Varicocele is the enlargement of the veins that remove the dirty blood from the testis and therefore cannot fulfill their duties. Varicocele formation is similar to varicose formation on the legs. Expansion of veins more than normal is the main mechanism.
What Causes Varicocele? What are the Causes of Varicocele?
The exact reasons leading to the formation of varicocele have not been fully clarified. It is thought to be caused by the defect in the valve structures in the veins that bring blood to and from the testicles in structures called the spermatic cord.
Varicocele is usually seen during adolescence. It mostly develops on the left side because the left testicular vein is longer than the right side. Even if it is seen on the left side, the presence of bilateral varicocele should be investigated and ruled out.
What are the Symptoms of Varicocele?
Clinical diagnosis of varicocele is quite easy. Vascular enlargement can be seen on the testicular skin.
- Sharp or blunt pain or discomfort
- Increased vasodilation with prolonged standing or physical exercise
- Testicular increase in the evening swelling on the skin
- The swelling and/or pain on the skin subsides when lying down
- Infertility
What is Varicocele Pain?
Varicocele pain can be felt in the groin area, ranging from annoying blunt to sharp. In some cases, it may spread to the leg on the same side. It responds to painkillers but recurs when the effect of the drug wears off.
What are the Grades of Varicocele?
Varicocele is clinically divided into three degrees.
Grade I: It is the mildest form. While the patient is being examined while standing, maneuvers that increase intra-abdominal pressure (such as coughing, straining) are observed.
Grade II: Diagnosis is made on hand examination without any maneuvers during physical examination.
Grade III: It is the form detected visually while the patient is standing.
How to Diagnose Varicocele?
While patients may present with swelling, varicocele is most commonly diagnosed during the investigation of the reasons why married couples cannot have children, while investigating the causes of male origin. Varicocele b Advanced imaging (computed tomography, magnetic resonance) methods can also be used to distinguish it from regional tumors.
Sperm analysis (spermiogram) is appropriate in these patients following the physical examination. In sperm analysis, cell structure, number and motility are examined.
Diagnosis of varicocele in adolescents is based on physical examination as in adults. Vascular structures that look like worms in the bag containing the testicles during physical examination are characteristic and diagnostic for varicocele. Doppler ultrasound is applied when suspicious examination findings are encountered.
In Which Age Period Is Varicocele More Common?
The fact that the frequency of varicocele is the same in both adolescent and adult ages, the disease starts in adolescence, but its insidious nature This suggests that it remained hidden for a long time without being noticed. For this reason, the disease can often be treated by being diagnosed when it presents with symptoms such as pain or infertility in adulthood.
When this disease is recognized and treated in adolescence, the volume loss due to damage to the testicles is improved by 80%, much higher than that which can be achieved in adulthood.
Does Varicocele Cause Infertility?
With the dilation of the blood vessels in the testicles, dirty blood flows back into the testicles. This situation disrupts the feeding and temperature regulation of the testis. It also causes an increase in the level of toxic substances in the testicles.
Sperms are sensitive to environmental conditions. In order for them to survive and maintain their functionality, the environmental conditions must be well regulated.
The most common cause of acquired infertility, varicocele is present in 15 of every 100 men you meet on the street. Only 40% of patients who undergo varicocele treatment for infertility in adulthood can have children.
When varicocele is not treated, the ipsilateral testis shrinks (atrophy) and softens.
How to Treat Varicocele?
Not every male patient with varicocele needs to receive treatment. Many boys with varicocele can have children.
However, every varicocele detected in adolescence requires close follow-up. In some of these patients, testicular volume at the time of diagnosis or during follow-up Very large veins in which blood reflux can be demonstrated will be detected with loss of blood or Doppler ultrasound. Surgery is required in this group of adolescents and these patients also benefit most from the treatment.
Varicocele is treated surgically. Persons who need surgical treatment:
- Men with varicocele in couples who want to have children and do not have signs of infertility in women,
- Men with abnormal findings in their spermiogram,
- Shrinking and softening of the testicles
- Single men in Grades II and III (because they will have problems conceiving in the future)
- If the enlarged vessel diameter is over 3 mm in scrotal Doppler ultrasonography,
- Patients whose scrotal Doppler ultrasonography detects reflux of blood in the veins.
What is Varicocele Surgery?
The first of the surgical methods that can be followed in varicocele is open surgery. It can be performed under local or general anesthesia in outpatient conditions. The gold standard in the current treatment of varicocele is microscopic inguinal varicocelectomy.
In this method, there is a bundle of vessels going from the skin incision of approximately 3 cm from the groin to the testis, and under the microscope, the arteries and lymphatic vessels are preserved, and the problematic veins are ligated and cut. This procedure, which requires anesthesia since it is performed under a microscope, takes approximately 40 minutes and the patient is discharged on the same day.
With this surgical intervention, the volume loss due to damage to the ovaries is also improved in 75 - 80% of the patients who have varicocele surgery. The only long-term scientific research we have indicates that young people whose varicoceles are surgically corrected during adolescence do not face any difficulties in conceiving a child in adulthood.
It prevents infertility that may develop in advanced age in varicocele disease that has been diagnosed, followed and treated appropriately in the adolescence period.
The second surgical method is laparoscopic varicocele surgery. This method is performed under general anesthesia and by entering from the abdomen.
What Happens After Varicocele Surgery?
With today's surgical methods, the recurrence rate of postoperative varicocele is almost non-existent. Patients can easily return to their daily activities within a few days, as they have been operated with the microsurgery method. Simple pain relievers are sufficient for wound healing. They may need a 4-6 week period for heavy sports or exercise. Patients are advised to use underwear in a way that will not put pressure on the groin and testicles in the postoperative period, and to avoid sexual intercourse for a while.
As the production period of mature sperm in the testicles is 90 days, it is necessary to pass 3 months at the earliest for the improvement in spermiogram results after varicocelectomy surgery. The success of the surgical intervention is more clearly understood in the 6th month after the operation. After varicocelectomy, there is a 60-80% increase in semen analysis and a 20-60% increase in pregnancy.
Read: 0
