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The testis and scrotum /varicocele, hydrocele and cryptorchidism

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الكلية كلية الطب     القسم  الجراحة     المرحلة 4
أستاذ المادة وضاح عدنان عباس المرزوك       08/06/2017 10:29:32
Varicocele
A varicocele is defined as dilated and tortuous veins within the pampiniform plexus of scrotal veins. It is the most surgically correctable cause of male subfertility. The varicocele is a disease of puberty and is only rarely detected in boys <10 years of age. A left-sided varicocele is found in 15% of healthy young men. In contrast, the incidence of a left varicocele in subfertile men approaches 40%. Bilateral varicoceles are uncommon in healthy men (<10%) but are palpated in up to 20% of subfertile men. In general, varicoceles do not spontaneously regress. The cornerstone of varicocele diagnosis rests on an accurate physical examination. Several anatomic features contribute to the predominance of left-sided varicoceles. The left internal spermatic vein is longer than the right; in addition, it usually joins the left renal vein at right angles. The right internal spermatic vein has a more oblique insertion into the inferior vena cava. This particular anatomy in the standing man may cause higher venous pressures to be transmitted to the left scrotal veins and result in retrograde reflux of blood into the pampiniform plexus.
Varicoceles are associated with testicular atrophy and varicocele correction can reverse atrophy in adolescents. There is indisputable evidence that the varicocele affects semen quality. In fact, a classic semen analysis pattern has been attributed to varicoceles in which low sperm count and motility is found in conjunction with abnormal sperm morphology. The finding of semen abnormalities constitutes the main indication for varicocele surgery in infertile men. Precisely how a varicocele exerts an effect on the testicle remains unclear. Several theories have been postulated; it is likely that a combination of effects results in infertility.
Pituitary-gonadal hormonal dysfunction, internal spermatic vein reflux of renal or adrenal metabolites, and an increase in hydrostatic pressure associated with venous reflux are also postulated effects of a varicocele. The most intriguing theory of how varicoceles affect testis function invokes an inhibition of spermatogenesis through the reflux of warm corporeal blood around the testis, with disruption of the normal countercurrent heat exchange balance and elevation of intratesticular temperature.





Cryptorchidism
(derived from the Greek ???????, kryptos, meaning hidden and ?????, orchis, meaning testicle) is the absence of one or both testes from the scrotum. It is the most common birth defect regarding male genitalia. In unique cases, cryptorchidism can develop later in life, often as late as young adulthood. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis. However, about 80% of cryptorchid testes descend by the first year of life (the majority within three months), making the true incidence of cryptorchidism around 1% overall. Cryptorchidism is distinct from monorchism the condition of having only one testicle.


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
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