in the inner ring. A few are still two or three. Going up in the retroperitoneal space. The right side is angled into the inferior vena cava. The left side enters the left renal vein at right angles. Due to the longer stroke of the left spermatic vein, the right angle of the vein into the kidney is greater. After the vein passes through the sigmoid colon, it is compressed by the segment of the intestine, and the vein lacks the venous valve . There is no muscle crushing around , so the backflow of the left spermatic vein is blocked. When standing, there is a considerable amount of blood column pressure. The lower part acts on the spread plexus, so that the varicose veins enlarge and thicken is the varicocele. This phenomenon also occurs in the posterior abdomen tumor or renal tumor compression vein, which makes the venous return blocked, also manifested as varicose veins. In order to distinguish from the former, the latter is called secondary varicocele. The former is called primary varicocele. The main difference between the two is that the primary varicocele is in the supine position and disappears quickly. The secondary often does not disappear or disappear very slowly.
Varicocele can cause testicular temperature to rise due to blood stagnation, affecting the ability of the testes to produce sperm, or causing testicular hypoxia, or adrenal metabolites to flow back into the testis, and changes in the function of the entire hypothalamus, pituitary gland, and testis. It may also be the cause of infertility caused by varicocele.
It recommended that male infertility patients should undergo a detailed examination to determine whether suffering from varicocele. In patients with varicocele, if the semen examination is normal, there is no need to worry too much about infertility, but regular follow-up examinations are required.
Varicocele can cause male infertility, but the mechanism of infertility has not yet been fully clarified and may be related to the following factors:
(1) After the scrotal temperature increases the varicocele, the temperature in the scrotum can be increased due to stagnant blood flow in the spermatic vein, which is higher than the normal 0.6 °C, which affects sperm production.
(2) Nutritional disorders Due to stagnation of venous blood flow, the blood circulation of testis and epididymis is affected, and the nutrient and oxygen supply required is lacking, thus affecting spermatogenesis.
(3) Testicular endocrine dysfunction due to elevated local temperature in the scrotum, lack of blood supply to the testes and insufficient oxygen supply, will inevitably affect the endocrine function of the interstitial cells in the seminiferous tubules of the testis , thereby interfering with spermatogenesis.
(4) Toxin effect Due to the abundant collateral circulation between the spermatic vein and the testicular vein, when varicocele occurs, it causes blood reflux, which can carry high concentration of toxic metabolism in the left adrenal gland and left renal vein blood. Products, such as steroids, catecholamines, serotonin and prostaglandins , flow into the bilateral testes before detoxification, causing sperm production to be affected, resulting in varying degrees of sperm, abnormal morphology, and dyskinesia .
(5) Oxidative damage of oxygen free radicals Some studies have shown that when varicocele occurs, oxygen free radicals in the testis tissue increase, lipid peroxidation increases, which affects spermatogenesis and sperm function.
1. The patient is completely asymptomatic and is only found during physical examination.
2. The scrotum can touch or see a swollen blood vessel like a scorpion, which the medical community calls “the insects wrapped in the bag.” The affected scrotum or testicles have a sense of bulging or falling pain, and the scrotum is swollen . When standing, the affected scrotum and testicles are lower than the healthy side, and the surface of the scrotum is dilated and distorted. Touching the soft mass of the lumps , the symptoms are more obvious when the standing or abdominal force is applied, and the symptoms can be alleviated or disappeared. Sitting for a long time will cause the local temperature of the spermatic cord to rise and the pain.
3. Patients may have symptoms of neurasthenia, such as headache , fatigue, and nervousness . Some patients have sexual dysfunction .
Varicocele can sometimes affect fertility. 9% of varicocele were infertile, and 39% of male infertility were caused by varicocele. Severe cases can cause testicular atrophy.
Clinically, it is found that people who are tall and thin are more likely to suffer from this disease. Although medical studies have not confirmed that the body type is related to varicocele, it may be due to the right angle of the spermatic vein returning to the left renal vein, which affects the return of blood.
