Surgery for varicocele: what types of operations exist and how do they do?
Varicocele can only be treated with one of the existing surgical procedures. The widespread belief that one can get rid of a disease at home is unfounded. Recommendations for wearing tight underwear, reducing physical activity and taking medications can help relieve some symptoms, but not cure the disease itself. Irreversible expansion of the spermatic cord veins can only be cured surgically. Postponing surgery can lead to infertility and other consequences of varicocele.
Do all patients with varicocele need surgery?
Doctors recommend surgery if the following symptoms and problems are present:
- Infertility with impaired spermatogenesis (according to the results of spermatograms)
- The appearance of pain
- In case of relapse
- To prevent the development of malnutrition or testicular atrophy
- Cosmetic defect (in rare cases with pronounced varicocele).
The most common indication for surgery is infertility (about 40% of men with diagnosed infertility suffer from varicocele). Surgical intervention in this case is prescribed regardless of the degree of development of venous vascular disease. In order to avoid the development of this problem, treatment is sometimes carried out in adolescence.
The operation to remove the dilated veins of the spermatic cord belongs to the category of simple and safe. Recently, however, many doctors are increasingly inclined to the prematureness of such prophylaxis and believe that it is enough after a diagnosis to visit a urologist once every six months to monitor the progression of the disease. In the case of the rapid development of varicocele, spermatogram deterioration and the appearance of pain symptoms, the doctor will prescribe surgical treatment.
The pain syndrome indicates the onset of possible inflammatory processes and the appearance of microthrombi. The degree of development of varicocele can affect their intensity and general discomfort.
The traditional method of open access (Ivanissevich and Palomo method)
Ivanissevich’s operation is a universally recognized effective method of treatment at any stage of varicocele and involves dressing the affected testicle veins at the level of the retroperitoneal department. During the operation, the surgeon makes a small incision (4-5 centimeters) in the left iliac region and performs bandaging of the diseased vessels.
The Palomo method is inherently identical to the Ivanisevich operational method. The difference between them is to choose the location of the section, which is located above Palomo.
Microsurgical method (Marmara)
The Marmara technique involves a small incision on the skin (about 2-3 centimeters) at the exit site of the spermatic cord. Intervention is carried out with the help of special tools and a microscope, which allows for more accurate bandaging, without affecting the nearby artery, nerves and lymph vessels. Doctors give this technique the most positive reviews, since the degree of injury and the rate of relapse are the lowest.
Endoscopic method (laparoscopic)
This method is applicable at any stage of the disease. The treatment is based on eliminating the problem by blocking the flow of blood through the veins of the testicle. Three punctures are made on the skin (in the navel and in the right and left iliac region) to insert the video camera and the necessary tools. This allows you to examine the entire vein under an increase (6-10 times), highlight the affected areas, put brackets from titanium on its branches and cross the vessels.
The method consists in introducing a sclerosant substance into the testicular vein, which blocks the lumen of the vessel and prevents the outflow of blood to the testicle. This method of treatment is often prescribed for patients with somatic diseases or in cases where other methods are not applicable. A catheter is inserted through a small incision, and blood vessels are examined using radiopaque material. Based on the obtained image, a sclerosant is injected into the affected areas, which solves the lumen of the vein.
Comparative analysis of treatment methods
Below are briefly presented the details and details that most concern patients and help determine the strengths and side effects of the proposed methods of treatment:
|Type and name of operation||Operation duration||Method Advantages||Disadvantages and possible complications||Method success|
|Open access (according to Ivanissevich and Palomo)||20-40 minutes||Simple and fast operation, the most proven and inexpensive method of treatment||The possibility of relapse (10-25%), dropsy of the testicle membrane (7%), ligation of the testicular artery (50%), hospitalization (recovery 1-2 weeks)||50-75%|
|Microsurgical method (Marmara)||40 minutes||High security, does not require hospitalization (2-3 days), the lowest relapse rate (0.5-1%), no complications||Longer time intervention and higher cost||95-98%|
|Endoscopic||40-60 minutes||Minimal injury, preservation of the testicular artery, prevention of testicular atrophy, quick recovery (1-2 days)||The possibility of relapse (5-15%) due to the inaccessibility of some veins with this method, dropsy of the testicles (10%) and other possible complications||85-90%|
|Embolization||60 minutes||Lack of incision, preservation of the testicular artery, prevention of testicular atrophy, rapid recovery (1 day)||The possibility of relapse (10-15% for unilateral and 30-49% for bilateral varicocele), possible damage to the testicular vein and the development of thrombosis||60-80%|
|Sclerotherapy||60 minutes||Does not require hospitalization||The possibility of relapse (10%), anatomical features of blood vessels||80%|
Possible complications after surgical treatment
The consequences associated with surgical intervention are directly related to the chosen treatment method. Modern methods of eliminating the expansion of veins can minimize their manifestation, but the patient is still not completely immune from them.
The most common postoperative problems include:
Dropsy of the testicle occurs in 0.5-9% of men who underwent surgery, and most often manifests itself after 6 months or 2 years after treatment. The main cause of the problem is the intersection of the lymph nodes. As a result, fluid begins to accumulate in the testicles. A hydrocele usually goes away on its own over time.
The possibility of relapse of varicocele
The reappearance of the disease is possible if the outflow of venous blood persists in the testicular vein, the outflow of blood has not been completely stopped, or additional venous vessels have developed.
