Deciphering the Causes of Urine Split and the Infertility Problems of Varicocele

Men sometimes experience urine stream splitting during urination, which often confuses them and makes them worry about whether they have a disease. In fact, there are many reasons for urine stream splitting, and they should be considered differently. Generally speaking, there are two types of urine stream splitting. One type is less frequent. This splitting is caused by a temporary partial obstruction in the anterior urethra or urethral opening. For example, urine stream splitting upon waking in the morning is because urine has accumulated in the bladder overnight, resulting in high bladder pressure and a strong force when the urine is expelled, causing a temporary change in the shape of the urethral opening.

Sometimes, after ejaculation, some semen remains in the urethra, and the engorgement of the corpora cavernosa hasn't completely subsided, leading to urinary obstruction and a split stream. Additionally, excessive alcohol consumption causing prostate congestion can also result in urinary obstruction and a split stream. These are all temporary changes in urination; once the triggering factor is removed, urination will return to normal. However, persistent split streams may be a pathological condition. A common cause is urethritis; repeated inflammation over a long period can lead to scarring of the urethral lining, causing partial urethral stricture and resulting in split streams and difficulty urinating.

Besides urinary stream splitting, this type of disease is often accompanied by symptoms such as urinary frequency, urgency, and dysuria. A typical example is the sequelae of gonococcal urethritis. Phimosis or paraphimosis causing partial urethral stricture, or small stones obstructing the urethra, can also cause urinary stream splitting. Additionally, patients with benign prostatic hyperplasia (BPH) may sometimes experience urinary stream splitting. In all these cases, it is important to seek medical attention as soon as possible for diagnosis and appropriate treatment.

Varicocele is a common condition characterized by the elongation, dilation, and tortuosity of the pampiniform plexus of veins in the spermatic cord. It has gained widespread attention from andrologists in the past decade. Studies have found that a significant proportion of cases can cause changes in the morphology and structure of the testes and epididymis, leading to functional disorders and affecting semen quality. Oligospermia can occur in 40%–50% of cases, making it a major cause of male infertility. Varicocele is most common in young men, occurring primarily between 16 and 25 years of age, with an incidence rate of approximately 15%. 99% of cases occur on the left side, with bilateral cases accounting for about 1%. It interferes with sperm production, thus leading to male infertility. Several factors contribute to this:

(1) High temperature burns sperm: Varicose veins raise the local temperature of the testes and epididymis, affecting testicular spermatogenesis. (2) Endocrine disorders interfere with hormone synthesis: Increased local temperature also affects endocrine hormone levels, reducing testosterone biosynthesis and interfering with sperm production. (3) Blood stasis damages the testes: Blood stasis and small blood vessel embolism in the testes and epididymis lead to tissue hypoxia and carbon dioxide accumulation, damaging the testicular seminiferous epithelium, naturally reducing the number and quality of sperm. (4) Metabolic products affect sperm production: Metabolic products of the adrenal glands and kidneys, such as catecholamines and prostaglandins, can reflux into the testes and epididymis through varicocele or communicating veins, affecting sperm production.

Currently, surgery remains the primary treatment for moderate to severe varicocele, mainly employing high ligation of the internal spermatic vein. Some have attempted non-surgical ligation using venous embolization, but this method cannot replace surgery due to its high failure rate. For mild varicocele, scrotal support can be used to improve local congestion, and consistent cold compresses to the scrotum, 1-2 times daily for 20 minutes each time, are beneficial for improving spermatogenesis. However, regardless of the treatment method used, to restore spermatogenesis, androgen or human chorionic gonadotropin (hCG) therapy should be used concurrently under the guidance of a doctor to promote the recovery of reproductive epithelial function.

Simultaneously, some auxiliary drugs are used, such as vitamin A, vitamin E, arginine, and glutamic acid. Human chorionic gonadotropin (hCG): In pregnant female mammals, not only does the anterior pituitary gland secrete gonadotropins, but the chorionic villi of the placenta also secrete them. The latter is called human chorionic gonadotropin (hCG). This substance in the urine of pregnant women is called human chorionic gonadotropin. Having a healthy and intelligent baby is the wish of every couple, and for the husband, the quantity, quality, and motility of sperm are key factors for eugenics. However, relevant surveys show that the sperm quality of Chinese men is getting worse and worse, declining at a rate of 1% per year. Looking at male reproductive health, people find that fertility problems are increasingly resembling modern "diseases of affluence," and modern lifestyles have brought new "killers" to male fertility.