Testicle Swollen On One Side Of 45 Year Old Man Varicoceles White Paper

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Varicoceles White Paper

Varicoceles

Varicocele ndi gulu lotambasuka (lokulitsa) la mitsempha mu scrotum. Monga momwe anthu ena amatambasulira kapena “varicose” mitsempha m’miyendo yawo, amuna ena amatambasula mitsempha mu scrotum yawo. Mitsempha yosungunuka imadzazidwa ndi magazi ochulukirapo. Amuna omwe ali ndi varicoceles amatha kuona kumverera kolemetsa, kukokera, kupweteka mu scrotum (“thumba la mpira”) kumapeto kwa tsiku. Varicoceles ndizomwe zimayambitsa kusabereka kwa amuna.

KODI VARICOCELES AMAKHALA BWANJI?

Varicoceles amakula nthawi zambiri paunyamata. Panthawi imeneyi, ma testes amakula kwambiri ndipo amafunika magazi ambiri kuti apereke kufunikira kowonjezereka kwa mpweya ndi zakudya. Ngati varicoceles lalikulu kukula pambuyo unyamata, mwamuna ayenera kufufuzidwa kuonetsetsa kuti palibe chotupa pamimba compressing mitsempha, kuteteza magazi bwino ikuyenda kubwerera ku mtima.

CHIFUKWA CHIYANI VARICOCELES NDI OFUNIKA?

Varicoceles angayambitse:

o Varicoceles angayambitse kusabereka chifukwa cha kuchepa kwakukulu kwa ubwino ndi kuchuluka kwa umuna.

o Varicoceles amatha kuwononga machende; sangakule bwino. Kuwonongeka uku kumapita patsogolo; Nthawi zambiri zimafika poipa pakapita nthawiVaricoceles imatha kuyambitsa kusapeza bwino komwe kumatsogolera kukumverera kolemetsa, kukokera m’chikopa.

o Varicoceles amatha kuwononga maselo omwe amapanga testosterone ndipo angayambitse kuchepa kwa testosterone. Testosterone, timadzi tating’ono tating’ono tating’ono tating’ono tating’ono tating’ono tating’ono tating’ono tating’ono tating’ono tating’ono ta amuna, timakhala ndi udindo wa “makhalidwe achiwiri aamuna” (mwachitsanzo, kuchuluka kwa minofu ndi kamvekedwe, kuchuluka kwa chidwi chogonana, tsitsi la thupi).

VARICOCELES NDI KUSABEREKA

Varicoceles amachepetsa chonde, koma sizikudziwika chifukwa chake. Pali malingaliro angapo otheka:

o Kutentha kwa machende: Machende amakhala m’chikhoko, chomwe chimawongolera kutentha kwake. Amasungidwa pa kutentha pang’ono pansi pa kutentha kwa thupi. (Ichi mwina ndichifukwa chake amakhala kunja kwa thupi osati mkati mwa thupi momwe angatetezedwe bwino.)

Popeza mitsempha imazungulira ma testes ndipo magazi ali ndi kutentha kwa thupi, varicoceles amasunga ma testes pa kutentha kwakukulu kuposa momwe amapindulira. Ngakhale mwamuna ali ndi varicocele imodzi, scrotum yonse imatenthedwa ndi magazi ndipo machende onse amatha kukhudzidwa.

Nthawi zambiri, machende akuluakulu amapanga umuna wambiri kuposa machende ang’onoang’ono. Nthawi zambiri, komabe, mumawona amuna omwe ali ndi varicocele yaikulu ya mbali imodzi yomwe yawononga testis kumbali imodzi, kuti ikhale yaying’ono.

Pamene varicocele ikukonzedwa, magazi sangathe kubwereranso mu scrotum. Izi sizimakhudza ma testes okha kumbali imeneyo, komanso mbali ina. Ndi kutentha kumeneku, pangakhale kusintha kwakukulu pakupanga umuna. Zikuoneka kuti kusinthaku kumabwera makamaka chifukwa chopanga bwino mu testicle yayikulu, yabwinoko.

o Amachulukitsa zinyalala zomwe zimabwereranso ku machende. Mitsempha yotulutsa machende imalumikizana ndi mitsempha yayikulu. Kumanzere, amakhetsa mumtsempha wa impso, womwe ukukhetsa magazi ku impso. Magazi a mu impso amanyamula zinthu zotayirira, zomwe zimatha kulowa mu scrotum. Izi zitha kusokoneza kupanga umuna.

