<meta charset="utf8"></head><body>電気刺激療法:精索静脈瘤誘発性疼痛に対する非外科的治療

<ol>
	<li>Bellastella, G., Carotenuto, R., Caiazzo, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Varicocele:+An+endocrinological+perspective.">Varicocele: An endocrinological perspective.</a> Front Reprod Health. 4, 863695 (2022).</li><li>Bozhedomov, V. A., Lipatova, N. A., Rokhlikov, I. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Male+fertility+and+varicocoele:+Role+of+immune+factors.">Male fertility and varicocoele: Role of immune factors.</a> Andrology. 2 (1), 51-58 (2014).</li><li>Bonyadi, M. R., Madaen, S. K., Saghafi, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+varicocelectomy+on+anti-sperm+antibody+in+patients+with+varicocele.">Effects of varicocelectomy on anti-sperm antibody in patients with varicocele.</a> J Reprod Infertil. 14 (2), 73-78 (2013).</li><li>Finelli, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+silico+sperm+proteome+analysis+to+investigate+DNA+repair+mechanisms+in+varicocele+patients.">In silico sperm proteome analysis to investigate DNA repair mechanisms in varicocele patients.</a> Front Endocrinol (Lausanne). 12, 757592 (2021).</li><li>Garolla, A., Torino, M., Miola, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Twenty-four-hour+monitoring+of+scrotal+temperature+in+obese+men+and+men+with+a+varicocele+as+a+mirror+of+spermatogenic+function.">Twenty-four-hour monitoring of scrotal temperature in obese men and men with a varicocele as a mirror of spermatogenic function.</a> Hum Reprod. 30 (5), 1006-1013 (2015).</li><li>Gomaa, M. D., Motawaa, M. A., Al-Nashar, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+subinguinal+varicocelectomy+on+serum+testosterone+to+estradiol+ratio+in+male+patients+with+infertility.">Impact of subinguinal varicocelectomy on serum testosterone to estradiol ratio in male patients with infertility.</a> Urology. 117, 70-77 (2018).</li><li>Goulis, D., Mintziori, G., Koliakos, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Inhibin+B+and+anti-M&#252;llerian+hormone+in+spermatic+vein+of+subfertile+men+with+varicocele.">Inhibin B and anti-M&#252;llerian hormone in spermatic vein of subfertile men with varicocele.</a> Reprod Sci. 18 (6), 551-555 (2011).</li><li>Jin, G., Liu, J., Qin, Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increased+Level+of+C-kit+in+semen+of+infertile+patients+with+varicocele.">Increased Level of C-kit in semen of infertile patients with varicocele.</a> Urol J. 14 (2), 3023-3027 (2017).</li><li>Kadioglu, T. C., Aliyev, E., Celtik, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microscopic+varicocelectomy+significantly+decreases+the+sperm+DNA+fragmentation+index+in+patients+with+infertility.">Microscopic varicocelectomy significantly decreases the sperm DNA fragmentation index in patients with infertility.</a> Biomed Res Int. 2014, 695713 (2014).</li><li>Lorenc, T., Krupniewski, L., Palczewski, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Warto&#347;&#263;+ultrasonografii+w+diagnostyce+&#380;ylak&#243;w+powr&#243;zka+nasiennego.">Warto&#347;&#263; ultrasonografii w diagnostyce &#380;ylak&#243;w powr&#243;zka nasiennego.</a> J Ultrasonography. 16 (67), 359-370 (2016).</li><li>Kummari, S., Das, S., Mahajan, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+high-resolution+ultrasonography+with+colour+and+duplex+doppler+in+the+evaluation+of+acute+scrotal+diseases.">Role of high-resolution ultrasonography with colour and duplex doppler in the evaluation of acute scrotal diseases.</a> Cureus. 15 (11), e49231 (2023).</li><li>Pogoreli&#263;, Z., Gaberc, T., Juki&#263;, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+subcutaneous+and+intraperitoneal+instillation+of+local+anesthetics+on+postoperative+pain+after+laparoscopic+varicocelectomy:+A+randomized+controlled+trial.">The effect of subcutaneous and intraperitoneal instillation of local anesthetics on postoperative pain after laparoscopic varicocelectomy: A randomized controlled trial.</a> Children (Basel). 8 (11), 1051 (2021).</li><li>Kilin&#231;, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+varicocele+induces+hypoxia-inducible+factor-1alpha,+vascular+endothelial+growth+factor+expression+and+angiogenesis+in+the+rat+testis.">Experimental varicocele induces hypoxia-inducible factor-1alpha, vascular endothelial growth factor expression and angiogenesis in the rat testis.</a> J Urol. 172 (3), 1188-1191 (2004).</li><li>Krzy&#347;ciak, W., K&#243;zka, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Generation+of+reactive+oxygen+species+by+a+sufficient,+insufficient+and+varicose+vein+wall.">Generation of reactive oxygen species by a sufficient, insufficient and varicose vein wall.</a> Acta Biochim Pol. 58 (1), 89-94 (2011).</li><li>Tian, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+varicocelectomy+on+serum+FSH+and+LH+levels+for+patients+with+varicocele:+a+systematic+review+and+meta-analysis.">Effect of varicocelectomy on serum FSH and LH levels for patients with varicocele: a systematic review and meta-analysis.</a> Indian J Surg. 80 (3), 233-238 (2018).</li><li>Paick, S., Choi, W. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Varicocele+and+testicular+pain:+A+Review.">Varicocele and testicular pain: A Review.</a> World J Mens Health. 37 (1), 4-11 (2019).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Low frequency neuromuscular therapy device</td>
			<td>Foshan Shanshan Datang Medical Technology Company</td>
			<td>BioStim pro</td>
			<td>Detachable and portable therapeutic instruments</td>
		</tr>
		<tr>
			<td>Medical infrared thermal imager</td>
			<td>Foshan Shanshan Datang Medical Technology Company</td>
			<td>PRISM 640A, PRISM 384A</td>
			<td>Instrument for infrared thermal imaging scanning of the human body</td>
		</tr>
		<tr>
			<td>Medical infrared thermal imaging system</td>
			<td>Foshan Shanshan Datang Medical Technology Company</td>
			<td>PRISM X 1.0.3</td>
			<td>Medical infrared thermal imager supporting computer system</td>
		</tr>
		<tr>
			<td>Surface electrodes for physical therapy</td>
			<td>Foshan Shanshan Datang Medical Technology Company</td>
			<td>JB50100, E6596, B50180</td>
			<td>Electrode plate</td>
		</tr>
	</tbody>
</table>