If the elderly find varicocele, they should consider whether the kidney tumor has oppressed the kidney.
Clinically, varicocele can be divided into three degrees:
1 degree (mild): When standing, you can’t see the scrotal skin with varicose veins, but you can touch the veins in the scrotum. When you are lying down, the veins of the varicose veins disappear quickly.
2 degrees (moderate): When standing, you can see the venous protrusion on the scrotum. You can touch the veins with obvious varicose veins in the scrotum. The mass gradually disappears when lying down.
3 degrees (severe): There are obvious large blood vessels on the surface of the scrotum, and there are obvious sacral dilated veins in the scrotum. The vein wall becomes thick and hard; it disappears slowly when lying down.
For the secondary varicocele should pay attention to the examination of the abdomen, should be used for intravenous pyelography to exclude kidney tumors.
95% of the disease occurs on the left side. Let the patient stand while checking. It can be seen that the scrotum of the affected side is obviously drooping, and sometimes there are curved veins on the surface of the skin. The scrotal veins are lumped into a mass, and the male examination reveals that the spermatic veins are distorted and expanded like a wart . At the time of percussion, a soft mass that can be compressed and touched in the spermatic cord above the testicle. Even small nodules that can reach the thrombus . A mass of the same nature can also be found in the lower back of the testicle. After the patient was lying down, the mass quickly disappeared. If it cannot disappear after lying down, it should be considered as secondary. A corresponding check is required.
The varicocele is the most reliable method for the diagnosis of primary varicocele. This method can not only understand the existence, extent and anatomical variation of varicocele , but also determine whether it is suitable for surgery or embolization . The reasons for the continued existence of posterior varicocele and the timing of the surgery. However, the law is an invasive method of inspection and its high cost, which limits its application.
At the time of examination, the palpation method is generally adopted , and the patient takes a standing posture and checks whether there is a swollen blood vessel above the testicle. Mild varicocele, only when the patient is stressed, can heal the swollen blood vessels, and in severe cases, it can be seen with the naked eye.
Because the swelling of the affected part may also be tumor, lymphadenitis , hernia or scrotal edema, cryptorchidism,etc., if necessary, abdominal and kidney ultrasound examination should be performed to rule out the possibility of other diseases. At present, the Doppler Ultrasonic Examination Instrument is developed to detect venous reflux and more accurately diagnose whether there is varicocele.
Varicocele ultrasound examination:
In recent years, with the rapid development of ultrasound technology, high-frequency probes and color Doppler technology have become increasingly mature, color Doppler examination of the spermatic vein has become intuitive, accurate and simple, has become the most important means of diagnosis of Vc.
Abnormal distortion and expansion of the varicocele of varicocele. A banded, non-echoic tube that appears to be curved and rounded over the testis in the scrotum. Venous line diameter measurement value increases, up 2-2.5mm. CDFI shows a lot of color filled with lumens. The instrument and method use a color Doppler ultrasound diagnostic instrument with a linear array probe frequency of 7.5 to 12 MHz. The subject took the supine position, fully exposed the genital area, attached the penis to the abdomen, and slinged the cloth to support the scrotum, and observed the direction of the varicose veins and the internal echo. The maximum internal diameter of the dilated vein was measured as a standard image with calm breathing and Valsalva respiration , and CDFI was used to determine the presence or absence of reflux.
“Fat varicose veins can be divided into light, medium and severe grades. After the standing breath, no varicose veins can be seen, but the venous group can be touched by the lightest. This varicose vein will disappear quickly when lying down. You can also feel the venous group when you see it. After the supine, the mass can gradually disappear. It is called moderate. The naked vein can be seen with obvious veins. The scrotum is also the most obvious. Even if it disappears when lying down, it is very slow. This situation is severe.
