Surgery for varicocele: which method is better. Surgeries for the treatment of varicocele Complications of ligation and transection of the testicular vein

(a traditional method of surgical treatment of varicocele), laparoscopic varicocelectomy is performed without a large incision of the skin in the groin area.

Instead of significant damage to the dermis, a puncture is made in the peritoneum, through which a small video camera and instruments enter the body.

Often this method is also compared with one, which has its own characteristics. Microsurgical method It is performed with a 3–5 cm incision through which the fascia of the spermatic cord is dissected, and then an operating microscope is used. Vein ligation is performed using vicryl ligatures.

For varicocele, laparoscopic surgery has a number of advantages over the microoperative correction method:

• the intervention does not involve the appearance of deep incisions;
• the operation is carried out using a camera (maximum visualization);
• the length of the seam does not exceed 0.7 mm.

According to statistics, this method leads to only 2% of relapses, while the microoperative method is 10% or more.
Laparoscopy under the supervision of an experienced doctor also excludes damage to the lymphatic vessels, arteries and the occurrence of common complications such as hydrocele or epididymal orchitis.

Additional benefit: only this method makes it possible to identify collaterals - bypass paths of blood flow, which can rarely be identified with other methods of intervention (including microoperative).

Warning. Laparoscopy for varicocele is not performed in the presence of adhesions and serious heart disease.

Laparoscopy of varicocele: types of operations

Depending on the condition of a man with varicocele, various operations with laparoscopy are prescribed, aimed both at eliminating the pathology and obtaining important information.

Types of laparoscopic operations:

1. Diagnostic. In difficult situations, diagnosis of the inguinal vein is required, but often the procedure is not required - the condition of the veins can be determined using ultrasound and palpation of the scrotum.
2. Operational. The intervention is performed directly to excise the testicular vein. May immediately include the diagnostic stage.
3. Control. In case of relapse of varicocele, it is possible to introduce only a video camera into the abdominal cavity, which will help identify the reasons for the deterioration of the patient’s condition.

Regarding methods testicular vein embolization, then there are several ways. The introduction of a sclerosant (a special suspension) allows you to quickly eliminate a damaged vein, however, the method is contraindicated in patients with cardiovascular pathologies due to the risk of developing a blood clot.

Mini-balloons are also used to occlude the testicular vein, and the use of coils is also applicable. However, the most progressive method for treating varicocele is the use of titanium staples that do not cause rejection by the body.

Indications

Availability can be eliminated in one procedure exclusively by laparoscopic method.

In the treatment of problems eliminated by other surgical methods, the laparoscopic method also demonstrates the rationality of its use due to minimal trauma.

In other cases, two incisions are required, which create a noticeable cosmetic defect.

During diagnostic laparoscopy for varicocele also the easiest way to determine the type of testicular vein, going with one trunk or many small vessels (the so-called scattered type of structure).

Fact. The patient can choose the laparoscopic method, focusing solely on the convenience of the method.

How to prepare for the procedure?

Before surgery you will need pass general tests related to the detection or absence of sexually transmitted diseases, HIV and hepatitis. The number of platelets, which are responsible for increasing the risk of increased blood loss during the procedure, is important in general blood tests. If no contraindications are identified, the patient with diagnosed varicocele undergoes further preparation.

Considering performing an operation under general anesthesia, doctors prohibit eating food and drinking water in the morning (12 hours in advance). The day before the procedure, the intestines are also cleansed (using an enema) to minimize the appearance of bloating during surgery.

Despite the absence of direct contact with the groin area, the doctor will require removing hair near the penis. This procedure eliminates the risk of hair getting inside the body.

Sequence

The man is injected with a substance that puts the person into a medicated sleep, after which three laparoscopic ports are installed on the abdominal area.

They are inserted through punctures of the abdominal wall, each element is located in a specific place: a port for a video camera (10 mm) - in the navel area, 2 ports for the aerial region (5-10 mm) - on the right and left sides of the abdomen.

To facilitate the procedure The patient's torso is raised 15 degrees for the necessary displacement of some organs located in the abdominal cavity.

When operating on a left-sided varicocele, there is an assistant on the left side and a surgeon on the right.

During the operation, carbon dioxide is also supplied, which simplifies the passage of instruments and visual control of surgical procedures.

Progress of endoscopic surgery for varicocele:

1. a Veress needle is inserted to fill the abdominal cavity with gas;
2. the entire testicular vein is examined using a flexible tube with a video camera;
3. titanium staples are applied to the damaged areas of the vein;
4. veins intersect between installed elements;
5. endoscopic equipment is removed.
6. an aseptic bandage is applied to the punctures.

You can see the entire process of the operation in this video:

The total duration of the operation to eliminate varicocele does not exceed 10–45 minutes, and after the punctures heal, there are no strong scars or other damage left on the body. It is possible to perform the intervention under local anesthesia if the varicocele does not have complications.

The effectiveness of the procedure can be checked after 7 days using ultrasound or Doppler ultrasound.

Rehabilitation period: timing, lifestyle, nuances

After the operation, a long stay in the hospital is not necessary - a man can go home in 1–2 days. On the first day, the patient has a mild pain syndrome, which is easily relieved with painkillers with a minimum number of side effects (instead of powerful analgesics prescribed after more severe methods of intervention).

Despite the smaller list of restrictions that must be observed after surgery,.

Many urologists also highlight the following dependence and the adaptation period - the older the man, the more time he needs to return to the usual rhythm of life after surgery on the groin area.

Taboos after surgery:

• body-building;
• lifting weights;
• exercises on the horizontal bar;
• constipation

However, after 2 weeks - in the absence of complications - light physical activity is allowed: brisk walking, swimming, gymnastics, cycling. You can engage in active sports after 21 days from the date of discharge from the hospital.

and masturbation is also usually allowed after the recovery period is over, however, excessive stress on the press should be minimized. If during the development of varicocele there were no inflammatory processes inside the testicle, then you can easily return to planning a pregnancy.

Fact. Restoring the production of healthy sperm and bringing their concentration to normal levels in the ejaculate occurs several months after the operation.

Laparoscopic intervention is a priority choice for quality. The low percentage of relapses and the rapid adaptation process make laparoscopy a promising method for correcting varicose veins of the spermatic cord.

Useful video

Laparoscopic surgery in urology:

From a medical point of view, varicocele in men is considered as one of the consequences of an acquired or hereditary anomaly of the inferior vena cava and renal veins.

In the early stages, this disease is asymptomatic, but often patients can detect varicocele themselves - the symptoms of the disease are as follows:

• significant enlargement of veins in the scrotum area;
• pain, heaviness on the affected side of the scrotum. These sensations intensify during periods of physical activity;
• infertility.

There are several classifications of the severity of varicocele. According to the WHO classification, the following degrees of severity of the disease are distinguished:

• 1st degree (diagnosed only by the Valsava test, since dilated veins are not palpable and not visible);
• 2nd degree (dilated veins of the scrotum are well palpated, but not visible);
• 3rd degree (veins are visible and well palpated).

In addition, varicocele, the causes of which are impaired development of the inferior vena cava and renal veins, are classified according to the type of reflux (reverse blood flow):

• ileo-testicular reflux is accompanied by the movement of blood into the testicular veins from the iliac veins;
• reno-testicular reflux is characterized by the movement of blood into the testicular veins from the renal veins;
• mixed type.

Indications for surgical treatment of varicocele

Surgical treatment of varicocele is indicated in the following cases:

• in case of infertility due to impaired spermatogenesis;
• in the presence of pain;
• in case of relapse of the disease;
• with repeated unsuccessful attempts at IVF/ICSI artificial insemination;
• in case of miscarriages or miscarriage of pregnancy in a couple undergoing treatment;
• for the prevention of testicular hypotrophy (atrophy).

If the disease is discovered during a medical examination, and the patient, nevertheless, is not infertile, already has children or does not plan to have them, then the doctor is obliged to warn him about the possible complications of this disease and offer surgical treatment.

Types of operations

Due to the widespread prevalence of varicocele, treatment can be carried out using several methods (in total there are about types of surgical intervention):

• ligation and removal of testicular vessels (operation of Ivanissevich, Bernardi, Kondakov; Palomo);
• retroperitoneoscopic and laparoscopic methods;
• microsurgical operations performed from the inguinal approach;
• X-ray endovascular interventions;
• vascular anastomoses.