The percentage of secondary occurrence of varicocele directly depends on the method of treatment and averages 10-40%. It is believed that the chance of relapse becomes higher if the operation to remove the varicocele was performed in early childhood. Given that the effectiveness of treatment decreases with the neglect of the disease, the patient should be regularly examined by a doctor. This approach will help you choose the best time for the surgical procedure.
Relapse prevention is possible at the stage of examination before the operation and the choice of treatment method, which allows you to examine in detail the lumen of the vein.
The operation is carried out under local anesthesia. An incision up to 5 cm long is made in the left part of the iliac region. In depth, the incision reaches the walls of the inguinal canal, in which veins and spermatic cord pass.Detected veins intersect and the wound is sutured.
The purpose of the operation is to dress absolutely all the veins in a single procedure. There is a high degree of risk. about the fact that one or more blood vessels will be missed, which can lead to the re-development of the disease.
The operation to remove testicular varicocele according to Ivanissevich was recognized as the most traumatic, recovery period after it can be about 3 weeks.
Among surgical operations recognized as effective. During the operation, the veins of the spermatic cord are doped with inguinal access.
The operation has several advantages:
- minimal invasiveness, since the incision length is 2-3 cm, it can be compared with laparoscopic,
- postoperative recovery in a short time,
- minimum number of repeated manifestations of the disease and complications,
- high cosmetic effect. The seam (scar) after such an operation for the treatment of varicocele is small and is located lower than the level of wearing underwear.
During the surgical operation, the testicular artery is first localized, after which there is a sequential localization of all large and small veins of the spermatic cord.
Stages of the disease and indications for surgery
There are 4 degrees of varicocele development:
- Varicose expansion is determined only by ultrasound.
- The veins of the plexus plexus are felt in a standing position.
- With palpation in any position, the doctor can diagnose the disease.
- Veins are visible to the naked eye.
A decrease in spermatogenic function, which can eventually lead to infertility, usually begins only in the last stages of the disease.
The operation can be performed in the following cases:
- Identified violations in sperm formation. During the study, it was found that in the seminal fluid the number of spermatozoa was reduced, their motility was reduced, blood or pus was present.
- The patient is in pain. They begin to appear at the 2-3 stages of the disease, at first they are insignificant. Unpleasant sensations intensify when walking, after physical exertion. Note. In the vast majority of cases, varicocele of the left testicle develops, so the pain most often has the same localization.
- The patient is not satisfied with the appearance of the scrotum.
- The testicle begins to decrease in size.
In the absence of symptoms, surgery may also be recommended.. Some doctors believe that timely surgical intervention can help prevent infertility. Others believe that this is an unjustified risk, and are advised to limit their observation through periodic examinations and ultrasound.
Important! Surgery before the age of 18 is usually not performed. According to statistics, in adulthood after surgery, relapses occur much less frequently - re-development of varicocele. Therefore, it is better to carry it out after puberty.
Vein compression can lead to the development of the so-called “secondary varicocele”. It occurs as a result of a tumor, cyst, or other formation. In this case, the patient is concerned about fever, blood in the urine, dull or stitching pain in the lumbar region. With secondary varicocele, the cause of the disease must be eliminated, truncation of the veins is not required before the manifestation of the results of therapy of the underlying pathology.
Different methods of surgery may have different contraindications. Open surgery is not performed with:
- The presence of diseases in the stage of decompensation (organ dysfunctions that cannot be restored without treatment) - diabetes, cirrhosis of the liver, etc.
- Inflammation in the active stage.
Endoscopic operations, in addition to the contraindications described, are not performed with surgical interventions in the abdominal cavity that have been transferred in the past.This is due to a violation of the clinical picture and an increased likelihood of a doctor’s mistakes.
Sclerosis is not carried out with the following contraindications:
- Large anastomoses (jumpers) between the vessels, which can lead to the use of the drug used for gluing in healthy veins or arteries,
- Increased pressure in nearby veins (e.g., renal)
- The structure of the vessels does not allow the introduction of a probe (friable nature of the veins).
Laparoscopic surgery (endoscopic)
Minimally invasive and modern treatment.
During the operation, punctures with a diameter of up to 5 mm are made in the anterior abdominal wall, into which instruments and a laparoscope will subsequently be inserted.
During a laparoscopic operation, with varicocele, veins and an artery of the testicle are secreted, moreover, titanium staples are superimposed on the first ones or they are ligated with a surgical thread.
This operation is performed under general anesthesia.. What is remarkable itself the operation to remove varicocele can last about time 15-40 minutes. The duration of the operation may vary.
During the operation, on the basis of the image provided by the laparosque, the doctor detects and crosses the testicular vein. After this operation, the patient should spend a maximum of two days in the clinic. For now laparoscopy is considered the most effective treatment for varicocele, since the instruments allow inspection of the entire length of the testicular vein.
Preparation for surgery
10 days before the proposed procedure, patients need to undergo some research:
- Blood test (general, per group and Rh factor, for coagulability, sugar content).
- General urine analysis.
- X-rays of light.
- Electrocardiogram (can be prescribed to all patients or only men older than 30 years).
- Analysis for hepatitis B and C viruses, HIV.
In addition, the doctor usually prescribes an ultrasound of the scrotum or an ultrasound using the Doppler method (using a contrast medium) to obtain a more complete clinical picture. Additional studies are possible depending on the patient's condition.
