VARICOCELE
A varicocele is an abnormal dilation of the veins of the pampiniform venous plexus in the scrotum [network of veins from the testis of the epididymis. constituting part of the spermatic cord].
[Varicoceles occur most frequently in the veins on the left side in adults.] In some men, a varicocele has been associated with infertility. There may be enlargement of the spermatic vein and as a rule, no treatment is required unless fertility is a matter of concern. Pain, tenderness ard discomfort in the inguinal region is corrected surgically by ligating the external spermatic vein at the inguinal area. An ice bag may be applied to the scrotum for the first few hours after operation to relieve edema. The patient then wears a scrotal support.
Impotence
Impotence is the alteration of a man's sexual capability to either achieve or maintain an erection sufficient to accomplish intercourse, It may be either erectile or ejaculatory.
Erectile impotence has
1. Psychogenic causes anxiety, fatigue, depression and culture pressure to perform sexually.
2. Organic causes occlusive vascular disease, endocrine disease (DM, pituitary tumors, hypogonadism), genito urinary conditions [(radical pelvic cancer, surgery)] hematologic conditions (Hodgkins’s disease, leukaemia), neurologic disorders (neuropathies, parkinsonism) trauma to the pelvic or genital area and drugs (alcohol, psychoactive drugs, anticholinergics) and drug abuse.
Diagnostic evaluation
1. Sexual and medical history analysis of presenting symptoms
2. physical examination and various laboratory studies. Arterial blood flow to the penis is measured with the doppler probe. Nerve conduction tests and psychological evaluation of the Patient.
Medical Management
1. Treatment of alcoholism and readjustment of hypertensive agents or other medications.
2. Vascular surgery to treat insufficient penile blood flow.
3. Endocrine therapy for impotence 2ยบ to hypothalamic pituitary gonadal dysfunction.
4. Sex therapy- Patients with impotence from psychogenesis causes.
5. Penile implants
[*Semi-rigid rod-smail-carrion prosthesis, has no moving parts:
*Inflatable prosthesis (+) natural erections and natural flaccidity.
Complication
Infection, erosion of prosthesis thro' skin and persistent pain.