The most common currently are

• laproscopic clipping;
• microsurgical ligation of veins (Marmara or Goldstein operation).

Preparation for surgery

The set of measures before surgery includes the following tests:

• coagulograms;
• tests for syphilis, AIDS, hepatitis;
• general blood analysis and biochemistry;
• general urinalysis;
• determination of blood group and Rh factor;
• spermograms;
• Dopplerometry and ultrasound of the scrotum.

Treatment of varicocele (endoscopic surgery)

Endoscopic varicocele surgery is less invasive compared to classical methods, and, accordingly, has a better postoperative course and fewer complications. The operation is performed under local anesthesia. Three punctures with a diameter of 5 mm are made in the navel area, through which surgical instruments and a laparoscope (a tube with a light source and a built-in video camera) are inserted. The surgeon watches the progress of the operation on the monitor. The essence of the operation is to apply titanium staples to the testicular vein to block it. After this procedure, the patient remains in the clinic for only two days.
Treatment of varicocele (Marmara operation)

Microsurgical ligation (Marmara operation) is performed from a mini-access under the inguinal canal. Through the incision, the surgeon separates the testicular veins, which are ligated individually using a special microscope instrument. This does not affect the lymph nodes and surrounding tissues. The duration of all manipulations is about 45 minutes. After 7-8 hours the patient is discharged home.

Postoperative period

For several days after surgery, the patient is advised to avoid any physical activity. Over the course of several months, a reduction in excessive physical activity is indicated. In the postoperative period, the patient needs to change the dressing and undergo an examination by the attending physician to monitor wound healing. Sutures are removed one week after surgery.

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The male body is susceptible to many diseases, including varicocele. Otherwise, this is called varicose veins (dilation of the veins) of the testicles and is formed when there is insufficient or complete absence of blood flow in the scrotum due to enlarged veins in the pampiniform plexus of the spermatic cord.

The disease was first described by Celsius in Art. BC. But the connection between testicular varicose veins and their dysfunction was proven only in the 19th century. The danger of the disease lies in the development of infertility.

When is surgery necessary?

Surgery for varicocele is prescribed for a man at any age in order to preserve the ability to fertilize. It is performed in the following cases:

• bad spermogram;
• testicular atrophy;
• changes in testicle size;
• pain in the groin.

With such symptoms, there is only one way out - surgical intervention, during which the patient ligates the veins passing near the spermatic cord and forces the blood to flow in a different direction. There are many types of operations for the treatment of varicocele and each of them has its own characteristics. The patient is pre-injected with anesthesia. The operation lasts about an hour.

Organizational aspects

10 days before surgery, the following studies are expected to begin:

• general urine examination;
• if necessary, it is recommended to do an ultrasound of the scrotum or a contrast ultrasound using the Doppler method, during which a complete picture of the situation is obtained;
• blood tests, in particular for the Rh factor, sugar content, coagulability, and general indicators;
• X-rays of light;
• testing for AIDS, hepatitis C and B

On the day of the operation, you need to completely stop drinking and eating, take a shower and carefully shave the groin area. If you are taking medications for chronic diseases (diabetes, hypertension, bronchitis, etc.), drug therapy is agreed with your doctor.

How is varicocele surgery performed?

There are many types of operations for treatment: laparoscopy, traditional surgery, according to Ivanissevich, carried out directly with direct contact, microsurgical methods and innovative developments.

Operation Palomo

performed by the Palomo method, involves incision of the testicular vein affected by varicose veins. It is performed above the inguinal canal. The surgeon immediately gains access to the testicular vein, ligates it and removes it. This approach will reduce the risk of injury to the neurovascular bundle. The operation can be performed under either local or general anesthesia. After the operation and suturing, a sterile bandage is fixed on the wound. The man can go home the very next day, and the stitches are removed within 8-9 days.

Varicocele: Ivanissevich operation

The most common method of treating varicocele in men is the Ivanissevich operation.

• It consists of ligating the mouth of the testicular vein.
• In this case, it is reached directly through the groin area, making a longitudinal oblique incision, behind which the venous inguinal plexus is located.
• The mouth of the testicular vein is first ligated and then cut.
• After the operation, the wound is sutured, connecting each layer, and then skin sutures are applied.

Before surgery, local anesthesia is administered. In some cases, general anesthesia is acceptable. However, it is worth remembering that Ivanissevich’s operation for varicocele can lead to consequences: damage to the femoral artery and other formations located in the neurovascular bundle of the inguinal canal.

Varicocele: endoscopic surgery

This method of getting rid of the problem is better than the previous one, since it is gentle (no incisions are made in the groin). In this case, all the principles of laparoscopy are used.

For varicocele, laparoscopic surgery involves making 3 small incisions (1 cm) in the abdominal cavity, through which an endoscope or laparoscope with a camera and miniature instruments is inserted. By moving the instrument during the operation, they enter the mouth of the testicular vein, where, using a titanium clip, clipping and subsequent cutting of the vein are performed.

According to reviews from doctors, this technology is good for its minimal tissue damage, rapid healing of scars and restoration of the body.

The disadvantage of laparoscopy is the inability to use local anesthesia, since the abdominal cavity is involved. In case of damage to both testicular veins (varicocele on the left and right), laparoscopic surgery for varicocele is the best option.

How does endovascular embolization surgery work?

This operation is performed under visual control.

• To do this, an intravascular endoscope 2 mm thick is inserted through the femoral vein and advanced to the testicular vein.
• Next, the course of the varicocele operation is as follows: the vein is examined using a radiopaque substance.
• Then, a sclerosant is injected into its expanded part - a substance through which “gluing” (embolization) of the lumens of blood vessels occurs.
• This method of treating the disease is carried out without anesthesia, is minimally invasive, takes less time, has virtually no consequences or relapses, and is well tolerated by the patient.

Operation Marmara

Microsurgical operation of varicocele using the Marmara method is also based on ligation of the testicular vein. The incision is made along the outer edge of the inguinal canal in the area located below the level of wearing underwear. It is there that the testicular vein is located under the skin. The length of the incision is maximum 2 cm. The advantage of the method is the almost complete absence of relapses and complications in the postoperative period.

Laser treatment

Laser surgery for varicocele is a modern, less complicated technique that is performed without incisions in the groin.

• The operation is performed using an intravascular endoscope.
• The presence of a miniature camera allows you to quickly find the location of the affected vessel, which is then coagulated under the influence of a laser beam and is no longer involved in the general blood flow.
• When treating varicocele, surgery using this method can be performed without anesthesia.

When surgery is not possible

Despite the good tolerance of the operation, there are also contraindications that do not allow surgical treatment. Thus, sclerotization is not carried out when:

1. Increased pressure in the veins located near the disease area.
2. The anastomases are large, which can result in sclerosant getting into healthy arteries and veins.
3. Situations when it is impossible to insert a probe into the veins due to their structure

You cannot perform an open operation in the following cases:

1. Active inflammatory processes.
2. Diseases in the stage of decompensation, when elimination of organ dysfunction is impossible without treatment (for example, with cirrhosis of the liver, diabetes).

Endoscopic surgery for varicocele is not prescribed for the above reasons, or if the client has undergone abdominal surgery in the past. In this case, the clinic is disrupted and the risk of doctor errors increases.

Recovery

Many men are interested in how long the recovery period lasts. It all depends on the characteristics of the body. It may take 2 weeks for complete recovery. To restore spermatogenesis, a man after surgery may be prescribed:

• Dietary supplements based on zinc and selenium;
• ointments containing antibiotics;
• vitamin preparations;
• hormonal medications;
• Painkillers may also be needed.

After surgery, during the first two days you must follow the following recommendations:

• move as little as possible and rest as much as possible;
• do not wet the wound (if pain occurs, you can apply ice);
• Be sure to wear a bandage (it helps hold the testicles in place).

In the first two weeks the following are strictly prohibited:

• bath;
• physical activity;
• sex.

Complications

Surgery for varicocele may be accompanied by the following complications:

1. Neuralgic pain that occurs due to injury to nerve endings.
2. Relapse (reoccurring disease).
3. Hydrocele of the testicle as a result of injury to the lymphatic vessels.
4. Deep vein thrombosis due to hematoma in the puncture area or contrast injection.
5. Inflammatory processes.
6. Lymphatic edema is another consequence of surgery due to injury to the lymphatic vessels.
7. Reduction in testicular size. Caused by affecting the spermatic artery.
8. Damage to the ureter or intestines due to the inexperience of the doctor.