In the morning before surgeryrefuse food and water, take a hygienic shower. The forehead and stomach must be cleanly shaved. The administration of drugs for chronic diseases (diabetes, hypertension, bronchitis, etc.) must be agreed with the doctor.
The result of this operation is normalization of blood flow in the testicular vein. Surgery is performed using general anesthesia.
The incision is made in the lower abdomen (5 cm), the testicular vein is removed into the wound along its entire length from the place where it flows into the renal vein to the testicle. In parallel, a section of the epigastric vein is highlighted. The testicular vein is completely removed; instead, the epigastric is sutured.
Methods of operation
The classification of surgical treatment methods can be based on the access method and technology. Based on the second feature, two large groups of operations are distinguished:
- With the preservation of the re-caval anastomosis,
- With its excision.
Note. Reno-caval shunt (anastamosis) is a jumper-message between the two veins of the testicle. It occurs as a pathology due to varicocele and contributes to blood stasis.
The second method is currently recognized as the most effective and is used most often.
By technology, it is customary to distinguish three main types of operations:
- Laparoscopy (minimally invasive method),
- Endovascular sclerotherapy,
- An open operation (can be performed in various versions - according to Marmar, Ivanissevich, Palomo).
Important! Removal operations for varicocele are not performed. All vessels remain inside the body, they are either glued together (sclerosed) or bandaged.
X-ray endovascular surgery
Surgery is performed under x-ray control..
A catheter is inserted into the body through a puncture in the femoral vein, delivering a sclerosing medicine to the testicular vein, blocking the testicular vein.
One of the least effective operations - after it there is a great huge likelihood of a relapse.
General recommendations after surgery
Men who have had varicocele removal surgery it will be necessary to refrain from sexual intercourse for three weeks. For some time after surgery to treat varicocele during sex pain or discomfort may occur.
Preferably in the next month after the traditional operation to remove varicocele avoid physical activity and sports. After endovascular or endoscopic surgery, physical activity can be started much earlier.
Surgery for varicocele with equal success is carried out at any age, both in children, especially in adolescents and adults, but the recommended age is at least 9 years.
In the late stages of varicocele, there is a high probability of developing infertility and erectile dysfunction.
As for nutrition, it is advisable to adhere to a sparing diet for the entire period of the rehabilitation period after the operation to remove varicocele.
3 months after the operation, it is necessary to make an analysis - a spermogram. If the test results are poor, andrologist treatment is prescribed to restore childbearing function after surgery to remove varicocele.
Postoperative period: how to rehabilitate and what may be the consequences (complications) after surgery?
The question is tormented, what can and should be done after the operation? If a man underwent surgery to remove varicocele, then after that various complications can occur, and the most common is dropsy of the testicle. In this case, an accumulation of serous fluid occurs between each of the testicle shells.
The occurrence of dropsy contributes to a violation of blood circulation in the testiclecaused by surgery. After some time, a venous collateral outflow is formed in the male reproductive system, allowing blood to flow through other scrotum veins.
Complications may occur if sexual activity is observed in the first weeks after surgery. Until the rehabilitation process is over after the varicocele cured by the operation, you should refrain from having sex with a partner and masturbation - these are the limitations.
It is also not recommended to consume alcoholic beverages during the recovery period after varicocele surgery - they can cause kidney overload, which will entail negative consequences up to relapse.
Also there is a likelihood of relapse even observing all the rules of rehabilitation. The main cause of relapse is a vascular vein or branch missed by the surgeon. In addition, after an unsuccessful operation, damage to the iliac artery, an infectious process in the wound, bleeding, hypertrophy, atrophy or azoospermia of the testicle is possible.
After varicocele surgery testicular pain may occur, but in 90% of cases they pass quickly. In the event that the pain does not stop, you must consult your doctor.
Find out what degrees of varicocele are undergoing non-surgical treatment.
And here you can find out all about the types of phimosis.
General anesthesia for this type of intervention is used more often, but local or epidural anesthesia is also possible. The essence of the operation is the ligation of veins with varicose veins while preserving the lymphatic vessels.
The surgeon makes an incision in the pubic region up to 10 cm long. Usually its size is smaller - 5-6 cm.Using a scalpel and hooks, he cuts and spreads all the underlying muscles to the vascular plexus of the testicle itself. Here it is necessary to separate the lymph vessels. Then, with the help of a dissector (blunt curved scissors), the veins are captured and bandaged. Muscles and tissues are sutured.
This type of intervention resembles the previous one. However, the incision is made higher, which gives a better overview for the surgeon. With this approach, the risk of relapse is lower, but the likelihood of cutting an artery supplying blood to the seminal canal is higher.
This is a small vessel that comes close to the plexus plexus, and therefore is often damaged during surgery. There is also a risk of seizure of the lymphatic channels, especially in childhood. This can lead to serious complications.
The prognosis is usually favorable. When using minimally invasive methods, the likelihood of relapse is close to 2%, with surgery according to Ivanissevich - about 9%. Some sources indicate other figures, private clinics provide data on the re-development of varicocele with open interventions in 30%.
In 45% of cases, the patient after the operation determines the normal spermogram, in 90% of cases there is a statistically significant improvement in performance. In the older age group, with running varicocele, all values are worse than in young patients.
The following medications can be prescribed for the patient to restore spermatogenesis:
- Vitamin complexes.
- Biological active additives with selenium and zinc.
