Surgical treatment of varicocele
Varicocele is one of the main reasons of male infertility. 40% of the men complaining on infertility and 15-20% of men in general population have varicocele. 20% of the army recruits have varicocele.
Varicocele is caused by excessive enlargement of veins taking dirty blood from the testes. As a result, blood circulation disorder causes scrotal temperature and toxic substances increase, which in turn cause compromised spermatogenesis (sperm count, motility and morphology) and infertility. Sometimes varicocele causes pain in the testicles and surrounded area.
Having varicocele in children and adolescents delays development of the testes and as a result stops spermatogenesis. Longer varicocele exists, bigger is the negative effect. Considering this, it is recommended that patients undergo treatment shortly after diagnosis of varicocele and when microsurgery is prescribed.
Varicocele is the common reason of infertility in the men and successfully treated by microsurgery. Even in couples with planned insemination, existence of varicocele decreases fertilization ability. As the men marry at earlier ages in our country, they have the first kid before the effect of varicocele, however varicocele is observed in 70% of the men that cannot have the second kid for many years.
What kind of complaints causes varicocele?
Varicocele is usually found in the men with complaints on the swollen, painful testicles and infertility. Varicocele causes atrophy (decrease of volume) of the testes, pain in the groin, perineum and testicles. Pain increases with while standing on the feet for long time or doing heavy works.
How is it diagnosed?
Varicocele is visible during physical examinations and felt by hand; in special cases, Doppler US examination (reflux test) is employed. Commonly it is left-sided; sometimes it is on the right side and rarely on both sides.
When varicocele shall be treated?
Varicocele is a treatable pathology. Attention shall be paid on the changes in spermiogram (sperm count, motility decrease, morphology disorder), at least have 2 spermiograms, complaint on infertility, hormonal changes, particularly FSH (follicle stimulating hormone) and T (testosterone) hormone changes. At high FSH levels, treatment of varicocele usually is very low effective. Not all varicoceles felt by hand have to be treated. If abovementioned cases are seen in complex, then treatment is required. In children and adolescents, 20% of volume loss of the testis with varicocele, is an indication for treatment.
What are the ways of treatment?
Varikoselin medikal (dərman) müalicəsi yoxdur, There is no drug treatment of varicocele and the only option is surgical. Different surgical methods have been used so far, but the only accepted option in recent years, is microscopic surgery. Microscopic surgery is efficient up to 99%. Varicocele microsurgery has to be conducted by an experienced urologist-andrologist.
The operation starts with small incision in the groin area and under 8X magnifying microscope, swollen veins are ligated. 2-days rest and sexual restraint for some time is enough for recovery. It is recommended to have first semen analysis 3 months and second semen analysis 6 months after the operation. Conceiving usually happens 5-6 months after the operation.