Pathogenesis (development of disease) Primary varicose veins result from degenerative disease of the vein wall and/or valves in the superficial venous system and a concomitant intraluminal (“inside the cavity”) increase in pressure in the affected veins. As a result, there is ectatic and varicose dilatation (expansion) of the veins (= varicose veins)Secondary varicose veins are … Varicose Veins (Varicosities): Causes
General measures Frequent movement, even during working hours, especially when working a lot in one and the same body position. Avoiding long periods of standing and sitting – walking and lying down is good. Wearing elastic stockings that do not constrict Frequent elevation of the legs Variceal bleeding: application of a compression bandage with an … Varicose Veins (Varicosities): Therapy
To prevent varices (varicose veins), attention must be paid to reducing individual risk factors. Behavioral risk factors Physical activity Physical inactivity Predominantly standing activity Tight, constricting clothing Overweight (BMI ≥ 25; obesity>). Other risk factors Pregnancy
Laboratory diagnostics are usually not required! 2nd order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification. Sterility diagnostics Spermiogram (sperm cell examination) – as part of infertility or fertility diagnostics [up to 55% of men with a grade III varicocele have a pathological (abnormal) … Varicose Vein Hernia (Varicocele): Test and Diagnosis
Obligatory medical device diagnostics. Scrotal sonography (examination of scrotal organs testis and epididymis by ultrasound) [testicular size (difference > 20% or 2 ml)?, venous covolate?, testicular tumor?] Varicocele [collection of echo-poor structures with anechoic borders; pathologic (pathological): vein diameter > 3.5 mm]Note: For diagnosis and classification of varicocele, Doppler sonography (ultrasound examination) is the appropriate … Varicose Vein Hernia (Varicocele): Diagnostic Tests
Surgical indications Infantile varicoceles with testicular atrophy, i.e., when a reduced testis is present in addition to the varicocele. The cutoff value is a testicular atrophy index (TAI) of 20%, meaning that one testis is 20% smaller than the other; another factor is a volume difference of at least 2 ml between the two testes. … Varicose Vein Hernia (Varicocele): Surgical Therapy
The following symptoms and complaints may indicate a varicocele (varicose vein hernia): In children: Swelling of the scrotal compartment (space of the scrotum surrounding the testicle). In adults: Drawing pain in the groin Feeling of heaviness in the scrotum Varicocele grade III: Varicocele already easily palpable and visible under resting conditions.
Pathogenesis (development of disease) The following forms of varicocele are distinguished: Primary varicocele/idiopathic varicocele – congenital form (nearly right-angled confluence of the testicular vein with the renal vein on the left side combined with insufficient venous valves → long, hydrostatic pressure column → decompensation, i.e. varicose vein formation in the area of the pampiniform plexus … Varicose Vein Hernia (Varicocele): Causes
Medical history (history of illness) represents an important component in the diagnosis of varicose veins (varicose veins). Family history Is there a frequent occurrence of connective tissue diseases or varicose veins in your family? Social history What is your profession? Do you have to stand most of the time in your job? Current medical history/systemic … Varicose Veins (Varicosities): Medical History
The following are the most important diseases or complications that can be caused by a varicocele (varicocele hernia): Genitourinary system (N00-N99) Testicular atrophy (“shrunken testicle”) due to varicocele (but also after antegrade sclerotherapy (sclerotherapy from the testicle) due to arterial malpuncture or extravasation (leakage of blood from a vessel) of sclerosing agent). Subfertility (limitation of … Varicose Vein Hernia (Varicocele): Complications
WHO classification of a varicocele Grade Description 0 Subclinical varicocele: detectable only by Doppler sonography (by ultrasonography) or thermography I Visible or palpable only under valsalva maneuver II Varicocele palpable under resting conditions but not visible III Varicocele already easily palpable and visible under resting conditions
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing) and palpation (palpation) of abdomen (stomach), inguinal region (groin region), etc. (tenderness?, tapping pain?, release pain?, coughing pain?, guarding pain?, hernial orifices?, kidney bearing tapping pain?) Inspection and palpation … Varicose Vein Hernia (Varicocele): Examination