- Hormones. Important!Their admission is carried out strictly by courses under the supervision of a physician and in conjunction with ongoing laboratory research.
- An ointment containing an antibiotic. It is necessary to prevent wound infection.
- Painkillers. In some patients, discomfort in the operated testicle may persist for a long time. Usually, the doctor prescribes ketonal or similar drugs.
In the first 1-2 days after surgery, it is necessary:
- Keep the wound dry. Perhaps the application of ice to relieve pain. A plastic bottle of frozen water wrapped in a towel will do.
- Minimize any activity, try to relax more.
- It is advisable to wear a bandage supporting the testicles.
Within 1-2 weeks after surgery is not recommended:
- Perform physical exercises that require increased effort.
- To take a bath.
- To have sex.
After the indicated period, sexual life is possible if, during or after the act, the patient does not feel pain, discomfort, or unpleasant pulling sensations. Erectile function after surgery does not suffer. The period of rehabilitation depends on the type of operation, anesthesia, the general condition of the patient.
Many patients are scared that the vein has remained after the operation. It seems to them that this is a sign of unsuccessful surgical intervention.
Important! It must be understood that the vessels are not removed from the scrotum, but only stop being supplied with blood. A vein can be palpated or visible up to six months.
Complications after surgery
After surgery, the following syndromes and diseases may occur:
- Inflammation. It is determined by the corresponding symptoms and results of an ultrasound scan, it is successfully stopped with medication.
- Neuralgic pain.It occurs as a result of damage to nerve endings and is difficult to treat (usually needle and physiotherapy are indicated).
- Lymphatic edema. It develops as a result of damage to the lymphatic vessels during the operation, can pass independently or by wearing a bandage supporting the scrotum, special pants.
- Dropsy of the testicle (hydrocele). The reason is the lymphatic vessels that were touched by negligence, the treatment is similar.
- Testis size reduction - a dangerous complication arising from damage to the seminal artery. This is one of the most unpleasant consequences of the operation, since it is quite difficult to stop it.
- Relapse - re-development of varicocele. The treatment is only surgical.
- Damage to the intestines or ureter. These complications after surgery occur during laparoscopy, more often in inexperienced young surgeons.
- Thrombosis (blockage) of deep veins. It occurs as a reaction to the introduction of contrast medium into the vessels, as a result of a hematoma (internal hemorrhage) at the puncture site.
An operation with varicocele is not included in the list of “high-tech assistance” services for which funds are allocated. On the website of some clinics it is indicated that they work with compulsory medical insurance and VHI, but in the first case we are talking only about the discount that a client who can contact them can get or a refund of part of the money spent.
The cost of the operation depends on the chosen technique and region. In provincial cities of central Russia, the price for an open surgical intervention starts from 5,000 rubles, in Moscow - from 8,000 to 10,000 rubles. Approximately the same amount of sclerotherapy will cost. Microsurgical intervention (according to Marmar) will cost at least 20,000 - 30,000 rubles. Laparoscopic surgery will cost a little less - 15,000 - 25,000 rubles. Prices are based on local anesthesia, if the patient prefers general anesthesia, he will have to pay separately - 7,000 - 10,000 rubles.
Most patients have enough surgery, especially if in this way they manage to get rid of infertility. When a man finds out that now he can have children, this significantly increases his self-esteem, even if he did not have such plans in the short term.
The operation is well tolerated. Many people prefer general anesthesia. The recovery period for everyone goes differently. Someone immediately returns to normal activity, while others, even with minimally invasive interventions, feel severe pain and have difficulty moving around the house for several days.
According to reviews, a bad blow for families is poor sperm count and difficulty conceiving a child, even after surgery and drug therapy. Sometimes at first sharply positive dynamics are observed, which worsens over time. Only a high-level specialist can help in this matter. Some patients change 5 or more urologists before they find a good diagnostician. The technique of the operation itself, as practice shows, is of secondary importance.
Surgical intervention with varicocele helps to get rid of the disease and its accompanying symptoms. It significantly increases the likelihood of conception and improves the quality of life of patients.
What operations are performed to eliminate varicocele, a review of options and methods
Varicocele is a purely male disease associated with degradation of the venous plexus in the scrotum, through which normal blood circulation in the testicle is ensured.
It happens one-sided or bilateral, depending on the etiology of the disease and the general clinical picture of the patient. It is treated with conservative and surgical methods.
How is varicocele surgery performed? Why do doctors recommend surgery, and how can an operation to remove varicocele be performed? Consider in our material.
Operation is the best solution.
What is a varicocele? This is a violation of the patency of the venous node.
In simpler words - testicular varicose veins. That is, the deformation of the veins and the violation of the transport of micronutrients in the scrotum.
In a severe stage (3-4), it can provoke infertility, and also causes physical and psychological discomfort for a man during sexual intercourse.
Does varicocele need to be operated on? This disease can be treated with conservative methods, but after them, as practice shows, the probability of relapse remains at a high level, since damaged and deformed vessels can no longer recover to their original state. That is, the blood flow of the scrotum and testicular feed will be permanently impaired.
For the treatment of varicocele, the following surgical methods:
It should be noted that surgical intervention can be carried out by different methods. In one case, the adhesion of the spermatic cords is simply performed, in the other, the whole vascular structure is removed without its subsequent possible restoration.
More modern variations are microsurgery, as well as the restoration of blood flow due to the connection to the epigastric vein (the ovarian is completely removed). This is the most modern and recommended method of treating varicocele, but such operations are far from being carried out in every clinic.