Varicocele is a dangerous disease that leads to serious consequences such as cancer. Self-medication will only make the situation worse. Therefore, at the first symptoms of heaviness or pain in the testicles, sexual dysfunction, swollen veins, you should immediately consult a doctor for advice.

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Diagnosis of varicocele

Feeling the scrotum
A mandatory procedure that allows you to determine the severity of varicocele. Ultrasound(ultrasonography). Ultrasound is always combined with Dopplerography (a technique that determines the quality of blood supply) of the renal vessels (arteries and veins) and the testicular vein.
The study is carried out with the patient standing (orthostasis) and lying down (clinostasis) with the measurement of the blood flow gradient in these positions.
During an ultrasound, it is necessary to perform Valsalva maneuver:

• Enlargement (varicose veins) of the testicular vein in size when the body is in an upright position.
• When the body is lying down, the vein collapses (reduces in size).

The testicular vein should not exceed 2 millimeters in diameter (normal). The speed of venous blood flow in the vein should not exceed 10 centimeters per second (normal). Absence of venous reflux (normal).

With varicocele of the first degree, the diameter of the testicular vein becomes 2 millimeters larger than normal and positive (up to 3 seconds) reflux is determined. Severe reflux indicates a more severe stage of the disease.

Ultrasound also allows you to determine the hemodynamic variant of varicocele, as well as identify renal venous hypertension (if any).

• General urine analysis before and after physical activity (march test). A positive march test - the appearance of a small amount of red blood cells in the urine (microhematuria) and the presence of protein in the urine (proteinuria) indicates renal venous hypertension.
• X-ray methods. X-ray methods include:
• Antegrade phlebotesticulography or retrograde renal phlebography - these research methods are performed after preliminary injection of a contrast agent into the veins of the scrotum.
• Hormonal profile study – includes the concentration of testosterone, estradiol, prolactin, FSH (follicle-stimulating hormone), LH (luteinizing hormone).
• Semiological research(semen examination) - in most patients pathospermia is detected (a decrease in the number of motile forms of sperm and an increase in the number of pathological forms) of varying degrees.

Treatment of varicocele

Non-drug treatment: Conservative treatment of varicocele is not effective.

Drug treatment: Drug treatment is prescribed only after surgery to stimulate spermatogenesis. Most often, a complex of vitamins and biologically active food supplements (containing selenium and zinc) are prescribed. Sometimes hormonal drugs are prescribed (androgens, human chorionic gonadotropin), they are used under strict laboratory control.

Preparation for surgical treatment: involves taking tests before surgery (to exclude decompensation of any organ or organ system). The following tests are required:

• General blood test (to determine the state of hematopoiesis)
• Blood type and Rh factor (for blood transfusion if necessary)
• Urinalysis (to check kidney function)
• Biochemical blood test (glucose, creatinine, urea)
• ECG (electrocardiogram) – to determine the work of the heart
• Chest X-ray (to exclude lung pathology)

Surgical treatment
Currently, there are more than 120 types of surgical treatment for varicocele.
All operations can be divided into two groups:

• Group I – operations in which the connection with the renal artery is preserved.
• Group II – operations in which the communication with the renal artery is interrupted

Currently, microsurgical techniques are successfully and widely used in the treatment of varicocele. This made it possible to reduce the number of relapses (repeats) of the disease, as well as significantly reduce the risk of complications after surgery.

Classical operations on varicocele
One of the most common operations is according to Ivanissevich. It consists of ligation and further resection of the left testicular vein. This leads to the elimination of reflux from the renal vein into the pampiniform plexus. But with this operation there is a possible risk of developing renocaval anastomosis due to difficulty in the outflow of venous blood from the kidney.

Microsurgical methods for treating varicocele
Laparoscopic clipping of the testicular vein
Laparoscopic varicoetomy is an endoscopic and minimally invasive method for the treatment of varicocele.

The operation is performed under general anesthesia (the patient is put under anesthesia). A trocar is inserted near the navel and the abdominal cavity is examined. Then the veins of the testicle are found, and the artery and lymphatic vessels are carefully separated from the veins. Then the veins are clipped (applying special clips) and the operation is completed.

Endovascular phlebosclerosis
The method consists of blocking the testicular vein with various substances or special devices.

Endovascular obliteration (occlusion) of the testicular vein is performed in both adults and children. Various substances are used for occlusion:

• Spiral emboli
• Fabric glue
• Wire umbrella devices
• Various cylinders
• Drugs that cause vein sclerosis

This method consists of catheterizing the femoral vein, then the probe is passed to the testicular vein and a thrombotic drug is injected, the blockage of the vein is checked and the operation ends.

Possible complications after surgery

Complications developing after classical operations.

Hydrocele (hydroxycele) – a complication in which fluid accumulates in the lining of the scrotum. In this case, hydrocele appears due to a violation of the outflow of lymphatic fluid. Disruption of lymph outflow occurs due to ligation of the lymphatic vessels along with the testicular vein during surgery.

This complication is treated, as a rule, either by puncture of the affected part with pumping out fluid or by surgery to restore lymph outflow.

Testicular atrophy. A very rare but serious complication is testicular atrophy. Testicular atrophy is characterized by a decrease in testicular size and a significant decrease in its function. According to statistics, this complication develops in 1:1000 patients operated on for varicocele.

Postoperative pain occurs due to blood overflow of the epididymis and, as a result, stretching of its capsule. But most often, patients after surgery experience a decrease in pain sensitivity.
Complications developing after laparoscopic clipping of the testicular vein.

Complications develop extremely rarely. The most common complication is mild abdominal discomfort after surgery, which is explained by pneumoperitoneum (abdominal cavity filling with air). Performed during endoscopic surgery for better visualization of organs. Over time, the air is absorbed and the discomfort goes away.
Complications that develop during testicular vein embolization:

• Allergic reactions to contrast agent. Can be avoided by administering desensitizing drugs before surgery
• Thrombophlebitis of the veins of the pampiniform plexus. Can be avoided by preventing thrombosis.
• Perforation of vessel walls.

Surgery to remove varicocele is indicated for varicose veins of the spermatic cord, as this is the main cause of infertility in men. Therefore, surgical treatment must be carried out at the very beginning of the formation of a testicular tumor.

Indications for surgical treatment

Due to the expansion of the veins, the normal blood supply to the testicular tissues and the process of thermoregulation are disrupted. The number of sperm decreases and they become less mobile. In most cases, the left side is affected, although bilateral pathology sometimes occurs.

Varicocele can be congenital and usually begins very early, but does not manifest itself in childhood. The first clinical signs begin to appear as the child grows older (in adolescence).

Surgery to remove varicocele is needed if the following symptoms are present in a teenager or an adult man: The course of the disease in a teenager may be asymptomatic, so the indication for surgical removal of varicocele may be data obtained as a result of the Valsalva maneuver, ultrasound examination or palpation of the pampiniform plexus. The effectiveness of treatment depends entirely on the degree of the disease and the chosen technique. If necessary, the patient is prescribed a testicular biopsy.

• pain in the groin;
• feeling of discomfort;
• swelling;
• testicular swelling.

The technique of surgical manipulation depends on the size of the testicle and the age of the patient. Before starting treatment, it is necessary to prepare for testicular surgery for varicocele in order to avoid serious complications and consequences.

Advice: The earlier the disease is detected, the sooner treatment will begin and the risk of developing serious complications will decrease. Therefore, if you have the slightest sign or concern, you should consult a doctor.

Preparation for surgery

Preparation for surgery begins with a laboratory examination of the patient. It is needed to exclude certain diseases: chronic diseases, lung pathologies, problems with the gastrointestinal tract. All this can affect the course of the operation and the patient’s condition.

• Before performing surgery to remove varicocele, it is necessary to establish the main cause that causes blood stagnation in the testicle.
• Also, depending on this, the type of operation is selected that will help preserve the man’s ability to fertilize.
• Immediately before surgery, the hair growing in the area of ​​the surgical field is shaved.
• First of all, you need to take a general urine and blood test, blood test for creatinine, Rh factor and group.
• An analysis for the prothrombin index and an electrocardiogram is also prescribed.
• The doctor is obliged to familiarize the patient with information about how long the operation will take and the methodology for carrying it out.

