Varicocele

varicocele

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Varicocele is varicose veins of the bunched testicular plexus. Varicocele affects 20% of young men. Skinny physique, weightlifting, and congenital weakness of the vascular wall contribute to developing the disease. The appearance of varicocele in adulthood can be caused by compression of the testicular or renal vein by a tumor, cyst, or enlarged lymph nodes, which requires in-depth diagnosis.

Pain in the groin during physical activity, abdominal tension, discomfort, heaviness in the scrotum, and infertility are all varicocele symptoms. In the scrotum, enlarged veins are defined as a bag of worms.

Varicocele in young, lean people can manifest as the veno-occlusive form of erectile dysfunction in which men note a normal erection, which disappears after 2-3 minutes of sexual contact. Viagra and similar drugs in this form of erectile dysfunction are of little effect. The problem is associated with pathological shunts that do not keep venous blood in the penis.

A special modification of Marmara’s operation has been developed to treat such patients, in which pathological shunts are bandaged together with the veins of the seminal rope.

Diagnosis of varicocele

Ultrasound of scrotum with dopplerography is used to diagnose varicocele. Significantly enlarged veins are visible to the naked eye, determined during palpation. The indication for surgery is the determination of reflux in veins of the venous plexus of more than five cm/s. The diameter of veins in varicocele is usually increased by more than 3 mm, but we often see pronounced reflux in veins with a diameter of even 2-2.5 mm.

What's dangerous about varicocele

In addition to pain and constant discomfort in the scrotum, varicocele can cause many other problems for a man.

  • Fertility problems

More than 50% of patients with varicocele have reduced sperm fertilization capacity, and this process develops with age. Thus, a man with the first degree of varicocele at the age of 20 is usually quite capable of having children, but at the age of 35 at 2-3 degrees of varicocele, will not be able to impregnate a woman. Varicocele occupies 25% of the overall structure of male infertility.

Varicose veins worsen the sperm’s ability to penetrate through the eggshell and fertilize it.

Men often come to us with varicocele and normal sperm count and mobility, but pregnancy does not occur in marriage.

Varicocele shows venous overflow of the testicle with blood with insufficient oxygen and nutrients; there is a deterioration in the blood circulation of the testicle, which leads to further reduction and atrophy.

In addition to pain and constant discomfort in the scrotum, varicocele can cause many other problems for a man.

  • Fertility problems

More than 50% of patients with varicocele have reduced sperm fertilization capacity, and this process develops with age. Thus, a man with the first degree of varicocele at the age of 20 is usually quite capable of having children, but at the age of 35 at 2-3 degrees of varicocele, will not be able to impregnate a woman. Varicocele occupies 25% of the overall structure of male infertility.

операция варикоцеле харьков

Another pathogenetic factor in varicocele is the increase in testicular temperature. It should be 35.5 °C in the scrotum. When blood comes from the renal vein, the testicular temperature rises to 37 °C. This disrupts sperm formation in this testicle, and over time anti-sperm antibodies (ASAT) are formed. At the same time, the process is bilateral and often irreversible.

In addition, varicocele enters the testicles from the testicle veins with toxic substances from the kidney and the hormone cortisol from the adrenal glands. They also harm normal sperm maturation, causing degenerative sperm.

After surgery to remove the causes of varicocele, the number and mobility of sperm do not change, but the desired pregnancy occurs after 3-4 months.

  • Prostate problems

Patients with varicocele are more likely to experience venous prostate hyperemia and develop chronic stagnation prostatitis. Only complex treatment can treat such congestive prostatitis only with complex treatment: conservative prostatitis therapy and Marmara’s surgery to normalize the blood flow of the reproductive system.

  • Erection problems

Men with a veno-occlusive form of erectile dysfunction often complain of unstable or sluggish erections. In this case, surgical treatment is highly recommended.

Treatment of varicocele

  • Treatment of varicocele should be preventive without waiting for spermogram disorders.

