WHAT IS A VARICOCELE?
Varicocele is the dilation of spermatic vein network in the testicle. It occurs more often in left testicular network. The ages who are at higher risk for the occurrence of varicocele is after puberty, between 15 and 30 years .
The varicocele are like varicose veins often seen in the lower limbs of humans.
WHAT ARE THE SYMPTOMS?
Usually this condition causes no particular symptoms and in some cases there is a moderate pain sensation . This pain varies as it can give a feeling of discomfort or lightweight in the scrotal area and becomes more intense when the patient is sitting or standing for a long time or performing a physical activity or other activity. Often varicocele is perceived by the patient during the self examination a soft mass in the scrotum .
WHAT CAUSES A VARICOCELE?
The seminal veins have the function to drain the blood from the testicles and achieve this through the good condition of a valve system. If this system is damaged or there is reflux of blood into the veins resulting in the dilatation. To this also contributes, the vertical ejection of the left spermatic vein in the left renal vein.
WHAT ARE THE POSSIBLE COMPLICATIONS OF A VARICOCELE?
If the varicocele is installed at a young age is likely to cause atrophy of the ipsilateral testis. The testicle is less in size than the contralateral testis and missing functionality.
The testicular veins when operating normally help maintain a certain low temperature to the spermatic artery, thereby creating the conditions for the production of spermatozoa. When normal blood flow is blocked, as in varicocele, the temperature rises and negative effects are carried on the seminiferous epithelium level, which results in the lowering testicular operation. Furthermore oxidative and harmful substances are not removed from the microenvironment of the testicles causing further damage to spermatogenesis.
The disorders caused by varicocele on sperm take the form of oligospermia (low number) , asthenospermia (reduced mobility) and teratozoospermia (abnormal sperm forms) .
IS THERE A RELATIONSHIP BETWEEN VARICOCELE AND FERTILITY?
It is sufficient here to say that Infertility occurs in about 12% of the general male population and in persons with varicocele its frequency is doubled (25%) .
HOW IS THE DIAGNOSIS MADE?
The suspicion of varicocele is made by the patient during self examination (spiral mass without pain on palpation, which feels like a 'bag of worms'').
The Urologist with the clinical examination will make the diagnosis.
The examination will be continued by taking ultrasound images using special ultrasound high sensitivity head - an expert in ultrasonography urogenital Urology system - and will discover the existence and extent of anatomical damage of the venous plexus and the reciprocating dysfunction of venous flow. Simultaneously will confirm or rule out any other possible causes that may be responsible for any kind of discomfort in the region.
I HAVE A VARICOCELE. DO I NEED AN OPERATION?
All individuals with varicocele should of course not be operated.
The indications of surgery are:
- When there is intense and chronic pain .
- When there is testicular atrophy in adolences.
- When it has caused clear abnormalities in sperm , as illustrated in the semen analysis , resulting in the person being infertile.
WHEN MUST I HAVE THE OPERATION?
Although varicocele usually develops in young age after puberty, is not entirely clarified the point where he surgery treatment should take place.
Restoring varicocele does not take the sense of urgency, but when there are indications where surgery should not be postponed.
AFTER SURGERY THE PARAMETERS OF SPERM IMPROVE?
In the vast majority of cases there is a clear improvement in sperm parameters as shown in semen analysis. Both the number and the mobility of sperm are improved while the pathological forms reduce.
WHAT TYPES OF SURGERY ARE THERE? WHICH DO YOU RECOMENT?
1. The primarily selected surgical technique to restore varicocele today is subinguinal access . The Urologist with a very small incision below the inguinal canal has access to the testicular network.
The advantages of this technique are:
a) It does not open the abdominal muscles and thus postoperative pain is limited .
b) intra-day hospitalization. The patient goes home the same day.
c) Fast recovery. In 1 week, the patient returns to his everyday life.
d) Much smaller complication rate than other techniques.
2. Open surgery. Other varicocele response option is to cut the to level of the inguinal canal (transinguinal) or above on the abdomen (known as a method by Palomo or retroperitoneal), the Microsurgical Varicocelectomy with the use of visual field magnification system.
3. Laparoscopic surgery. It is an alternative. The approach is performed in small holes in the abdomen (which means that the post-operative pain is minimal and or re-direct activity). And this method or course performed with general anesthesia, and needs a minimum hospital stay (one day only).
4. Percutaneous Embolization.