Types of operations

Today, there are different types of testicular surgery to remove varicocele. Among them are the most important:

• Marmara operation for varicocele;
• laparoscopic varicocelectomy;
• laser surgery;
• Ivanissevich operation.

The Marmara microsurgical operation is the best method for replacing a diseased testicular vein with a healthy vein. To do this, doctors provide themselves with mini-access to the required area of ​​the body, without penetrating the abdominal cavity. The microsurgical technique is considered the least traumatic among all other techniques, since it almost never causes the appearance of cosmetic skin defects.

Also, microsurgery has the lowest risk of relapse and serious complications. Its advantages include a quick recovery period and low invasiveness.

Microsurgical manipulation does not require mandatory hospitalization of the patient in a hospital and can even be performed on an outpatient basis. The preparatory period is standard, as for all other surgical interventions.

Progress of Operation Marmara

The patient is given an anesthetic injection, which has an anesthetic effect. The anesthesiologist decides how much anesthetic to administer based on the patient’s total weight and age. Next, the surgeon makes a small incision in the groin area no more than 2-3 cm. After the swollen vein is found, it is bandaged, stitched and crossed. This helps normalize blood flow and relieve the negative symptoms of varicocele.

• During Marmara microsurgery, in rare cases, accidental nerve damage in the groin or bleeding may occur.
• The recovery period is only 3 days, and the stitches are removed already 8-10 days after they are applied.
• The only disadvantage of this technique is its high cost, because special tools and expensive optics are used.

During the postoperative period, it is recommended to avoid severe physical activity and sudden movements. You cannot have sex for one month and you must protect the incision area from friction. Underwear should be natural and not tight.

After three months, you should take a spermogram in order to assess the ability of sperm to fertilize. Six months after treatment, you can return to your normal lifestyle.

Advice: The doctor must decide which types of surgical interventions to prefer from all available ones, taking into account the patient’s age and individual problem.

Progress of Ivanissevich's operation

During the Ivanissevich operation, complete closure of the lumen of a varicose vein is performed under local anesthesia for adults. For children, surgery is usually performed under general anesthesia. It takes about 30 minutes. This type of treatment for testicular varicocele is considered cheaper. The essence of the method is to cut and ligate the left vein in the testicle. This helps eliminate the main negative factor that causes backflow of blood into the plexus of the testes.

• The postoperative period in this case is longer, and the risk of complications is quite high.
• During all manipulations, the femoral artery and other anatomical formations in the inguinal canal may be damaged.
• In addition, the disadvantages include complete dissection of the abdominal wall and penetration into the abdominal cavity.
• The patient will be unable to work for several months.
• There remains a chance of relapse, which is about 40%.
• The advantages of Ivanissevich’s operation include the absence of the need to use special equipment and the ability to perform it for everyone.

Laparoscopic surgery

Endoscopic varicocelectomy is performed in cases where the patient has bilateral dilatation of the veins of the spermatic cord. Incisions are made in the navel, left and right iliac region. Their size very often does not exceed 1 cm. Endoscopic devices, instruments and an endoscopic television camera pass through them. Therefore, the doctor can monitor the progress of the operation and, if necessary, adjust his actions.

• The most non-invasive operation is considered to be laparoscopic, which occurs with minimal trauma to the patient.
• In this regard, it carries a lower risk of complications than other types of surgical interventions, which often cause bleeding or the formation of infiltrates.
• After using the laparoscopic technique, the patient does not receive a cosmetic defect, since the seam remains almost invisible.

Disadvantages include the high cost of the operation and the need for general anesthesia. The postoperative period usually takes about 3 days, after which the patient is discharged. The doctor tells him when he needs to come to have the stitches removed, how many days it will take to fully recover after varicocele surgery, etc.

Laser surgery for varicocele

The advantages of this type of intervention include the absence of the need for anesthesia and a quick rehabilitation period.

• You can also highlight the minimal risk of complications or serious consequences.
• Surgeries for varicocele have significant differences from circumcision of the foreskin, surgery to remove a testicle in men, or amputation of the penis.
• Only a doctor can answer the question of how long the rehabilitation period will take and what the cost of surgery to restore the testicle will be.
• Laser treatment of varicocele is one of the most modern methods of solving this problem.
• To do this, there is no need to make an incision in the groin area, and all manipulations are performed using an intravascular endoscope.
• Fiber optics helps to find the exact area of ​​vessel dilation and coagulate it under the action of a laser beam.
• After this, it is switched off from the general bloodstream.

Contraindications

Not all patients can undergo surgical treatment of the testicle, as there are certain contraindications. Laparoscopic surgery cannot be performed if the patient has already undergone such an intervention earlier or if he has a malignant tumor. Microsurgical operation is prohibited if the patient has diabetes mellitus or severe cardiovascular pathologies.

• Before undergoing surgery to remove testicular varicocele, the patient must undergo a thorough examination so that the doctor can identify the exact cause of the disease.
• After this, it will be possible to select the optimal type of surgical intervention, taking into account the individual pathology, the patient’s age and his financial capabilities.

vseoperacii.com/mps/mpo/udalenie-varikocele.html

Varicocele - general information

Varicocele is a very common disease that develops from insufficient functioning of the valves of the internal testicular vein or their complete absence, and is characterized by dilation of the veins of the spermatic cord of the testicle.

• According to its anatomical structure, the genital organ consists of a tubular muscular wall, with a passing testicular artery, which supplies blood to this organ, and venous vessels through which the outflow of blood occurs in the opposite direction.
• The spermatic cord contains the vas deferens, which exists to transport sperm to the urethra and lymphatic vascular collectors.

This disease affects up to 20 percent of the male population. The anatomical features of the structure of this organ provoke the occurrence of this disease on the left side. Right-sided varicose veins may indicate a tumor in the right kidney. The internal testicular vein drains blood from the testicle.

• On the right side, the outflow of blood is directed to the inferior vena cava, while on the left side all the blood is directed to the left renal vein.
• The testicular vein has a much lower hydrostatic pressure than the renal vein into which it flows.
• During normal activity of the testicular vein valves, blood from the renal vein does not enter the testicular vein.
• If these valves do not exist or their operation is ineffective, blood from the system, where the pressure is much higher, will be thrown to where the pressure is lower.

In this case, blood from the left renal vein will flow into the left testicular vein. As a result, blood circulation in the testicle is disrupted - blood stagnates in the veins of the spermatic cord. From the accumulation of a large amount of blood, its temperature rises, which has an extremely negative effect on its function, and subsequently will lead to its complete loss. Normal spermatogenesis is possible under the condition of a stable temperature, which is also lower than body temperature.

Elevated temperature negatively affects the process of formation and maturation of sperm.

Manifestations of the disease

Clinically, the manifestation of varicose veins of the spermatic cord is manifested by pain in the scrotum and its significant enlargement. Sometimes the clinical picture is completely absent.

• Most often, varicocele is discovered in adolescence.
• Having reached a certain stage, it has no tendency to develop further.
• Often they learn about the existing diagnosis during the next medical examination.

Patients rarely complain about this disease. This is due to the fact that the symptoms of such a disease are more likely to be visual than to cause any concern. There may be slight, nagging pain on the affected side, which tends to intensify with walking, physical activity and sexual arousal. Often, an enlarged left side of the scrotum can be detected when a man is standing. In a supine position, it is not possible to see any sign of the disease due to its absence.

When the disease is in an advanced state, then the feeling of pain is constant. This disease is characterized by a significant enlargement of the scrotum, a decrease in the left testicle, and varicose veins of the scrotum.

Is surgery necessary?

• If a varicocele is diagnosed, men are interested in: is surgery necessary in this case?
• When treating varicose veins, there is no other method than surgery.
• However, not all cases of varicocele are an indication for surgery.

The operation should be performed for male infertility, when, due to existing disorders, the quality, motility and quantity of sperm deteriorate, with constant pain in the testicular area, for an aesthetic effect and for the reason that the affected testicle stops growing at puberty.

What types of varicocele removal operations are there?

To have an idea of ​​how surgery is performed for varicocele, it is necessary to consider all the main surgical techniques used today.