Adolescents or parents can check regularly to see if the scrotum is equal when standing upright, and whether a sickle-like vein is visible on the wall of the scrotum. A venous tract can be seen and one side of the scrotum below the contralateral side can be diagnosed as varicocele. If there is no obvious change in the scrotum from the appearance, but the venous mass can be touched along the outside of the scrotum; or the patient’s breath holding (increased abdominal pressure) can touch the venous mass is also a spermatic varicose vein, which is relatively lighter. If you are unclear and have doubts, you should go to the hospital and ask a specialist to diagnose.
Asymptomatic mild varicocele does not require treatment.
Non-surgical treatment: varicose veins or neurasthenia can be scrotum, cold compress and so on.
Surgical treatment: heavier varicocele, sperm count three times in less than 20 million or testicular atrophy; supine varicose veins can disappear, supposable internal spermatic vein ligation.
Heavier varicocele, sperm count three times in less than 20 million or testicular atrophy; varicose veins can disappear when lying down, high spermatic ligation of internal spermatic vein.
The surgical routes are:
There are mainly two ways of trans- abdominal and trans- abdominal hernia through the axillary fossa . It is not necessary to add shunt . The main reasons for the failure of the operation are the leakage of the vein branch and the damage of the internal spermatic artery.
It is divided into two types : the preserved testicular artery and the Palmo . The chances of recovery of spermatogenesis after surgery to preserve the testicular arteries are increased. Palmo is simple and does not require identification of spermatic cords and veins. There are no reports of testicular atrophy.
Varicocele with testicular atrophy, only after the successful operation of the testicular atrophy can be reversed, postoperative recurrence of testicular atrophy can not be reversed. Therefore, the failed varicocele ligation is more damaging to the testicle than the high-cut testicular artery. Therefore, although the varicocele is a minor operation, it requires that the operation must be fine to achieve its ideal therapeutic purpose, so choose It is vital that experienced doctors perform surgical procedures.
High ligation of the internal spermatic vein is the most effective treatment for infertility caused by varicocele. In the past, the entire spermatic blood vessel was ligated. At present, the spermatic artery is detached and protected. Especially for the purpose of restoring fertility, it is more necessary to pay attention to this during the surgical treatment. However, a considerable number of medical personnel are currently operating. This cannot be done for technical reasons during the treatment.
The recurrence rate of traditional inguinal spermatic vein ligation is 5% to 45%, the incidence of hydrocele is 3% to 39%, and the possibility of testicular artery injury is also greater. Recently , the spermatic fascia was opened under the operating microscope , the testicular artery, lymphatic vessels and vas deferens and their blood vessels were preserved, and all the veins with a diameter of more than 1 mm were ligated in the spermatic cord. The recurrence rate was only 0.6%.
The rate of semen improvement after varicocele infertility can reach 50% to 80%, and the total pregnancy rate can reach 25% to 31%, which is more than twice that of non-surgical patients. There are many factors affecting the improvement rate of semen and the pregnancy rate, which are related to the age, the course of disease and the quality of semen before surgery. The number of sperm before surgery is >10×109/L. (< Reproductive medical network> is your friend) The postoperative semen improvement rate is 85%, the pregnancy rate can reach 70%; if the preoperative sperm count is <10×109/L, The semen improvement rate is only 35%, and the pregnancy rate is only 27%. There is little chance that azoospermia will restore fertility after surgery. Varicocele with infertility or abnormal semen, regardless of the severity of the symptoms are indications for surgery. Some even advocate that surgery should be performed early in adolescence so as not to affect future fertility. If the symptoms of varicocele are not obvious and there is normal fertility, there is no need for surgery.
Due to varicocele, the left renal vein blood flow to the left spermatic vein is an important pathological change. Therefore, the surgery only removes the variegated varicocele venous plexus, which is not ideal. The higher position of the internal spermatic vein ligation, that is, the Palmo operation, generally does not require a shunt. The main cause of surgical failure is the branching of the vein. The spermatic artery must be carefully removed and retained. Medical staff in the infertility center of Shangqiu Citizens’ Rights Hospital in Henan Province can use microsurgery to more closely and completely ligature the varicose veins, and at the same time reduce surgical complications and improve the operation. In recent years, laparoscopic varicocele ligation has been performed, and patients with bilateral varicocele can be ligated simultaneously.