What operations are acceptable for varicocele?
Ever since the Soviet Union existed in state clinics, operations to eliminate varicocele have been carried out according to the Ivanissevich method.
At the moment, such surgery is considered one of the worst treatment options.since the probability of relapse is almost 40%. And various complications are possible, up to infertility (with bilateral varicocele).
How is such an operation performed? A sufficiently large incision is made in the iliac region, after which all damaged ovarian veins are ligated. This is the main drawback of the operation.
With such an incision, and in such an area, the surgeon does not have full access to the venous ligament, therefore it is almost impossible to dress all absolutely deformed and damaged veins (their processes).
Therefore, a tendency to relapse persists. The result directly depends on the stage of the disease at which the patient sought qualified medical help.
Operation Palomo It is carried out in a similar way, only the incision is already performed above the frontal region, under the peritoneum. In this case, there is no need to bandage each process of the ovarian vein - the entire ligament is blocked by one stretch.
The likelihood of relapse persists (since the clamps for blood vessels can stretch over time), but much lower than when operating according to the method of Ivanissevich. To date, the Palomo operation is performed quite rarely due to the complexity of its execution.
Surgery according to the Marmara method is considered the most progressive variation in the treatment of varicocele, where Ivanissevich surgery is taken as the basis.
That is, a similar ligation of the ovarian veins is performed, but an incision is already being made in the pubic area, namely from the scrotum. In this case, the doctor gets access to the entire vascular ligament (therefore, the procedure is performed by a vascular surgeon or under his direct control).
After performing all the manipulations, the skin is sewn with a cosmetic suture, so only a barely visible scar remains.
You can familiarize yourself with the progress of the above procedures in the following video:
The course of Marmara’s operation with varicocele:
Operation according to Ivanissevich with left-sided orthostatic varicocele:
Endoscopy and laparoscopy
The operation with ligation of the ovarian veins through the incision, although they are most often performed, does not allow the cure of bilateral varicocele in one procedure.
That is, if varicose veins affect two testicles at once, then you will have to perform two operations (on the left and right side). Doctors recommend performing them with a break of several months (until the end of the prescribed rehabilitation).
However, mention should be made of endoscopic surgery for varicocele. With this method of treating the disease, an incision is not needed. Several punctures are made in the peritoneum, through which an endoscope and all the necessary tools are inserted.Through it, the doctor receives an image on an external monitor and can pull the veins with titanium staples followed by cutting off, practically without causing damage to the patient.
Recovery after such an operation takes only a few weeks, after which the patient is allowed to even exercise. And by the way, endoscopic microsurgery is the only method in which simultaneous cutting of two veins is allowed, that is, treatment of bilateral varicocele.
Indications for surgical treatment
Due to the expansion of the veins, the normal blood supply to the tissues of the testis and the process of thermoregulation are disturbed. The sperm count is reduced, and they are no longer so mobile. In most cases, the left side is affected, although bilateral pathology is sometimes found.
Varicocele can be congenital and usually begins very early, but does not manifest itself in childhood. The first clinical signs begin to occur as the child grows older (in adolescence).
The course of the disease in a teenager may be asymptomatic, therefore, an indication for surgery to remove a varicocele may be data obtained as a result of a Valsalva test, an ultrasound scan or palpation of the vaginal plexus. The effectiveness of treatment depends entirely on the degree of the disease and the chosen technique. If necessary, the patient is assigned.
An operation to remove varicocele is necessary if there are the following symptoms in a teenager or adult man:
- pain in the groin,
- swelling of the testicle.
The technique of surgical manipulation depends on the size of the testicle and the age of the patient. Before starting treatment, it is necessary to prepare for testicular surgery with varicocele in order to avoid serious complications and consequences.
Tip: the sooner the disease is detected, the faster treatment will begin and the risk of serious complications will decrease. Therefore, at the slightest sign or concern, you should consult a doctor.
Microsurgery with hemming
well and The most modern and recommended treatment for varicose ovarian veins - This is the removal of the entire deformed vessel and suturing in its place of the epigastric vein.
The body quickly enough after that restores the nominal blood flow in the testicles and scrotum, therefore, the reproductive function is in no way impaired. But such operations are performed only by the most experienced vascular surgeons.
Of course, it will cost much more than others, more radical treatments. But the probability of relapse is zero.
And the main advantage of this method of treatment of varicocele is that the rehabilitation period takes only 3 weeks (taking into account medical supervision). But the functioning of the testicles and sperm production is restored within 1-2 days after surgery.
Varicocele: photo before and after surgery
Types of operations
Today, there are different types of testicular surgery to remove varicocele. Among them, the most basic can be distinguished:
- Marmara operation with varicocele,
- laparoscopic varicocelectomy,
- laser operation
- Ivanissevich operation.
Marmara microsurgery is the best technique for replacing a diseased testicular vein with a healthy vein. To do this, doctors provide themselves with mini-access to the necessary area of the body, without penetrating into the abdominal cavity. The microsurgical technique is considered the least traumatic among all other techniques, since it almost never causes the appearance of cosmetic skin defects.
Microsurgery also has the lowest risk of relapse and serious complications. Its advantages include a quick rehabilitation period and low invasiveness.
Microsurgical manipulation does not require mandatory hospitalization of the patient in a hospital and can even be performed on an outpatient basis. The preparatory period is standard, as for all other surgical interventions.