    Conservative treatment of varicocele can only be performed in varicocele of 1st degree when the patient has no complaints or deterioration of spermograms. At the same time, the veins are palpated when on the ultrasound, their diameter does not exceed 3 mm, and the reflux rate is less than five cm/s. In case of any of the above signs, urgent consultation with a urologist is recommended.

    Varicocele of 2-3 degrees requires surgical treatment. Today, the most common, safe, and effective operation is Marmara’s operationalthough many hospitals perform Ivanissevich’s surgery, after which there are often relapses.

When varicocele surgery is necessary

  • The presence of pain. As a rule, patients complain of pain or discomfort in the left half of the scrotum, the left groin canal, and sometimes in the left lumbar area associated with circulatory disorders.

    All patients with male infertility factor. Varicocele surgery significantly improves the quality and mobility of sperm, and most importantly, the acrosome reaction — the penetration of sperm into the egg. Very often, men with normal spermograms in varicocele are contacted. After surgery, the long-awaited pregnancy usually occurs. Even with a small sperm count, Marmara’s preliminary surgery increases the chances of artificial insemination or IVF-ICSI programs.

    Varicocele in young men. Even if there are no adverse changes in the spermogram at the age of 20-25, in the future, the presence of varicocele may cause male infertility, so up to 25% of cases of male infertility are related to varicocele. In cases of progressive varicocele in young people, we recommend that the operation not be postponed if it is preventive. After 35 years of age, surgery does not constantly improve the spermogram. By this age, as a rule, anti-sperm antibodies develop, and signs of testicular degeneration appear.

    Presence of erectile dysfunction in patients with varicocele. For such patients, Marmara’s combined operation is performed with the intersection of pathological shunts from the penis and dressing of the dorsal vein of the penis.

    The appearance of signs of atrophy, reduction of the left testicle. Even a slight decrease in the left testicle than the right testicle indicates a significant lack of oxygen and toxic substances in the testicle. At the same time, the formation of anti-sperm and anti-testicular antibodies can lead to a substantial decrease in the hormone-forming function of both testicles and a reduction in libido and potency.

Types of surgical treatment of varicocele

  • Until 2011, the standard of surgical treatment of varicocele in Kharkiv was high ligation of the seminal vein — Ivanissevich’s surgery. In this operation, the seed vein is bandaged, after which it is crossed, and the wound is sewn. The process usually lasts 30-40 minutes, is performed under local or combined anesthesia, and requires 2-3 days of hospitalization. The main disadvantage of the operation is the high frequency of relapses of up to 30%. The discharge of blood from the ilium veins persists, which is often the cause of the recurrence of varicocele.

    Marmara’s surgery in varicocele is the best method of treatment. The advantage of this operation is a smaller incision of 2.5-3 cm, the possibility of local or combined anesthesia, abdominal muscles are not opened, and the duration of hospitalization is reduced. We release patients after surgery the same day or the next day. This surgery method is especially shown to be very effective for fragile patients — them. The standard Ivanissevich operation may be ineffective. After the Marmara operation, varicocele recurrences and accompanying complications very rarely develop.

Patient stories

Patient K., 34 years old, with bilateral varicocele.

The patient contacted by phone with complaints of infertility in marriage for 3 years. From the anamnesis it is known that 8 years ago Ivanissevich’s operation was performed in Poltava, but after 2 years he began to notice a repeated increase in veins.

For the surgical treatment of recurrent varicocele and right-sided varicocele I came to Kharkov to prof. A.V. Knigavko

In the patient’s spermogram, there is a moderate decrease in mobility (fraction a + in 27%), however, pronounced agglutination +++ is determined. The patient underwent surgery on both sides. After that, drugs that stimulate fertility were prescribed: Tribeks, Karliv, Enat.

3.5 months after the operation, the patient’s wife was diagnosed with the desired pregnancy.