Some people inserted the catheter through the inferior vena cava and left renal vein into the left internal spermatic vein, and then injected 5% sodium cod liver oil or gelatin sponge and steel ring to embolize the vein to treat varicocele.
Disadvantages: venous malformation, collateral circulation, varicocele is a common disease in young men, generally about 10% of young men will have varicocele, and more than 90% are on the left. Varicocele is a pathological phenomenon in which the spermatic veins form a local vein dilatation , degeneration, and elongation from various causes . Clinically, many patients with varicocele have oligozoospermia and azoospermia, which affect fertility.
The recovery of fertility after varicocele treatment is mainly related to the degree of reversibility of testicular damage, and the degree of varicose veins is not necessarily parallel. The treatment of high internal ligation of the spermatic vein is effective. Most people have better effects. The quality of semen is improved to some extent. The improvement of a few semen quality is not related to the operation of the ligation of the vein and the dysent artery. The function has been irreversibly damaged. According to reports, after six months to one year after surgical ligation, the quality of semen is significantly improved, accounting for 50% to 85%, and the conception rate is 30% to 70%. Therefore, in order to improve the postoperative conception rate of varicose veins, it is very important to choose an experienced surgeon. Because the degree of detriment of the testicular sperm in the preoperative varicose veins can not be changed, and the choice of experienced surgeons to change the cure rate is variable.
Currently, the treatment of varicocele severe still surgery, some people try using non-surgical ligation and vein thrombosis therapy , but the failure rate is high but can not replace surgery. Surgical methods from the beginning of the use of magnifying glass, to the subsequent surgery under the microscope , until the modern use of laparoscopic surgery, has been recognized as the most effective surgical method in the medical community, but with good tools, it does not mean that there must be good As a result, how to control the complications of surgery has always been an important topic in medical research.
Male specialists tell us that scrotal edema and testicular hydrocele are the most common complications after surgery, with an incidence of between 3% and 40%. Severe edema can cause testicular hydrocele and can also cause testicular (substantial) edema. In the published medical literature, according to the clinical data cited in the literature, most people think that the incidence of edema in minimally invasive surgery and open surgery is different, minimally invasive surgery can significantly reduce the incidence of edema. Some literature also pointed out that improved minimally invasive surgery can reduce the incidence of edema to zero.
Qi stagnation type
[See the certificate] The scrotum is swollen and painful, the lower abdomen is stagnant, and the urgency is inactive. Every time because of anger, crying is aggravated. Pale tongue red, thin white fur , pulse string .
[Therapy] liver qi .
1. The main party Tiantai Wu Yao San ( Li Wei “Medical Invention”)
Prescription: 9 grams of black peony , 6 grams of woody (below), 9 grams of cumin, 9 grams of galangal, 9 grams of betel nut , 6 grams of green skin , 9 grams of Chuanxiong . Shuijianbi, daily dose, 10-15 days for a course of treatment.
2. Chinese patent medicine
(1) Muxiang Shunqi Pill , oral, 9 grams each time, 3 times a day.
(2) Seven-scented fragrant pills , taken orally, 9 grams each time, 3 times a day.
Qi deficiency and blood stasis type [see evidence] Scrotal swelling and pain, lead to less abdominal discomfort, to overwork. Reddish tongue, thin white fur, pulse string
[治治] Yiqi is trapped, soothing the liver and qi.
【方药】
1. Main side Buzhong Yiqi Decoction
For prescriptions, see the “ Nocturnal emission ” temper trap type prescription.
2. Chinese medicine Fuzhongyiqi pill , oral, 9 grams each time, 3 times a day.
3. Unilateral prescription, Shumai Shengjing Decoction (Mao Jingsheng prescription)
Prescription: 20 grams of Astragalus , 10 grams of Angelica , 15 grams of dodder, 15 grams of medlar, 15 grams of Salvia , 10 grams of red peony, 10 grams of safflower, 10 grams of Bupleurum, 10 grams of fragrant, 10 grams of lychee , and kinky藿 10 grams, 12 grams of Chuanxiong, 12 grams of raspberry, 12 grams of Cistanche . Shuijianbi, daily dose.