Ankaganiziridwa kuti varicocele angayambitse kupsinjika maganizo komwe kumawonekera pakuwunika kwa umuna (ie, kuchepa kwa chiwerengero cha umuna wosuntha kapena umuna wokhala ndi mitu yowoneka mosadziwika bwino). Kafukufuku waposachedwa akuwonetsa kuti ma varicoceles amakhudza pafupifupi magawo onse pakuwunika kwa umuna (ie, kukhazikika, kuyenda, kupita patsogolo, ndi morphology). Mitsempha ya varicoceles imakhudzanso kugwira ntchito kwa umuna, ngakhale kuti izi sizingayesedwe ndi kufufuza kwa umuna wachizolowezi. Kuyezetsa kwapadera kwa umuna kungathe kuchitidwa, ngakhale kuti izi ndizodula ndipo ntchito yake imatsutsana.

Matenda

Varicoceles amatha kupezeka m’njira zosiyanasiyana.

Kudzifufuza

Amuna ambiri amadziwa kuti ali ndi varicocele chifukwa amatha kumva kuchuluka kwa mitsempha yotuluka mu scrotum. Akhozanso kuzindikira:

o Machende ndi ochepera mbali iyi.

o Amakhala ndi vuto m’machende kapena mbali ya thumba.

Mayeso akuthupi

Poyang’ana thupi dokotala akhoza kupeza varicocele. Ikhoza kumveka bwino pamene mwamuna wayimirira ndipo monga tafotokozera kale, idzamva ngati thumba la spaghetti. Zitha kutha mwamuna atagona (monga kulemera kwa magazi ndi mitsempha sikukankhiranso pansi pa ma valve osagwira ntchito mu scrotum). Atayima, mwamunayo athanso kufunsidwa kuti atsike (monga ngati akutuluka matumbo). Dokotala angamve kuti mitsempha ikukankhira zala zake pamene magazi akuyenda cham’mbuyo (chifukwa cha kuwonjezereka kwapakati pamimba) kupita ku scrotum.

Mayeso Amakono

Kuti atsimikizire varicoceles, mayesero apamwamba amagwiritsidwa ntchito nthawi zambiri.

o Doppler stethoscope imakulitsa phokoso la magazi omwe akudutsa. Wodwalayo akakankhira pansi, magazi ochuluka amayenda chammbuyo mu scrotum ndipo amatha kumveka ngati phokoso lothamanga.

o Ultrasound: The duplex ultrasound pakali pano imatengedwa kuti ndiyo njira yabwino kwambiri yosasokoneza kuzindikira kapena kutsimikizira kukhalapo kwa varicoceles.

o Kuyeza kwina, komwe sikumagwiritsidwanso ntchito kawirikawiri, kumaphatikizapo kubaya mankhwala otulutsa poizoni m’magazi. Izi zitha kuwoneka zikusonkhanitsidwa mu scrotum.

Chithandizo

Njira yochepetsetsa, yothandiza kwambiri yokonza varicocele (varicocelectomy) ndiyo njira ya microscopic sub-inguinal. Sub-inguinal imatanthawuza malo odulidwa. Kudulira kumodzi kumeneku kumakhala pafupifupi inchi imodzi pamwamba pa mbolo ndi inchi imodzi mbali zonse. Ngati mbali zonse ziwiri zikuchitidwa opareshoni, mbali ziwiri zimadulidwa. Pambuyo pake, zipserazo zidzakutidwa ndi tsitsi lobisika. Apa ndi pamene chingwe cha umuna (mtolo wonyamula vas deferens, mitsempha ya testicular, mitsempha, lymphatics, ndi minofu) chimachoka pakhoma la mimba. Popanga chotupa apa, minofu ya m’mimba imatha kupewedwa, zomwe zimapangitsa kuti pakhale kusamva bwino kwambiri pambuyo pa opaleshoni komanso kuchepetsa nthawi yochiritsa.

Microscopic imatanthawuza kuti makina opangira ma microscope amagwiritsidwa ntchito. Maikulosikopu yaikuluyi imayima pamwamba pa wodwalayo, ndipo dokotala amachita mbali yofewa ya opaleshoniyo akuyang’ana. Izi zimathandiza dokotala wa opaleshoni kuti awonetsetse bwino mitsempha yonse yomwe imayenera kusokonezedwa, komanso mitsempha ndi ma lymphatic (omwe amachotsa madzi amadzimadzi kuchokera pakati pa ma testes ndi thumba lozungulira), zomwe ziyenera kupeŵedwa.