The patient is given an analgesic injection, which has an anesthetic effect. How much anesthetic is administered is decided by the anesthetist based on the total weight of the patient and his age. Then the surgeon makes a small incision in the inguinal region of no more than 2-3 cm. After the swollen vein is found, it is bandaged, stitched and crossed. This helps to normalize blood flow and relieve negative symptoms of varicocele.
During Marmara microsurgery, in rare cases, accidental damage to the nerve endings in the groin or bleeding may occur. The recovery period is only 3 days, and the sutures are removed as early as 8-10 days after they are applied. The disadvantages of this technique include only the high cost, because special tools and expensive optics are used.
In the postoperative period, it is recommended to avoid serious physical exertion and sudden movements. For one month you can not have sex and you need to protect the incision area from friction. Underwear should be natural and not tight.
Three months later, you should pass a spermogram in order to assess the ability of sperm to fertilize. Six months after treatment, you can return to your usual lifestyle.
Tip: the doctor must decide which types of surgical interventions to choose from all available, taking into account the patient's age and individual problem.
This type of treatment for varicocele in the testis is considered cheaper. The essence of the method is to cut and bandage the left vein in the testicle. This helps to eliminate the main negative factor that causes the reverse flow of blood into the plexus of the testes.
During the operation of Ivanissevich, the lumen of the varicose vein is completely closed under local anesthesia for adults. Children usually have surgery under general anesthesia. In time, it takes about 30 minutes.
The postoperative period in this case is longer, and the risk of complications is quite high. During the execution of all manipulations, the femoral artery and other anatomical formations in the inguinal canal can be damaged. In addition, the minuses include a complete dissection of the abdominal wall and penetration into the abdominal cavity. The patient will be incapacitated for several months. There remains a likelihood of relapse, which is about 40%. Advantages of the operation of Ivanissevich include the lack of the need to use special equipment and the ability to carry it out to everyone.
Laser treatment of varicocele is one of the most modern methods of solving this problem. For this, there is no need to make an incision in the inguinal region, and all manipulations are carried out using an intravascular endoscope. Fiber optics helps to find the exact region of the expansion of the vessel and coagulate it under the action of a laser beam. After that, it turns off from the general bloodstream.
The advantages of this type of intervention include the absence of the need for anesthesia and a quick rehabilitation period. You can also highlight the minimal risk of complications or serious consequences. Operations with varicocele have significant differences from, operations with or. Only a doctor can answer the question of how long the rehabilitation period will take, what will be the cost of the operation to restore the testicle.
Attention! The information on the site is provided by specialists, but is for guidance only and cannot be used for self-treatment. Be sure to consult a doctor!
Varicocele is not just one of the most common pathologies among men, but also a rather young disease: it occurs in men 15–25 years old. The frequency of occurrence of varicocele varies from 2.3 to 30.7%. In 35% of cases, with the development of this pathology, primary male infertility occurs, in 80% - secondary.
Most often, the development of varicocele provokes puberty. Pathology quickly reaches a certain degree, after which it rarely progresses. Due to some anatomical features, varicocele is left-sided - in 80 - 86% of cases.
If we turn to the definition, then from the point of view of the andrologist a varicocele is a change in the veins of the plexiform plexus passing in the spermatic cord. Dilation of the veins leads to impaired reproductive function of the testicles and to male infertility.
Depending on the stage of the disease, the treatment of varicocele will be different: surgery or conservative therapy. In the first stage, the doctor may try to get along with medication, that is, eliminate stagnation in the pelvis.
However, in all other cases, the operation is used to remove the varicocele. Indications for surgical intervention:
- Primary or secondary infertility,
- Testicular atrophy,
- Pathological changes in the spermogram,
- The cessation of testicular growth when puberty occurs,
- In rare cases, a cosmetic defect comes first.
Operations with varicocele testicle: types
Modern urology offers more than 120 types of varicocele operations. Many of them are already a thing of the past in European countries, as they are traumatic, have a large number of complications and relapses. Varicocele surgery can be divided into two groups:
- With the preservation of the message with the renal artery,
- Interruption of the message with the renal artery.
Based on the essence of the operation, two types can also be distinguished:
- Removal of varicose veins - after the intervention, blood flow stops completely, as a result of which new ways of outflow of blood in the testicles open. Pros in the simplicity and low invasiveness of the procedure. Cons - high relapse associated with a large variability in the location of blood vessels in the testes. Interventions of this type include testicular varicocele surgery according to the Ivanissevich method, endoscopic, Marmar.
- Removal and plasty of testicular veins. The only representative of this type is microsurgical revascularization of the testis. The advantage is physiological restoration of blood flow, relapse of the disease is excluded. Cons - high complexity of the intervention and the cost of the procedure.
Varicocele surgery may vary in the way it is carried out:
It is important to know that untreated varicocele can lead not only to a decrease in the reproductive function of the testis, but also to its death.
Microsurgical operation varicocele
Modern urologists prefer minimally invasive operations, in which the risk of postoperative complications is reduced, the number of relapses is reduced. The most commonly used intervention is the microsurgical operation of varicocele.
The most common operations of this type are:
- Marmara operation
- laparoscopic clipping of testicular veins,
- endovascular phlebosclerosis,
- The risk of postoperative complications is reduced:
- Minimum rehabilitation period,
- There is no pain during and after surgery,
- Minimal cosmetic defect
- Spermogram indicators are restored,
- The operation can be performed under general or local anesthesia.