1. Laparoscopic intervention technique– is characterized by high efficiency and is low-traumatic. During the intervention, it is possible to intraoperatively determine the number of branches of the internal testicular vein, perform their resection, without touching the artery, which makes relapse impossible. During the operation, the patient is under general anesthesia. Patients are discharged after surgery the very next day.
2. Microsurgery– this technique is carried out using local anesthesia, takes several hours, is highly effective, but some complications and relapses are possible. For such an intervention, a specialized microscope is required.
3. X-ray endovascular surgery– to perform it, X-ray control is used, under which the testicular veins are blocked. Being minimally invasive, the operation is not highly effective.
4. Open surgeries that are traditional– such methods include Ivanisevich and Palomo operations. A somewhat outdated version of surgical intervention. It is traumatic and has a high rate of complications and relapses. The recovery process is long. It is performed under local anesthesia.

The main reason for treating varicocele is the prevention and treatment of male infertility.

Postoperative period

After surgery for varicocele, sex is possible after the rehabilitation period, taking into account the characteristics of each organism and the type of operation, this is approximately three weeks. After surgery, sex usually remains at the same level.

The most unpleasant complication after surgery may be damage to the nerve located in the inguinal canal.

In addition, there may be cases when, after varicocele surgery, bleeding occurs, the postoperative wound becomes infected, and testicular hydrocele occurs. In almost all cases, patients recover quickly and the pain goes away. If pain still occurs, you should consult your doctor.

• Varicocele is a disease that is common in young people.
• It is necessary to follow the rules of prevention so that, if necessary, you do not miss the early diagnosis of varicocele.
• This includes proper distribution of physical activity, avoiding constipation, and periodic visits to a urologist.

Stages of the disease and indications for surgery

There are 4 degrees of development of varicocele:

• Varicose veins are determined only by ultrasound.
• The veins of the pampiniform plexus are palpated in a standing position.
• By palpation in any position, the doctor can diagnose the disease.
• Veins are visible to the naked eye.

A decrease in spermatogenic function, which can eventually lead to infertility, usually begins only in the last stages of the disease.

The operation can be performed in the following cases:

1. Disturbances in sperm formation were revealed. During the study, it was found that the number of spermatozoa in the seminal fluid is reduced, their motility is reduced, and blood or pus is present.
2. The patient is experiencing pain. They begin to appear at stages 2-3 of the disease, at first they are minor. Unpleasant sensations intensify when walking, after physical activity. Note. In the vast majority of cases, varicocele of the left testicle develops, so the pain most often has the same localization.
3. The patient is not satisfied with the appearance of the scrotum.
4. The testicle begins to decrease in size.

In the absence of symptoms, surgery may also be recommended. Some doctors believe that surgery, done in a timely manner, can prevent infertility. Others believe that this is an unjustified risk and advise limiting monitoring through periodic examinations and ultrasound.

Important! The operation is usually not performed before the age of 18. According to statistical data, in adulthood, after surgical intervention, relapses occur much less often - re-development of varicocele. Therefore, it is better to carry it out after puberty.

Compression of the veins can lead to the development of the so-called “secondary varicocele”. It occurs as a result of a tumor, cyst or other formation. In this case, the patient is worried about fever, blood in the urine, dull or stabbing pain in the lumbar region. With secondary varicocele, it is necessary to eliminate the cause of the disease, vein truncation surgery is not required until the results of therapy for the underlying pathology appear.

Contraindications

Different surgical techniques may have different contraindications. Open surgical interventions are not performed for:

The presence of diseases in the stage of decompensation (impaired organ functions that cannot be restored without treatment) - diabetes mellitus, cirrhosis of the liver, etc.

• Inflammation in the active stage.

In addition to the described contraindications, endoscopic operations are not performed in cases of previous surgical interventions in the abdominal cavity. This is due to a violation of the clinical picture and an increased likelihood of physician errors.

Sclerosis is not carried out with the following contraindications:

1. Large anastomoses (bridges) between vessels, which can lead to the entry of the drug used for gluing into healthy veins or arteries;
2. Increased pressure in nearby veins (eg, renal veins);
3. The structure of the vessels does not allow the insertion of a probe (the crumbly nature of the veins).

Preparation for surgery

10 days before the proposed procedure, patients need to undergo some tests:

• Blood test (general, group and Rh factor, coagulability, sugar content).
• General urine analysis.
• X-rays of light.
• Electrocardiogram (can be prescribed to all patients or only to men over 30 years old).
• Analysis for hepatitis B and C viruses, HIV.

In addition, the doctor usually prescribes an ultrasound of the scrotum or an ultrasound using the Doppler method (using a contrast agent) to obtain a more complete clinical picture. Additional studies are possible depending on the patient's condition.

In the morning before surgery you need refuse food and water, take a hygienic shower. The pubis and abdomen must be clean shaved. Taking medications for chronic diseases (diabetes, hypertension, bronchitis, etc.) must be agreed with your doctor.

Methods of performing the operation

The classification of surgical treatment methods can be based on the method of access and technology. Based on the second characteristic, two large groups of operations are distinguished:

1. With preservation of the recocaval anastomosis;
2. With its excision.

Note. A renocaval shunt (anastamosis) is a communication bridge between two testicular veins. It occurs as a pathology due to varicocele and contributes to blood stagnation.

The second method is currently recognized as the most effective and is used most often.

According to technology, it is customary to distinguish three main types of operations:

• Laparoscopy (minimally invasive method);
• Endovascular sclerotherapy;
• Open surgery (can be performed in various modifications - according to Marmar, Ivanissevich, Palomo).

Important! Removal operations for varicocele are not performed. All vessels remain inside the body; they are either glued together (sclerotic) or ligated.

operaciya.info/urologia/varikocele/

Stages of the disease (varicocele)

1. at the first stage there are no external manifestations of varicocele, except on palpation;
2. at the second stage of the disease, dilated veins on the testicle (usually the left one, due to anatomical features) are clearly visible, but its size is not changed;
3. at the third stage, with pronounced varicose veins, a change in the size of the testicle is visible.

Symptoms of varicocele

In the initial stages, a varicocele may not bother a man with pain symptoms. However, this disease can progress into chronic disease and lead not only to discomfort in sexual life, but also to infertility.
The occurrence of pain caused by varicocele can be observed in the groin, scrotum, and both testicles. Characteristic is a sharp increase in pain when walking, running, physical activity, or during sexual intercourse.

Diagnosis of varicocele

Primary diagnosis of the disease is carried out using an external examination of the patient, palpation, and ultrasound. The doctor may also prescribe tests to study sex hormones in the blood and a spermogram to determine the degree of impaired fertility.

Treatment of varicocele and effect on male infertility

Treatment of varicocele is carried out exclusively by surgery, since only surgery can give the best effect. There are different types of operations. It is believed that at present the microsurgical method of surgical treatment is the most effective: it allows surgical intervention to be performed with the least tissue damage as a result, rehabilitation time takes less time. The operation helps restore blood flow in the testicles and restore normal spermatogenesis (production of a sufficient number of living and anatomically correct sperm). Improving the quality of sperm and eliminating pain will allow you to have a full sex life, without the threat of infertility.

From childhood, varicocele prevention should be done, since hereditary acquisition of the disease is possible. It is important to see a urologist regularly.

https://euromed.ru/patients/simptomy/male-infertility/varicocele/

Causes of varicocele

Varicocele is not an independent urological disease. Doctors view it as a symptom of pathology of the renal veins or inferior vena cava, a genetic developmental abnormality.

The term “reflux” is used to describe the process of blood moving through the veins of the spermatic cord in the opposite direction. Reflux happens:

• Primary. It is a consequence of: - lack of valves in the testicular vein (congenital anomaly); - weak venous wall.
• Secondary. It occurs due to valvular insufficiency, which develops due to high pressure in the renal veins and the inferior vena cava. Due to venous hypertension, blood seeks additional pathways for outflow. A large area is formed that connects the vena cava and the renal vein. Since the dilated communication occurs between the external and internal spermatic veins and the common iliac vein, it compensates for the high pressure in the renal vein. Among the causes of high pressure in the renal veins: - Localization of the left renal vein behind the aorta. - Spasm of the lumen of the renal vein. - Annular shape of the renal vein. .- Presence of arteriovenous fistula.

Possible causes of venous reflux (and, as a consequence, varicocele) include conditions that compress the spermatic cord:

• diseases of the scrotum;
• pathologies of the inguinal canal;
• abdominal hernia.

Symptoms of varicocele

Signs of varicocele depend on how dilated the veins of the spermatic cord are. In the first and second stages, the disease does not manifest itself in any way. It can only be detected during a medical examination using ultrasound.

