VARICOCELE
Varicocele, which can cause infertility in adult men, is a condition we also encounter in adolescents.
While the frequency of varicocele at the age of 10 and under is found to be around 1%. The prevalence of varicocele in adolescence is 11%.
The prevalence of varicocele gradually increases at the age of 13 and beyond, and varicocele often does not cause symptoms at this age.
During adolescence, varicocele is often detected incidentally during physical examination. They are detected or noticed by families.
While the diagnosis of adolescent varicocele can be made by examination, ultrasonography and venography similar to adults; Today, the gold standard in the diagnosis of varicocele is physical examination.
There is no need for radiological imaging methods other than examination to diagnose varicocele.
Measurement of testicular volumes is necessary for the necessity of varicocele treatment and evaluation of testicular volumes after varicocele surgery. Orchidometry is sufficient for testicular volume measurement in those with varicocele.
The accepted absolute treatment requirement for varicocele detected in this period is a volume decrease of 2 ml or more than 10% in the testicle.
The aim of varicocele treatment during adolescence is fertility.
The ideal varicocele surgery method should preserve testicular activities optimally, varicocele should disappear and complications should not be observed.
The most common problem encountered after varicocele surgery in adolescence is postoperative hydrocele, with a rate between 1 and 32%.
Optical magnification is necessary to reduce complications such as recurrence, artery damage and hydrocele in pediatric and adolescent varicocele surgeries.
The use of a microscope in varicocele surgery minimizes complication rates.
>While those with one testicle remaining small before varicocele surgery can regain normal testicular volume with varicocele surgery, testicular consistency may improve after varicocele surgery in those over 14 years of age, but adequate improvement in volume may not be achieved.
Apart from testicular volumes, sperm count of adolescent cases after varicocele surgery may not be achieved. Significant improvement can be achieved in tests and hormone values.
Families of those who will undergo varicocele surgery should be informed about varicocele surgery in the light of these findings. They should be informed about the flood.
Follow-up in cases with varicocele: Children and adolescents with varicocele should be followed up every year with physical examination and volume measurement.
If there is no increase in the degree of varicocele detected during the examination, annual follow-up and varicocele level should be determined. Follow-up every 6 months is appropriate for those with an increase.
Varicocele surgery should be recommended for those with abnormal sperm test results.
Follow-up after adolescent varicocele surgery: Varicocele recurrence, hydrocele, testicular consistency and varicocele recurrence in those treated with microsurgical methods due to varicocele. An examination should be performed once a year to monitor the volumes, and additionally serum hormone (FSH and testosterone) tests and sperm tests should be performed.
FOLLOW-UP AFTER VARICOCELE SURGERY
Patients should be monitored regularly after varicocele surgery.
Sperm tests should be performed every 3 months for 1 year after varicocele surgery or until pregnancy is achieved.
Total motile sperm in couples whose varicocele problem has been eliminated but infertility continues. Depending on the number of births, assisted reproductive techniques such as intrauterine insemination (IUI) or in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) should be used.
Couples face infertility problems at some point during their marriage with a probability of approximately 20%. In this case, there is a 20% chance that the problem is entirely in the man, and there is also a 40% chance that the problem can be detected in both men and women at the same time. As a result, the effect of the male factor on couples' infertility problems can reach up to 60%. The causes of male infertility can usually be revealed by sperm analysis and examination; In some cases, further examinations are required. Infertility does not have a clear distinction like black and white, but is usually seen in gray tones; In other words, most of the time the person is not completely infertile and the possibility of having a child is partially reduced. In this case, the aim is to optimize the person and enable the couple to have children as a result of the treatments. It is a very common mistake to start infertility treatment for women without examining the man by a Urologist-Andrologist and evaluating the spermiogram performed in a specialist laboratory. Serious underlying and life-threatening causes of male infertility It should not be forgotten that it may be a symptom of a disease.
What causes varicocele?
The testicles are formed at the same level as the kidneys during development in the womb and move downwards over time. During this movement, they pass through the inguinal canal and come out of the abdomen, and usually settle in the bag before birth. During this migration, the testicles carry their vessels with them; Therefore, the main vein of the left testicle flows directly into the vein of the left kidney. Varicose veins are common because there are no muscles around this vein, which forms a vertical column when we stand, to compress and pump them like the veins in the legs. The valves that form the check-valve mechanism in the veins, called veins, become insufficient with the expansion in the diameter of the vein and cannot prevent reverse flow. In this case, in situations that increase intra-abdominal pressure, such as taking a deep breath or lifting a weight, blood flows back towards the testicle and increases the pressure at the exit of the testicle, slowing down the blood flow in the testicle and affecting its functions.
How should a varicocele be diagnosed?
Varicocele diagnosis should be made by hand examination. The examination is performed standing and in a non-cold environment. If varicose veins can be seen with the eye, Grade 3 varicocele is diagnosed. If the veins are found to be tortuous on hand examination or become tortuous with straining, Grade 2 varicocele is diagnosed. If the vein is felt to be filled from top to bottom only with straining and even if it is a little late, Grade 1 varicocele is diagnosed. The degree of varicocele and its negative effects do not always parallel each other.
Varicocele shows its effects by increasing over the years. Even if it is the first child, it may not be the second child. Varicocele begins in adolescence, does not constitute an emergency, and if necessary, surgery is recommended within a few months.
What are the effects of varicocele:
Varicocele does not directly cause erectile dysfunction in men, but over time, varicocele can affect the testicles and reduce the male hormone testosterone to some extent. Decreased testosterone levels due to varicocele may also occur together with decreased sexual desire and decreased sexual performance.
15-20% of all men and those with infertility problems. Varicocele is present in 40% of the population. As a result of varicocele, sperm parameters such as a- number, b- mobility, c- morphology (structure) and d- viability may be impaired; d- DNA Fragmentation Index (DFI) may increase. As a result of the increase in DFI (increase in the fragmentation rate of sperm DNA), the capacity of the sperm to fertilize the egg decreases and even if fertilization occurs, the possibility of early miscarriage increases. Additionally, those with varicocele may experience pain and, over time, some decrease in the male hormone testosterone.
What is done in varicocele surgery?
Used dirty blood moves away from the testicle through 3 paths.
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The main path, which we call the branches of the Internal Spermatic Vein, enters the inguinal canal, the branches gradually merge, it leaves the inguinal canal and rises over the posterior abdominal membrane, collecting the kidney on the left. It flows into the vein and on the right, just below the renal vein, into the main collecting vein that goes to the heart called Vena Cava.
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B- The second path, which we call the External Spermatic vein, does not rise from the inguinal canal to the abdomen, it flows into the veins in the region. It is poured out.
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C- The vasal vein pair, which is the third excretory route, enters the inguinal canal together with the accompanying seminal duct called Vaz, but after exiting, it turns down and forms a part in the region behind the seminal vesicles and prostate. It terminates in the web-like vein structure.
The first two of these three systems may cause varicocele by reflecting the pressure back, but the third system, the Vas deferens vein pair, does not create back pressure due to the web-like structure in which it terminates, causing varicocele problems. does not create.
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