Scorpion venous
[See the card] Scrotal tingling, or even less abdomen. The tongue is dark purple or has ecchymoses , sputum spots , thin white fur, and fine veins.
[Governance Law] phlegm and pass through .
【方药】
1. The main party 桂枝茯苓丸 ( Zhang Zhongjing, “The Golden Chamber “)
Prescription: Guizhi 10 grams, Poria 15 grams, tree peony bark 10 grams, peach kernel 10 grams, white peony root 15 grams. Shuijianbi, daily -2 doses.
2. Chinese patent medicine
(1) Guizhi Fuling Pills, taken orally, 9 grams each time, 3 times a day.
(2) Shaofu Zhuyu pills , oral, 9 grams each time, 3 times a day.
3. Unilateral prescription
(1) Tong Jing Jian (戚广荣验方)
Prescription: 15 grams of purple salvia , 15 grams of peony , 15 grams of achyranthes , 10 grams of Bupleurum, 30 grams of raw oysters (first fried), 30 grams of raw jaundice . Decoction 2 times, 2 times, daily dose.
(2) Danshen Huoxue Decoction (戚广荣验方)
Prescription: 15 grams of Salvia, Curcuma 15 grams, Achyranthes 15 grams, Rehmannia 15 grams, Epimedium 15 grams, Eupolyphaga 10 grams, 10 grams of Angelica, Dipsacus 10 grams, Woodwardia 10 grams, Cistanche 10 grams, antlers 10 grams of frost , 5 grams of cassia twig, 5 grams of aconite . Decoction 2 times, 2 times, daily dose.
4, finished medicine
Fructus rutin granules : once daily, after meals. It is mainly used for varicose veins caused by “chronic venous insufficiency”, including: varicocele varices .
1. Therapeutic prescription for varicocele 1 – kumquat root煲pig belly
30 grams of kumquat root, 100~15 grams of pork belly, add 4 bowls of water, drink soup and eat meat. Applicable to varicocele of liver qi stagnation.
2. Therapeutic remedies for varicocele 2 – sesame sesame fennel package pig large intestine
10 grams of cohosh, 60 grams of black sesame , 10 grams of fennel, a section of pig large intestine, put the three herbs in the pig’s large intestine, tighten the two ends, add some water to cook, go to cumin, cohosh and sesame, seasoning and drink soup Eat pig big intestines. Those who have constipation can eat black sesame seeds. It is suitable for varicose veins of qi and blood stasis.
3. Therapeutic prescription for varicocele 3- Shenzhen double-core porridge
20 grams of astragalus, 30 grams of Codonopsis , 15 grams of litchi core, 15 grams of mango kernel, 15 grams of glutinous rice , porridge to eat. It is suitable for varicose veins of qi and blood stasis.
4. Therapeutic prescription for varicocele 4- orange motherwort black bean sugar water
15 grams of orange core, 30 grams of motherwort, 60 grams of black beans, add 3 bowls of water to a bowl, add brown sugar . It is suitable for stenosis of choroidal varicocele.
What do patients with varicocele eat?
Vitamin E has a certain function on the recovery of blood vessels, so eating foods rich in vitamin E often has a certain effect on preventing and restoring varicocele.
Common foods rich in vitamin E are: corn oil , peanut oil , sesame oil , lettuce leaves and citrus peel are also very rich, almost all green leafy vegetables have vitamin E; milk, eggs and cod liver oil also have a certain amount of vitamins E; animal foods such as meat and fish, and vitamin E in fruits and other non-green leafy vegetables are rare. Lettuce , cabbage, and vegetable jam are vegetables containing more vitamin E.
Celery , peppers , tomatoes, etc.