At the third stage, men complain of:

• Discomfort, pain in the scrotum area (can be aching or sharp, severe).
• Inconvenience while running, walking (pain that occurs in the groin when moving often resembles neuralgia).
• Increased sweating.
• Burning sensation in the scrotum.
• Deterioration of sensitivity during sexual intercourse, decreased libido.

During a physical examination at the third stage of varicocele, the urologist records dilated veins reaching the lower pole of the testicles and descending below it. The affected testicle is located lower than the healthy one, causing the scrotum to appear asymmetrical.

At the fourth stage of varicocele, pain becomes unrelated to movements and physical work. It never goes away and gets stronger at night. The scrotum increases significantly in size. Testicular asymmetry is clearly visible.

If you notice similar symptoms, consult a doctor immediately. It is easier to prevent a disease than to deal with the consequences.

Diagnosis of varicocele in men

If a varicocele is suspected, the doctor first feels the scrotum to understand how much the veins of the spermatic cord have dilated. The patient is prescribed:

• Get an ultrasound and Doppler ultrasound.
• Take a urine test using the March test (before physical activity and immediately after it). If red blood cells and protein are detected (positive result), we can talk about venous hypertension.
• Undergo X-ray methods.

Ultrasound as a way to detect varicocele

During the examination, the man first lies down, then stands. Changing posture is necessary in order to determine the speed of blood flow in different positions. During the procedure, the ultrasound diagnostic doctor must perform the Valsava maneuver. Its essence is as follows: the testicular vein increases and expands when the patient stands, and decreases if he lies down.

Normally, ultrasound shows that:

• the diameter of the testicular vein is not more than 2 mm;
• the speed of venous blood flowing through the testicular vein is no more than 10 cm/s;
• There is no venous reflux.

With a large diameter of the testicular vein and reflux, a diagnosis of “varicocele” is made.

Also, using ultrasound diagnostics, the doctor can determine the development of renal venous hypertension, if any.

X-ray methods for varicocele

Of the radiological methods used to diagnose varicocele, the following can be used:

• retrograde renal venography;
• antegrade phlebotesticulography.

They involve injecting a contrast agent into the scrotum before taking pictures.

Additional methods for diagnosing varicocele

Men who are at high risk of developing varicoceles should undergo two additional tests:

• Semiological. Aimed at studying sperm quality. Most people with varicocele have pathospermia (a small number of motile sperm).
• Hormonal profile assessment. The levels of estradiol, testosterone, luteinizing and follicle-stimulating hormones, and prolactin are determined.

A full diagnosis can be performed at any modern urological medical center.

Treatment of varicocele in men

Treatment of varicocele in men without surgery is not effective. Doctors resort to drug therapy only after surgery to stimulate spermatogenesis.

Typically, operated patients are prescribed vitamin and mineral complexes and nutritional supplements containing selenium and zinc. Hormones may be used if necessary.

Operations for varicocele in men

The cost of surgery for varicocele depends on the chosen surgical method. Today there are more than a hundred ways to combat this disease. All of them can be divided into two large groups:

• Provide for maintaining communication with the renal artery.
• Interrupting communication with the renal artery.

Now doctors give preference to microsurgical techniques that reduce the duration of the rehabilitation period, minimize the risk of developing postoperative complications and reduce the likelihood of disease recurrence.

Preparation for surgery

Before the operation, the man must undergo the following tests:

• CBC (to determine clotting);
• blood type and Rh factor (any surgical intervention is associated with the risk of bleeding, so doctors need to know what blood type the patient has);
• OAM (to check kidney function);
• electrocardiogram (to study the functioning of the heart);
• blood biochemistry for urea, glucose and creatine;
• chest x-ray.

Types of operations performed to remove varicocele

A man will find out how much an operation to remove varicocele costs at a preliminary consultation. The price is determined by the complexity of the planned intervention and the type of equipment used.

Operation according to Ivanissevich

The Ivanissevich operation is most often used by surgeons to remove varicoceles in men. Its essence is ligation and resection of the left testicular vein. As a result, reflux is eliminated.

The indication for this type of treatment is grade 3 and 4 varicocele. Contraindications include: hemophilia, diabetes mellitus. It should be noted that this is one of the oldest ways to solve the problem.

Marmara operation for varicocele

The Marmara operation is the safest way to remove varicocele. It is passed through the outer ring of the inguinal canal. This is the main advantage of this type of treatment - it is much easier to find an enlarged vein through the groin than through the abdominal cavity.

The incision made does not exceed 2-3 cm. Having gained access to the canal of the groin area, in which the testicular vein is located, the doctor ties it, stitches it and crosses it. The surgical incision is then sutured.

Sperm quality improves significantly after Marmara surgery.

Laparoscopic surgery for varicocele

Laparoscopic testicular vein clipping is a minimally invasive and endoscopic method for removing varicoceles. They resort to it when:

• any degree of illness;
• mixed type varicocele.

The price of varicocele laparoscopy is quite high, but it is justified, since the operation is characterized by a large number of advantages:

• Allows clipping of veins if they are affected on both sides.
• Almost completely eliminates the risk of complications.
• Reduces hospital stay to 3 days.
• Provides excellent cosmetic effect (the seam is almost invisible).
• After treatment there is almost always a good spermogram.
• Even in the first days while walking, the patient does not feel pain.

Laparoscopy of varicocele is performed under general anesthesia.

Endovascular phlebosclerosis for varicocele

Endovascular phlebosclerosis is the closure of the lumen of the testicular vein using a special device or composition. The operation is performed for the renotesticular type of pathology, if there is no venous hypertension and stenosis of the renal artery. It does not require general anesthesia and does not involve any incisions. Within 2 days after treatment, the man can return home.

Endovascular obliteration of the testicular vein can be performed not only in adults, but also in children. To close the vein, use:

• cylinders;
• fabric glue;
• spiral emboli;
• wire devices shaped like umbrellas;
• preparations for vein sclerosis.

Complications arising after surgical treatment of varicocele

After treatment of varicocele (especially if an Ivanissevich operation was performed), complications may arise:

• Hydrocele of the testicle (fluid collects in the lining of the scrotum).
• Testicular atrophy (the testicle significantly decreases in size and its functions deteriorate).
• Pain in the groin area (the blood-filled epididymis stretches its capsule).
• Perforation of vascular walls.

Why is varicocele dangerous?

Varicocele leads to male infertility. The disease is also accompanied by:

• pain in the scrotum;
• production of antisperm antibodies (due to disruption of the barrier between testicular tissue and blood);
• high testicular temperature;
• excessive production of hydrocortisone;
• disruption of the production of pituitary hormones.

Prevention of varicocele

If a man is predisposed to developing varicocele, prevention measures are usually ineffective.

To minimize the likelihood of dilatation of the veins of the spermatic cord, you need to:

• wear comfortable underwear that provides good support but does not pinch the scrotum;
• do not lift weights;
• treat constipation in a timely manner;
• have regular sex life;
• exercise;
• take walks.

https://illness.docdoc.ru/varikotsele

Testicular varicocele in men: what does the diagnosis mean?

If a man is diagnosed with varicocele, then initially one might think that the disease is somehow related to varicose veins, since both names have the same root. Indeed, the names are similar, as are the mechanisms of pathology development.

Testicular varicocele is a varicose vein in the spermatic cord. This disease is observed mainly in adolescents aged 14–15 years and in young men of reproductive age. Statistics show that in general the pathology occurs in 15% of men.

Symptoms of testicular pathology in men

Varicocele disease in men belongs to the category of pathologies that occur without significant symptoms. Most often, originating during puberty of a young person, it quickly develops to some extent and then stops. There are also cases when the disease regresses on its own and then disappears altogether.

However, the following alarming signs of this disease may indicate a developing varicocele:

• Increase in size and descent of the left testicle (if the pathology is localized on the left).
• Mild “pulling” pain in the scrotum and groin. While walking or during heavy physical activity, these sensations may become more pronounced and cause discomfort.
• If the scrotum is severely drooping on one side, this can interfere with normal walking.
• Pain in the scrotum, bulging of its veins, shrinkage of the left testicle (with severe varicose veins of the testicle).

If signs of varicocele are detected, it is better to immediately go to a specialist rather than wait for the pathology to regress.