Operation Method Selection
Varicocele removal operations are common in European clinics. No less successfully such interventions are carried out by specialists of the Open Clinic network.The presence of high quality equipment, international experience of doctors, comfortably equipped hospitals, positive results, patient confidence make such operations preferable in the treatment of varicocele.
Testicular varicocele surgery: rehabilitation
Thanks to the possibilities of modern medicine, the operation of varicocele testicle is quick, simple and does not require special rehabilitation. The postoperative period lasts 2-3 days, during which the patient is under the supervision of doctors from the Open Clinic network.
The main rehabilitation consists in the correct selection of the physical activity of the patient, as well as his sexual activity. Active sex life is allowed 2-3 weeks after surgery, and active sports - after 1 month.
Correctly, reproductive function is restored within a few months, and conception occurs 1 to 2 years after the intervention.
Why should you come to us?
Online Clinic Network:
- Consultation and surgical treatment are carried out by experienced specialists with international experience.
- Modern standards of treatment for varicocele are used.
- The operating rooms are equipped with advanced equipment that allows for microsurgical interventions.
- We have extensive experience in conducting operations to remove varicocele, which are well tolerated by patients, have a low percentage of complications and do not require special rehabilitation.
- If necessary, our specialists draw up a rehabilitation course, which includes all methods of physiological and psychological rehabilitation.
The degrees and causes of varicocele
According to various classifications, varicose veins of the spermatic cord are divided into 3 or 4 degrees (in particular, Wikipedia indicates 3 types or degrees). Depending on whether the author takes into account the zero degree, when the pathology only arises and comes to light only at, but is not determined by palpation.
However, not everyone runs an ultrasound scan, so it’s better to start the classification with varicocele 1 degree, when dilated veins can be detected by touch, however, only in a standing position and . If the pathological process goes further, then further diagnosis does not even require additional devices and determines the following “achievements” of varicose veins:
- Varicocele 2 degrees you can detect visually where the dilated veins are clearly visible, but the testicle itself has not changed in size,
- Varicocele 3 degrees characterized by severe varicose veins and a decrease in the testicle, which can change its consistency.
Of course, many young people are interested in why it was such a "misfortune" that could make him "lie under the surgeon’s knife," but the causes of varicocele are no different from those for other species:
- The anatomical structure of the vessels of the testis, genetically programmed,
- Hereditary predisposition to varicose veins, which appear either in the father or in the mother, even on the lower extremities, at least in another place,
- Excessive physical activity (loads associated with power sports, cycling and horse riding),
- Renal venous thrombosis.
- Work associated with prolonged upright stays.
The mechanism of occurrence of varicocele in men is also typical of other types of such pathology and consists in the failure of the venous valves, which leads to stagnation of blood in the testicular veins, which accumulates, dilates the vessel, which contributes to the development of testicular varicocele.
Dangerous age and upcoming operation
The pathological process usually prefers more left side , however, it is two-way or selects the location of localization on the right.The disease begins early or can be generally congenital, which is due to the peculiarities of the anatomical structure of the testicular vessels, however, as a rule, it does not appear in children, except that the blue color of the scrotum on the left may indicate its presence (due to the peculiarities of venous outflow device, more than 95% of cases occur on the left ).
The asymmetry of the circulatory system explains why varicocele often occurs on the left. (The vein of the right testicle flows directly into the inferior vena cava, the vein of the left testicle into the left renal vein)
With the onset of rapid growth and puberty, the frequency of varicocele increases, and in adolescents can not only express itself, but also be diagnosed to a certain extent. The pathology discovered during some kind of research often causes shock not only because of its presence, but because of the impossibility of treating varicocele with any method other than surgical. Although, it should be noted that operation far not always required .
Many young men live long with a disease that is asymptomatic, they have children and are not worried about anything, and by the age of 40, it happens and goes away by itself. In most cases, it is this option that is characteristic of varicocele.
Some men spend in order to avoid interference treatment of varicocele without surgery by wearing a special device for the scrotum, which raises a testicle and is called suspensory . They say that a suspensory is very helpful for those who want to engage in cycling and horse riding, and the signs of varicose veins are an obstacle to your favorite activities. And others generally use the "testicle bag" solely for the purpose of prevention.
However, the disease is not the same for everyone and does not always have only a favorable prognosis in terms of maintaining reproductive function. Testicular varicose veins are known may result to his atrophy as a result of sclerotic changes and ischemia, which will inevitably lead to impaired spermatogenesis with a sad outcome called male infertility. Varicocele can lead to the fact that the testicle, where the development of the sperm cell occurs, is in an environment unfavorable for itself, which has completely unsuitable conditions for the full development of germ cells.
In cases where the pathology requires surgical intervention, no pills and lotions will help. In this situation, one should not hope for luck, but after weighing all the pros and cons, one should choose the most optimal method of surgical treatment, because at the present time surgery for varicocele is a frequent phenomenon and has several varieties.
Patient's right to choose
In addition to choosing the surgical method, the question of the average cost of surgical intervention for varicocele also often worries the patient himself and his parents if he has not yet reached the age for making independent decisions. To go to a state medical institution for two weeks and get by with low material costs? Or contact to a commercial clinic , spend in comfortable conditions with meals for five days and return home already without a varicocele, paying for everything about everything thousand 100 Russian rubles ?