transcutaneous neuromuscular electrical stimulation for treating varicocele-induced scrotal pain

Varicocele is a prevalent vascular abnormality affecting the male reproductive system, characterized by the enlargement, elongation, and tortuosity of the spermatic cord&#39;s venous plexus. It often leads to scrotal pain, discomfort, and progressive testicular hypogonadism, and is a major contributing factor to male infertility. Epidemiological studies have shown that varicocele affects approximately 10% to 15% of adult males. Among infertile men, the prevalence of varicocele can reach 40%, and scrotal pain occurs in 2% to 10% of cases1.
Varicose veins commonly occur on the left side of the spermatic cord, which can be attributed to two primary factors. Firstly, the left spermatic vein is anatomically longer than the right spermatic vein. Secondly, the right spermatic vein connects to the inferior vena cava, experiencing lower pressure, whereas the left spermatic vein joins the left renal vein at a right angle, resulting in higher pressure2. Increased venous pressure in the left renal vein, situated between the abdominal aorta and the superior mesenteric artery, leads to elevated pressure within the corresponding spermatic vein3.
The exact mechanism underlying scrotal pain in varicocele remains unclear. Potential contributing factors include elevated testicular temperature, oxidative stress, testicular hypoxic injury, endocrine dysregulation, and the influence of renal/adrenal metabolic toxins. These factors stimulate receptors, triggering the generation of action potentials that propagate through neural pathways within the spinal cord, ultimately transmitting electrical signals to the brain via the thalamic tracts located on the medial and posterior aspects of the spinal cord, resulting in pain perception4.
Clinical treatments for scrotal pain associated with varicocele encompass general measures, medication, and surgical interventions. General treatment involves lifestyle and dietary adjustments, which can provide some degree of symptom reduction. Pharmacological approaches often include the administration of hepatic saponins, such as Aescuven Forte, which exhibit anti-inflammatory and anti-exudative properties and help maintain the structural integrity of venous walls, particularly collagen fibers5. Treatment with hepatic saponins, such as Aescuven Forte, gradually restores the elasticity and contractile function of venous walls, thereby increasing venous blood reflux rate, reducing venous pressure, and alleviating symptoms like scrotal discomfort. Flavonoids and non-steroidal anti-inflammatory drugs are other commonly employed therapeutic agents that offer some efficacy in improving scrotal pain symptoms. Although physical cooling and scrotal rest have been utilized for varicocele-associated scrotal pain, their usage is limited due to decreased patient acceptance6.
Surgical interventions, such as open surgery, laparoscopic surgery, microscopic surgery, and interventional surgery, are commonly selected for patients with varicocele who experience more pronounced scrotal pain symptoms or infertility. Surgical treatment is currently regarded as the most effective approach, achieving up to an 80% success rate in relieving pain symptoms. However, it is important to acknowledge potential postoperative complications, including bleeding, wound infection, testicular sheath effusion, and testicular atrophy. Regardless of the surgical method chosen, the recurrence rate of varicocele ranges from 1.9% to 17.2%7.
Transcutaneous electrical nerve stimulation (TENS) is an extensively employed non-invasive physical therapy that applies electrical stimulation to the skin&#39;s surface, leading to pain relief and enhanced nerve function. By transmitting electrical currents through electrodes into nerve tissue, TENS influences nerve activity and finds widespread applications, including: (1) Pain relief: TENS effectively alleviates various types of pain, including muscle pain, neuralgia, and joint pain. The stimulation of nerve endings through TENS promotes the secretion of natural pain-relieving substances, such as endorphins, thereby reducing pain; (2) Rehabilitation training: TENS serves as a valuable tool in rehabilitation training, aiding in the restoration of impaired muscle and nerve function. For instance, after a sports injury, TENS can be used to alleviate pain and facilitate the recovery process; (3) Neuromodulation: TENS is also utilized for neuromodulation purposes, such as managing symptoms associated with urinary incontinence and constipation8.
The diverse therapeutic potential of transcutaneous electrical nerve stimulation (TENS) in pain management, rehabilitation, and neuromodulation highlights its efficacy and applicability. Through the stimulation of nerve endings, TENS promotes desirable neuromuscular responses, effectively ameliorating associated symptoms. Notably, TENS has demonstrated favorable efficacy in addressing male conditions such as erectile dysfunction and premature ejaculation. Patients readily embrace TENS due to its advantageous features of safety, reliability, and affordability. Furthermore, TENS treatment for venous vascular diseases yields beneficial outcomes, including pain relief, enhanced blood flow, and expedited wound healing9.
This study utilizes electrophysiological therapy-related technology to examine the effectiveness of transcutaneous neuromuscular electrical stimulation in alleviating scrotal pain associated with varicocele. The findings of this investigation have the potential to offer a valuable alternative treatment approach for individuals experiencing varicocele-related scrotal pain.