Causes of varicocele in men

The reason why varicocele appears is the occurrence of a malfunction of the valves in the veins of the testicles. These valves should normally prevent blood from flowing back at any level of pressure in the veins. In cases where, when the pressure increases (for example, during physical exertion), the valve does not cope with its job, the blood flows in the opposite direction, expanding the vein near the spermatic cord.

The cause of varicocele may also be associated with a kidney tumor. If a tumor is localized in the kidney, it compresses the renal vein and disrupts blood flow in the ovarian vein, which just branches off from the renal vein. As a result of blood stagnation, varicose veins develop.

Degrees (stages) of development and types of disease

The more dilated the testicular veins are, the deeper the degree (stage) of varicocele development:

• Zero degree. As a rule, a disease to this extent is discovered by chance if the patient is prescribed a Doppler ultrasound of the scrotum to examine signs of other male pathologies (for example, hernia, tumor, and so on). During palpation, dilation of the testicular veins cannot be felt.
• First degree. An enlarged testicular vein can be detected by palpation only with the patient standing.
• Second degree. Testicular veins affected by varicose veins can be easily palpated in any position.
• Third degree - dilation of the veins is noticeable upon visual examination of the scrotum.

Left-sided varicocele is the most common variant of the pathology. The cause of varicocele is the special location of the vein surrounding the left testicle. It is connected to the renal vein, which, in turn, due to its plethora, often suffers from the influence of various internal and external factors. In 98% of cases of the total number of identified pathologies, it is varicocele of the left testicle (varicocele on the left) that is diagnosed.

Bilateral varicocele or varicocele of the testicle on the right can develop due to vascular abnormalities, which, in turn, can be congenital or a consequence of vascular diseases.

Is varicocele dangerous and why: what complications and consequences of the disease may arise in men?

Despite the fact that varicocele often has mild symptoms and may not affect a man’s normal life, this disease has complications. The first and most important threat from varicocele is infertility in men.

The chain of formation of an unpleasant complication is as follows: blood flow in the scrotum is disrupted, the testicles do not receive proper blood supply, and harmful compounds and free radicals begin to accumulate in them. The consequence of these factors is impaired spermatogenesis. There are fewer sperm in a man’s semen or their morphological qualities sharply decrease. In other words, the sperm of a man with varicocele cannot fully participate in the fertilization process. However, you should not literally think that varicocele always leads to infertility. We are talking only about individual observed cases.

Another consequence that the presence of varicocele leads to is phimosis. The problem is more common in boys and is expressed in the lack of opening of the penis due to a narrowed foreskin.

The doctor will be able to explain to the man how dangerous varicocele is in each specific case after diagnosis.

Ultrasound diagnostics for the diagnosis of varicocele

When, visually or by palpation, the doctor (and maybe the patient himself) detects the presence of enlarged, thickened veins, a decrease in the size of the testicle on the affected side, an ultrasound with Doppler is prescribed to clarify the diagnosis.

An ultrasound probe is applied to the scrotum, and the doctor begins to study certain parameters. Ultrasound technology allows you to compare the size of the testicles, determine their consistency, and also estimate the size of the vein surrounding the testicle. You also need to evaluate the speed of blood flow in this vein, which determines how correctly and fully the testicle will function.

If the ultrasound monitor visualizes veins with noticeable thickenings (there may be several of them, they look like dark circles), a varicocele is confirmed.

What treatment is prescribed for men when they are diagnosed with testicular varicocele?

Before talking about treatment, you need to decide which doctor to go to if you suspect a varicocele. Urologists deal with this problem. Very often, the first meeting with a urologist for young men occurs at school, when various medical examinations at the military registration and enlistment office begin in high school. After such checks, young people learn about their problem for the first time, after which they only have to make an appointment with a urologist for a more detailed diagnosis.

Treatment of varicose veins of the spermatic cord of the testicle involves surgery. But it is important to know for sure whether surgery for varicocele is necessary or is it not indicated for everyone?

If a boy has pain, there is a decrease in the testicle on the affected side, and there are signs of underdevelopment of this testicle, surgery is needed. It is also prescribed to men with varicocele who cannot have children. A preliminary examination of sperm (spermogram) is carried out, which shows the presence or absence of spermatogenesis disorders. However, the doctor does not give a 100% guarantee that after eliminating the varicocele, the patient will have the opportunity to have children.

If there are no special indications for surgery, the varicocele is simply observed over time.

Types of operations

Today, doctors use several methods and types of surgical operations to treat varicocele:

• Laparoscopy for varicocele involves punctures of the skin in several places to provide access to the veins of the instrument (laparoscope). If dilated veins are detected, they are ligated.
• Endovascular sclerotherapy involves gluing together pathological vessels by introducing a special therapeutic substance into them.
• Open surgery for varicocele involves an incision in the pubic part with further ligation of the vein.

From the last group of operations, it is worth considering the Marmara operation technique for varicocele. The doctor makes an incision in the pubic region close to the ilium, then excises the integument and subcutaneous tissue, isolates the spermatic canal and ligates the vein.

To determine the patient’s health status before surgery for varicocele (laparoscopy, Marmar, or others), tests are prescribed: blood sugar, coagulability, Rh factor, HIV, hepatitis, urinalysis, fluorography, ECG.

Is it possible to treat varicocele without surgery? Non-surgical conservative treatment for varicocele is usually unsuccessful and only makes sense as a preparation for surgery.

Rehabilitation and recovery after surgery for varicocele

The postoperative recovery period in the case of surgery to eliminate varicocele may have different periods:

• 1 month for microsurgery or laparoscopy;
• 2 months for open operations.

For normal recovery after surgery to remove varicocele, a man/boy needs:

• exclude physical activity;
• maintain sexual rest;
• exclude visiting saunas, swimming pools, baths;
• Avoid drinking alcohol.

What can be the consequences and complications after surgery to eliminate varicocele in men?

Any operation is always associated with risk, so in case of varicocele it is necessary to clearly determine whether it is indicated or not. The main complications after varicocele surgery include:

• the appearance of swelling, hematoma in the scrotum area;
• pain in the testicles;
• purulent and serous discharge from the area of ​​the puncture or incision;
• redness of the skin;
• increased temperature of the penis;
• disturbance of spermatogenesis;
• infectious contamination as a result of the use of non-sterile surgical instruments.

Recurrence of varicocele: is it possible for the disease to return after surgery?

Before surgery, many patients are interested in whether varicocele can recur after surgery? It must be said that the likelihood of varicocele recurrence is small, but it exists.

The reasons for the return of the disease may be poorly performed manipulations by the doctor, the patient’s failure to comply with the rules of conduct in the postoperative period, a genetic predisposition to the disease, or abnormal vascular structure. Also, the cause of relapse of varicocele can be a pathology of the cardiovascular system, against the background of which varicose veins of the lower extremities develop.

Prevention of testicular varicocele in men

To prevent varicocele disease and prevent it from progressing to a deeper degree, you should:

• avoid stress;
• lead an active lifestyle, avoid prolonged sitting;
• Healthy food;
• take vitamins containing zinc, selenium;
• have regular sex life.

How can varicocele affect conception and is pregnancy possible after surgery to eliminate male pathology?

Urologists often hear the question: can a woman become pregnant from a man with varicocele or is it possible for him to conceive and have children after surgery?

The diagnoses of varicocele and infertility can overlap - that is, the first causes the second. But this is not always the case. It is difficult to give an unambiguous answer as to when you can get pregnant after removal of a varicocele. Definitely not earlier than 1–2 months after the operation, since a man needs sexual rest during this period.

Studies do not provide specific figures about the statistics of infertility with varicocele or what the proportion of successful pregnancies is after eliminating the pathology. It is only worth saying that if varicocele is the only pathology in the male body and it is this disease that affects the quality of sperm and the lack of conception, then after the operation is performed, the probability of becoming pregnant will be high.

In principle, you can have children with varicocele, if this pathology does not cause underdevelopment of the testicle and impaired spermatogenesis.

https://mcgenesis.ru/services/urologia/varikocele-u-muzhchin

Varicose veins of the spermatic cord and testicle today considered one of the most common male diseases. According to WHO statistics, this disease is diagnosed in more than 16% of the male population.

In 2% of cases, right- or bilateral varicocele occurs, in 98% - left-sided.

The degrees of varicocele vary depending on the intensity of the venous dilation.

Subclinical varicocele: testicular veins are not detected by palpation; varicocele can only be detected based on ultrasound results.