Pali zovuta zochepa zomwe zimagwirizanitsidwa ndi njirayi ndipo nthawi yochira imakhala yofulumira. Pa ndondomeko, wodwalayo amamva pafupifupi kanthu; nthawi zambiri, wodwala kwathunthu kugona mwa ndondomeko. Pakhoza kukhala kusapeza bwino, kutupa, ndi mikwingwirima kwa masiku angapo pambuyo pake. Pafupifupi amuna onse amabwerera kuntchito pambuyo pa masiku awiri kapena atatu. Kafukufuku wasonyeza kuti pambuyo pa mtundu uwu wa varicocelectomy, amuna amagwiritsa ntchito mankhwala opweteka ochepa kuposa momwe anthu ambiri amagwiritsira ntchito pambuyo pa ndondomeko ya mano.

Njira ina ya opaleshoni ya varicoceles imatchedwa inguinal varicocelectomy. Ngakhale akatswiri ambiri osabereka amagwiritsa ntchito njira ya microscopic sub-inguinal, akatswiri a urologist nthawi zina amapanga varicocelectomy. Pankhaniyi, chodulidwacho chimapangidwa ngati chotupa cha hernia. Mitsempha ya m’mimba yomwe imaphimba mitsempha ya varicocele imadulidwa pamalo omwe amachoka pamimba. Chingwe chawululidwa. Kenako, mitsempha imadulidwa. Kuchekako ndikotalika kuposa kudulidwa kwa sub-inguinal. Komanso ndi yokwera kwambiri, zomwe zimapangitsa kuti chilondacho chiwoneke pamwamba pa tsitsi la pubic. Chifukwa chakuti minofu ya m’mimba imadulidwa, kupweteka kwapambuyo kumawonjezeka kwambiri ndipo kuchira kumatenga nthawi yaitali. Komanso, ngati maikulosikopu sagwiritsidwa ntchito, zimakhala zovuta kuwona ndikusunga mitsempha (ena yomwe nthawi zambiri imadulidwa) ndi ma lymphatic kapena kuwona ndi kusokoneza mitsempha yonse yofunikira. Choncho, pali chiwerengero chachikulu cha kulephera (5% mpaka 15%) komanso kuwonjezeka kwa mapangidwe a hydrocele, kusonkhanitsa kwamadzimadzi kuzungulira testicle (3% mpaka 30%).

Njira yachitatu yomwe ingagwiritsidwe ntchito imaphatikizapo kudula kwapamwamba kwambiri kuti mitsempha ipitirire mmwamba (njira ya retro-peritoneal). Izi zimasiya chilonda chowonekera komanso chachilendo. Zimaphatikizaponso kudula minofu ya m’mimba, yomwe imawonjezera ululu wa postoperative ndi kuchira. Mtsempha wamagazi susungidwa. Ili ndi kulephera kwa 15% mpaka 25% komanso chiopsezo chopanga ma hydrocele pafupifupi 7%.

Pomaliza, varicocele akhoza kukonzedwa laparoscopically, koma wodwalayo ayenera kuikidwa pansi pa mankhwala ochititsa dzanzi. Katheta (chubu) amayikidwa mchikhodzodzo kuti mkodzo utuluke kuti chikhodzodzo zisalowe m’chikhodzodzo. Kang’ono kakang’ono amapangidwa pansi pa umbilicus (bellybutton) ndipo mimba imadzaza ndi mpweya. Singano imasinthidwa ndi trocar yokulirapo, yotopetsa (chida chakuthwa) ndi sheath kuti kamera ikhoza kuyikidwa pamimba. Zowonjezera ziwiri zimapangidwira pakhoma lamimba ndipo zida ziwiri zogwirira ntchito zimayikidwa m’mimba. Mtolo wonyamula mtsempha ndi mitsempha umadziwika. Panthawi imeneyi, mtolo uwu umadulidwa. Chisamaliro chimatengedwa kuti asadutse vas mwangozi.

Kaŵirikaŵiri njira imeneyi siivomerezedwa chifukwa imafuna kuti wodwalayo azichitidwa opaleshoni yamankhwala, kuti aloŵetsedwe katheta m’chikhodzodzo, ndiponso kuti m’malo mong’amba kunja kwa khoma la m’mimba apangidwe katatu pakhoma la m’mimba. Palinso zoopsa zomwe zimachitika ndi laparoscopy zomwe zimakhala zazikulu kuposa zomwe zimakhala ndi njira yaying’ono yotseguka yochitidwa ndi microscopic varicocelectomy.

