Varicocele

WHAT IS VARICOCELE?

It is an abnormal enlargement, folding or varicosity of the veins that carry the venous blood from the testicles (venous blood vessels). This enlargement can begin at a young age and progress due to gravity. Vicocele is the most common and treatable cause of male infertility. It can be asymptomatic. It can lead to swelling in the scrotum, pain (on the groins) and disorders of sperm count and activity over time.

What is the prevalence of varicocele?

Varicocele typically occurs in 15-20% of men after puberty, and in 40-50% of men, we get the complaints of infertility.

Left venous blood vessels are connected to the main vessel, where the blood flows vertically and is longer. For this reason, the varicocele is typically seen on the left side (85%). The observation rate on the right venous blood vessel is about 15%. It can be seen in both testes. A varicocele on one side.

VARICOCELE and INFERTILITY

Although it is not known exactly how the varicocele causes infertility, there are some theories on the subject. Venous blood, which accumulates in the venous blood vessels with varicosity, causes heat development and pressure increase in the testes. Reduction of oxygen content and accumulation of various metabolites by the kidney and adrenal glands can affect sperm production. As a result, sperm levels and activity decrease.

Symptoms of a varicocele;

• Pain in the testicles (pain in the groin and the inner part of the legs)
• Swelling in the testicles
• Reduction of the testicle size
• infertility
• Observable, dilated vessels
• Dilated vessels that are palpable by hand

Diagnosis of varicocele:

It is diagnosed by physical examination. Usually it is diagnosed by palpation. Dilated and folding vessels (venous blood vessels) are felt. This was confirmed by color Doppler sonography (USG). If physical examination is not possible, colored Doppler ultrasound may be helpful.

(Left Varicocele Grade 3)

Sorting varicocele:

• Subclinical varicocele: Can not be diagnosed with PE, but is diagnosed with ultrasound.
• Varicocele grade 1: Asymptomatic at rest, diagnosed during exercise (valsalva +)
• Varicocele grade 2: Venous blood vessels can be felt by hand (palpable)
• Varicocele grade 3: Visible varicocele (observable).

After diagnosis of varicocele, a spermiogram should be performed. The patient should discontinue his / her sexual activity 3-4 days before the spermiogram. If sperm production is damaged, a decrease in the sperm activity, amount and structure is observed. More than half of the people with varicocele have been diagnosed with spermiogram-diagnosed disorders.

Sometimes the sperm count is very low. In these cases, various hormones (FSH, LH, testosterone, prolactin …) and other possible systemic diseases (thyroid, diabetes, cholesterol) should be checked.

Patients with hormonal imbalances are supplied with deficient hormones, and infertility can be treated by increasing the sperm count.

In rare cases sperm production may be possible but no sperm are observed in the spermiogram. In these cases, the blockages in the spermatic ducts are controlled. This blockage would be opened by endoscopic or microsurgical methods and it would be possible to have a child in a normal manner.

TREATMENT OF VARICOCELE

Varicocele is the most treatable cause of male infertility. The treatment is a surgical operation. However, any patient with varicocele can not undergo surgery. Therefore, varicocelectomy should be performed on the right patient at the right time and with the right technique by the specialists in this field.

WHO CAN HAVE VARICOCELE OPERATION?

• Male individuals with varicocele complaining of infertility (those diagnosed with a disorder in the spermiogram)
• In those cases where the varicocele shrinks the testicles, one testicle is smaller than the other, or both have shrunk
• Patients with severe pain (those who do not respond to analgesics and scrotal enhancement)

VARICOCELECTOMY-OPERATION

This is an operation that lasts between 30 and 60 minutes, whereby venous blood vessels become bound with varicosity and the connection of these vessels is blocked. It can be performed by general, spinal or local anesthesia with a 2 cm section in the groin area.

The venous blood vessels (internal, external spermatic and cremasteric sites) should be tied, and not least, vas deferens, testicular arteries and lymphatics should be preserved. Complications such as the shrinking of the testicles in cases where the arteries are bound and the hydrogels (accumulation of fluid between the testes and swelling) in cases where the lymph channels are bound may be possible.

In view of this information, the microsurgical varicocelectomy operation performed with microsurgery (microscopy) is the best technique for varicocele surgery. The success rate of specialist microsurgery varicocelectomy surgery and the possibility of complications would be minimal. (I always do the varicocele surgery with microsurgery technique, except for certain conditions.)

Varicocele is not repeated due to successful varicocele surgery.

Spermiograms are needed at 3, 6 and 12 months after varicocele surgery. Sperm production of about 70-80% of patients returns after surgery. The reproductive rate of varicocele infertility patients after surgery is about 50-70%.

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