<meta charset="utf8"></head><body>著者スポットライト:神経筋電気刺激による精索静脈瘤治療の進歩

精索静脈瘤誘発性陰嚢痛を治療するための経皮的神経筋電気刺激

Varicocele is a prevalent vascular disorder affecting the male reproductive system, leading to scrotal pain and testicular dysfunction. Epidemiological ...

transcutaneous-neuromuscular-electrical-stimulation-for-treating

Research

JoVE Journal

Medicine

Transcutaneous Neuromuscular Electrical Stimulation for Treating Varicocele-Induced Scrotal Pain

346 ビュー.  Northern Jiangsu People's Hospital of Jiangsu Province. 私たちの研究は、精索静脈瘤陰嚢痛の治療における経皮的神経筋電気刺激の使用に関するものであり、精索静脈瘤陰嚢痛の治療のための新しい代替オプションを提供します。経皮的電気神経筋刺激療法は、骨盤底障害の治療に広く使用されており、勃起や早漏などの男性障害の治療に効果的です。精索静脈瘤陰嚢痛の治療における経皮的神経筋?...

ビデオ: 著者スポットライト:神経筋電気刺激による精索静脈瘤治療の進歩

Varicocele is a prevalent vascular disorder affecting the male reproductive system, leading to scrotal pain and testicular dysfunction. Epidemiological studies have shown that varicocele occurs in approximately 10% to 15% of adult males, while scrotal pain affects 2% to 10% of the population. Currently, clinical treatment options for varicocele-induced scrotal pain include general therapy, medication, and surgery. Among these, surgical intervention is considered the most effective method, boasting a success rate of 80%. However, it carries risks such as postoperative bleeding, infection, and recurrence, making it less desirable for some patients. In recent years, transcutaneous neuromuscular electrical stimulation has gained wide acceptance for treating various andrological conditions, including erectile dysfunction and premature ejaculation, yielding positive outcomes. This non-invasive technique offers a promising alternative for managing varicocele-induced scrotal pain, potentially reducing the need for surgical intervention and its associated risks. Its growing popularity underscores the need for further research and clinical trials to validate its efficacy and safety in treating this condition.

This protocol outlines the use of transcutaneous neuromuscular electrical stimulation for treating varicocele-induced scrotal pain. It compares visual analog scale (VAS) scores and imaging changes before and after treatment to assess effectiveness. Results indicate that patients experienced improved scrotal pain symptoms following the treatment.