ZOCHITA ZOCHITA:

Miyezo yopambana ya chithandizo cha varicoceles ikhoza kuyesedwa malinga ndi chiwerengero cha mimba: 60% ya amuna adzakhazikitsa mimba mkati mwa chaka chimodzi cha varicocelectomy. Makumi asanu ndi awiri mphambu awiri pa zana aliwonse aamuna adzachita izi pakatha zaka ziwiri. Izi zikufanizira ndi 16% ya amuna omwe abwenzi awo adzakhala ndi pakati popanda kutenga varicocelectomy panthawi yomweyi.

Kupambana kungayesedwenso ndi kusintha kwa zotsatira za kusanthula umuna. Amuna makumi asanu ndi limodzi mphambu asanu pa zana aliwonse awonetsa kusintha kwakukulu pakuwunika kwa umuna mkati mwa miyezi 12. Kusintha kwakukulu kumatanthauzidwa ngati kuwirikiza kawiri kwa chiwerengero cha motule. Chiwerengero chonse cha ma motile ndi chiwerengero chowerengedwa cha umuna umene mwamuna amautulutsa.

Amuna omwe ali ndi varicoceles zazikulu adzawonetsa kusintha kwakukulu. Mwa amuna awa, 69% adzakhala ndi kusintha katatu mu chiwerengero chonse cha motile mu ejaculate. Amuna ambiri ali ndi varicocele yaikulu mbali imodzi ndi yaing’ono varicocele mbali inayo. Kafukufuku waposachedwapa wanena ngati, muzochitika izi, ma varicoceles onse ayenera kukonzedwa kapena ngati yaikulu iyenera kukonzedwa. Amuna makumi asanu ndi limodzi mphambu asanu pa zana a amuna omwe ali ndi maiko awiri (awiri-mbali) omwe ali ndi mitsempha yaing’ono kumbali imodzi ndi varicocele yaikulu pambali ina anasankha kuti onse awiri awonongeke. Gululi linawonetsa kuwonjezeka kwa 104% mu chiwerengero chonse cha motile. Amuna makumi awiri ndi asanu ndi limodzi pa zana aliwonse adaganiza zochitidwa opaleshoni kumanzere kokha ndipo adawonetsa kusintha kwapakati pa 45% mu chiwerengero chonse cha motile. Kawirikawiri, ngakhale kuti varicocele yaing’ono imapezeka pambali ya varicocele yaikulu, ndi bwino kuti onse awiri akonzedwe.

KODI ZIMACHITA NTCHITO BWANJI KUONA KUSIYANA?

Umuna umatenga masiku 78 kuti ukule. Iyi ndi njira yosalekeza kwambiri ngati mzere wa msonkhano. Pa nthawi ina iliyonse, payenera kukhala mamiliyoni a umuna pa msinkhu uliwonse.

Choncho zimatenga miyezi ingapo ya 4 kuti muwone kusintha kwakukulu mu kusanthula kwa umuna pambuyo pa varicocelectomy. Kuwongolera kowonjezereka kumatha kuwoneka mpaka zaka ziwiri. Ngati, komabe, palibe kusintha mkati mwa miyezi 6, zosankha zina ziyenera kuganiziridwa nthawi imodzi.

Kupeza Dokotala

Akatswiri ena a urologist amaliza maphunziro apadera okhudzana ndi kusabereka kwa amuna (mayanjano), ndipo ndibwino kuti mupeze mmodzi wa madokotalawa kuti akuchitireni opaleshoni.

Pambuyo pa maphunziro awo a urological wamba, (zaka 5 mpaka 6 pambuyo pa sukulu ya zachipatala) madokotala ena amasankha kumaliza maphunziro owonjezera operekedwa ku kusabereka (chiyanjano). Pachiyanjano chawo, amakumana ndi amuna ambiri omwe ali ndi vuto losabereka ndipo amaganizira kwambiri za matenda ndi chithandizo cha amunawa.

Mbali yofunikira ya maphunziro apamwamba amathera luso la opaleshoni ya microsurgery, opaleshoni yomwe imachitidwa pansi pa maikulosikopu. Luso logwiritsa ntchito njirayi limawathandiza kuti azitha kuchita maopaleshoni ovuta kwambiri komanso ocheperako oyenera a varicoceles komanso maopaleshoni ena osabereka aamuna (mwachitsanzo, kumanganso vas).

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