Vegetable oil is the best food source of vitamin E. Foods rich in vitamin E include sesame, walnut , lean meat, milk, eggs, peanuts, lettuce, etc. In addition, soybeans , peanuts, walnuts , melon seeds , animal liver, egg yolk , cream and corn, yellow-green vegetables, are rich in vitamin E.
We must master the psychological characteristics of patients, talk to the family members of the patients, and educate them about the knowledge of the disease. Friendly interpersonal relationships are extremely important to alleviate the psychological stress and anxiety of patients and promote rehabilitation . With the cooperation of family members, the serious psychological burden and consequences brought about by such bad attitudes are avoided. Before surgery, patients should be introduced to the family members of the advantages and methods of high varicocele ligation, to eliminate the nervousness of patients and their families, so that they can actively cooperate with surgery. Let the patient have sufficient mental preparation to meet the surgery with a relaxed mood.
1 Under the guidance of medical staff before the operation, perform various examinations and treatments as planned;
2 routine preparation: do a good job in admission to the school, explain the preoperative, postoperative attention and the importance of surgery, carry out various biochemical examinations and electrocardiogram , chest penetration , clotting time check, skin preparation, and cleaning the vulva;
3 patient preparation: personal hygiene before surgery, such as shampooing, bathing, etc. The patient pays attention to rest and prevents colds ;
4 Sign the surgical consent form.
1 Closely observe the changes in the condition, pay attention to changes in blood pressure , pulse, respiration, consciousness, etc., and report abnormalities to the doctor in time;
2 Use the sandbag to compress the inguinal operation area, remove it 24 hours, use the “D” character to lift the scrotum, encourage the patient to get out of bed early, and can take deep breathing and lower limb activities during bedtime ;
3 prevent bleeding . After 24 hours of bed rest, avoid strenuous exercise, prevent wound suture breakage, fall off, regular dressing change, observe whether the incision has oozing or exudate;
4 pay attention to aseptic operation , avoid cross-infection , rational use of antibiotics to prevent infection ;
5 talk about the importance of changing position when pain. Maintaining a comfortable position after surgery not only relieves pain, but also promotes blood circulation. Explain to the patient that if the pain can be tolerated, no analgesics can be used, and psychological care should be strengthened to make the patient’s mood stable, relax, and shift the attention to the pain, thus effectively alleviating the pain.
All patients recover from the recovery after anesthesia, on the day of surgery, they can be discharged, oral analgesicsand anti-inflammatory drugs. The patient returned to the hospital for a review one week after the operation . For infertile men, semen was examined at 4 weeks postoperatively and every 3 months thereafter to assess the response to surgery.
1 pay attention to rest, life should be regular, keep a good mood, avoid fatigue . Avoid excessive activity after half a year. Prohibit sex life;
2 non-smoking, alcohol, avoid irritating food. Drink more water and eat more fresh vegetables and fruits;
3 pay attention to the cleanliness of the perineum to prevent retrograde infection;
4 Take the medicine according to the doctor’s advice and return to the hospital for review.
The main causes of recurrence after varicocele are as follows.
1. The varicocele branch ligation is not complete
The retroperitoneal incision was performed by spermatic vein angiography because the branches were not completely ligated; the inguinal incision was also due to the fact that the branches were not ligated completely.
2. The spermatic vein is not cut after ligation
The internal spermatic vein was only ligated, not cut, and relapsed after long-term ligature absorption.
3. Mistaken abdominal wall vein
The inferior epigastric vein is closely spaced from the spermatic vein, and the former is mistaken for the spermatic vein and is ligated. What to pay attention to after discovering varicocele
Cryptocurrency has captivated the world since Bitcoin's mysterious arrival in 2009. It began as a…
Hello, Guys Welcome to our Website. Today we will give you information about a Famous…
Alkenes are chemical elements with double bonds or carbon double bonds. Its general formula is…
Logical semantics is a branch of logic that focuses on studying the meaning of statements…
The Game Boy Advance (GBA) was a popular handheld gaming system developed using the Game…
Soft Puzzle - Drop The Slime APK - Simple and Easy! But that's why this…