• 1st degree: dilated veins can be felt with your hands only in a standing position.
• Grade 2: varicocele can be easily detected by palpation in any position of the body.
• Grade 3: a visual examination is sufficient to identify dilated veins.

In most cases, varicocele rapidly progresses and, having reached any specific stage, stops developing.

Varicocele of subclinical and first stages does not require treatment. To eliminate negative phenomena, it is enough to eliminate stagnant processes localized in the pelvic organs.

The list of such measures includes giving up alcohol, normalizing bowel movements, regular sex life, and balanced physical stress.

Such elementary actions can reduce dilated veins and prevent the disease from progressing.

Elderly people whose disease has frozen at an early stage will benefit from wearing a suspensor.

During the second degree of varicocele, if the disease is characterized by pain, surgery is necessary.

An inevitable measure is surgery for third-degree varicocele. Now we have dealt with the question of whether surgery is necessary for varicocele and at what stages it should be done.

Varicocele can lead to other, more unpleasant problems, such as infertility.

This is exactly the diagnosis in 40% of men suffering from. The fact is that dilated veins contribute to increased temperature in the scrotum, and this leads to disturbances in the morphology, motility of sperm and their number.

Surgery for varicocele: types, types, methods, methods (how is it done?)

The essence of all types of operations is the elimination of the affected areas of the veins. The operations differ in the method of execution, degree of injury, effectiveness and possible complications.

Traditional Operations

There are 3 types of traditional surgical intervention- By Ivanissevich, Marmar and Palomo.

Operation Ivanissevich

This operating technique is one of the very first developments to eliminate varicocele. Today she recognized as one of the most ineffective, because the relapse rate reached 40%.

Surgery in progress under local anesthesia. An incision up to 5 cm long is made in the left part of the iliac region. In depth, the incision reaches the walls of the inguinal canal, in which the veins and spermatic cord pass. The identified veins are crossed and the wound is sutured.

The purpose of the operation is to ligate absolutely all veins in one procedure. There is a high degree of risk due to the fact that one or more blood vessels will be missed, which can lead to re-development of the disease.

The likelihood that the testicular artery will be ligated by mistake depends on the level of skill of the operating doctor and the quality of his work, and this can lead to disruption of spermatogenesis.

The operation to remove testicular varicocele according to Ivanissevich is recognized as the most traumatic, The recovery period after it can be about 3 weeks.

Operation Marmara

Among surgical operations recognized as most effective. During the operation, the veins of the spermatic cord are ligated through the inguinal approach.

The operation has a number of advantages:

• minimal invasiveness, since the length of the incision is 2-3 cm, it can be compared with laparoscopic;
• postoperative recovery in a short time;
• minimal number of repeated manifestations of the disease and complications;
• high cosmetic effect. The seam (scar) after such an operation is small and located lower than the level of wearing underwear.

During the surgical operation, the testicular artery is primarily localized, after which all large and small veins of the spermatic cord are subsequently localized.

After the operation, the patient will need to spend about 4-7 hours in the clinic as a day patient. After this time, he can be sent home under the supervision of relatives.

Operation Palomo

This procedure is an improved version of the Ivanissevich operation. The difference is that the incision site is located higher than in the first case. The vein is ligated in the retroperitoneal tissue.

Laparoscopic surgery (endoscopic)

Minimally invasive and modern treatment method.

During the operation, punctures with a diameter of up to 5 mm are made in the anterior abdominal wall, into which instruments and a laparoscope will subsequently be inserted.

During laparoscopic surgery for varicocele, the veins and artery of the testicle are isolated, and titanium staples are applied to the former or they are tied with a surgical thread.

This operation is performed under general anesthesia.. What’s remarkable is that she surgery to remove varicocele can last about 15-40 minutes. The duration of the operation may vary.

So, the later the stage of the disease, the less time will be spent on the operation due to the fact that the varicocele is already pronounced by this time.

During the operation, based on the image provided by the laparoscope, the doctor locates and crosses the testicular vein. After this operation, the patient must spend a maximum of two days in the clinic. For now laparoscopy is considered the most effective method of treating varicocele, since the devices allow you to examine the entire length of the testicular vein.

Laparoscopic surgery to remove varicocele is also good because it allows for simultaneous surgery on bilateral varicocele. The probability of relapse after endoscopic surgery does not exceed 2%.

Microsurgical revascularization

The result of this operation is normalization of blood flow in the testicular vein. Surgery is performed using general anesthesia.

An incision is made in the lower abdomen (5 cm), the testicular vein is brought into the wound along its entire length from the place where it enters the renal vein to the testicle. In parallel, a section of the epigastric vein is isolated. The testicular vein is completely removed and the epigastric vein is sutured in its place.

Considered a physiological operation, since blood circulation in the scrotum can be restored immediately after the operation, which reduces the risk of complications.

X-ray endovascular surgery

Surgery is performed under X-ray control.

By puncture in the femoral vein, a catheter is inserted into the body, delivering a sclerosing drug into the testicular vein, which occludes the testicular vein.

One of the least effective operations - after it there is a high probability of relapse.

For men who have undergone surgery to remove varicoceles, You will need to abstain from sexual intercourse for three weeks. For some time after varicocele surgery, during sex Painful or unpleasant sensations may occur.

Preferably within the next month after traditional surgery to remove varicocele avoid physical activity and sports. After endovascular or endoscopic surgery, you will be able to start physical activity much earlier.

In general, for the first few postoperative days, the patient should wear a suspensor, which is a special bandage for the scrotum, designed to reduce the tension of the tissues of the spermatic cord and scrotum.

Surgery for varicocele is performed with equal success at any age, both in children, especially in adolescence, and in adults, but the recommended age is at least 9 years.

If the operation is performed immediately after detection, the man’s reproductive function will be preserved. This suggests that a man who has undergone surgery to remove a varicocele remains fertile. The presence of this disease in many cases is precisely the temporary reason that a couple cannot have children.

In the later stages of varicocele there is a high probability of developing infertility and erectile dysfunction.

As for nutrition, it is advisable to adhere to a gentle diet for the entire rehabilitation period after surgery to remove varicocele.

3 months after the operation it is necessary to do an analysis - a spermogram. If the test results are poor, treatment by an andrologist is prescribed to restore reproductive function after surgery to remove varicocele.

Postoperative period: how to rehabilitate and what may be the consequences (complications) after the operation?

The question is, what can and should be done after the operation? If a man has undergone surgery to remove varicocele, then after that Various complications may occur, and the most common is hydrocele. In this case, serous fluid accumulates between each of the testicular membranes.

The occurrence of dropsy is facilitated by impaired blood circulation in the testicle caused by surgery. After some time, a venous collateral drainage forms in the male reproductive system, allowing blood to flow out through other veins of the scrotum.

Complications may occur if you are sexually active in the first weeks after surgery.. Until the rehabilitation process is completed after a varicocele cured by surgery, you should refrain from having sex with your partner and masturbation - these are the restrictions.

Also there is a possibility of relapse even if all rehabilitation rules are followed. The main cause of relapse is a pampiniform vein or branch missed by the surgeon. In addition, after an unsuccessful operation, damage to the iliac artery, an infectious process in the wound, bleeding, hypertrophy, atrophy or azoospermia of the testicle are possible.

In some cases, it is possible to repeat operations to remove varicoceles several times until the damaged veins are completely ligated.

After varicocele surgery Pain in the testicles may occur, but in 90% of cases it passes quickly. If the pain does not stop, you should consult your doctor.

The purpose of endoscopic surgery for varicocele is ligation, intersection of the altered veins to restore normal blood flow in the organ and its functions. The difference between this method and microsurgical or traditional interventions is the use of endoscopic technology. This ensures minimal tissue trauma and a short rehabilitation period. Usually after two days you can go home.

The ability to eliminate bilateral varicoceles during endoscopic surgery is a distinctive feature of the method. When using other methods in such cases, two operations are performed. The effectiveness of treatment in this way is 95%, and the duration of all manipulations is approximately half an hour. The main advantages of this treatment are the ability to treat the veins of the left and right testicles in one go, low invasiveness, easy rehabilitation and a minimum of complications.

How is endoscopic surgery for varicocele performed?

Endoscopic surgery for varicocele is performed under general anesthesia, so the patient is not sent home immediately, as with Marmar treatment, but is left under medical supervision for 2 days. During recovery, the patient feels well due to the fact that the wounds heal quickly and without complications.