However, this is the average price, where each method has its own cost, so you can think and decide, and first get acquainted with the main characteristics of the proposed surgical interventions.
Marmar microsurgery is currently one of the most popular and preferred, as does not require penetration into the abdominal cavity , less traumatic, practically does not give cosmetic defects, complications and relapses. Its cost starts from 35-40 thousand rubles if the intervention is one-sided, but during operations on both sides, they are considered independent of each other and evaluated in 70-120 thousand rubles ,
Laparoscopic varicocelectomy considered the most effective and only method in the case bilateral vein expansion of the spermatic cord . The day after the operation, the patient can go home and begin his usual business and worries, the rehabilitation period is quick and easy, there is no cosmetic defect.
The operation is carried out by piercing the anterior abdominal wall under general anesthesia, and the surgeon monitors the progress of the operation using optical equipment in real time on the monitor. The laparoscopic method practically does not relapse and reduces to zero the risk of ligation of the testicular artery. An indication for endoscopic intervention is the presence of severe pain in the scrotum, relapse, infertility, the elimination of a cosmetic defect, a combination of several clinical signs of varicocele. The average cost of such an operation is approximately 50 thousand rubles.
Indications for the appointment of the method
The main indication for varicocele surgery for choosing the method of surgical intervention is the age of the patient, as well as the stage of his illness.
With bilateral varicocele, complete ligation of venous and spermatic cords leads to testicular degradation. As a result, a man becomes barren.
The hormonal background is still partially disturbed, the production of testosterone is reduced. All this in total reduces his attraction to women. And some men have complexes against the background of all this.
Who makes the decision what operation the patient will have? Of course, the decision is up to the patient himself, but it should be understood that in state clinics only Ivanissevich’s operation is performed free of charge.
For more modern and optimal treatments, you will have to pay a certain amount of money. Even better - without wasting time contacting private clinics. It will cost more, but the reproductive function of a man after surgery will in no way be impaired.
Is it possible to carry out an operation for a compulsory medical insurance policy?
The compulsory medical insurance policy includes a wide range of free surgeries, however, only according to the Ivanissevich method and laparoscopy (punctures in the peritoneum).
That is, the compulsory health insurance policy covers only the most radical methods of treating varicocele. This is only suitable if the patient no longer plans to have children in the future or if varicose veins are unilateral.
In other cases, it is recommended to contact private clinics or conduct microsurgery.
Embolization, spermatic cord are endovascular manipulations and are considered almost non-surgical methods that do not include incisions, sutures and general anesthesia, the patient does not even sleep in the hospital after the procedure, but goes home, where he spares himself for several days, avoiding physical exertion. However, the price of such an “easy” intervention is the same as during normal surgery and depends on the clinic, region and doctor’s qualifications.
Photo: embolization with varicocele. The embolizing spiral stops blood flow through the affected vein.
Does the patient experience pain during the procedure?
Operations to eliminate varicocele are performed under local anesthesia, since there is no need for general anesthesia. And the doctor needs to monitor the patient’s condition during the procedure. Does he feel something during surgery?
The most painful is the performance of a primary incision or puncture. But the operation is carried out quickly enough, so no complications after this can arise.The main thing is to comply with the rules for the treatment of the suture in order to prevent the infection from connecting, otherwise you will have to open the incision again.
But the place where the operation was performed will hurt after the anesthesia ceases to function. And even then - the very next day the patient can be discharged from the hospital.
A longer rehabilitation and hospital stay will be required only if the surgical intervention was carried out according to Ivanissevich, or the patient has the following complications:
- signs of infection of the suture,
- low hemoglobin
- relapse of varicocele.
How to process a seam?
Postoperative suture treatment involves 2 times a day obligatory dressing.
First of all, it is treated with a solution of furatsilina for disinfection, then Levomekol ointment is applied to it. From above everything is covered with cotton wool and wound up with a bandage.
After 3-5 days, any wound healing ointment is prescribed instead of Levomekol, which also helps scar tissue.
On average, suture treatment is performed approximately 7-10 days after surgery, after which sutures or staples are removed (depending on the treatment method used).
On day 5-6, a second examination is carried out by the attending physician (surgeon). If necessary, the doctor will prescribe additional procedures for the treatment of the seam.
Complete rehabilitation takes 3 weeks (21 days) from the moment of surgery. If a person is engaged in power sports, then you can restore your form only after 30 days, while starting with minimum loads.
It should be noted that vascular healing occurs much faster than epithelium. That is, when the seam has already disappeared - the veins are guaranteed to restore nominal blood flow. After all this, it is recommended to take blood tests to determine the concentration of hormones - this way the work of the testicles and prostate gland is controlled.
The shortest rehabilitation period is introduced with endoscopy or microsurgery. There, treatment of the sutures is not required (after the operation, only an ice bladder is applied to prevent swelling of the soft tissues and bleeding).
Physical activity is allowed from 12 days, but you should focus on the assurances of the attending physician.
Altogether, varicocele is best treated precisely with surgery. Moreover, the operation should be performed in the early stages of the detection of the disease. The best method is microsurgery followed by hemming of the vein. After such an operation, testicular function is fully restored, as well as the reproductive function of a man (but only if there was no atrophy before). But the operation according to Ivanissevich should be abandoned. It has not been carried out in most countries for a long time due to the high morbidity and the likelihood of relapse.
Based on the opinion of the doctor
Is it worth it to go for surgery if the symptoms of varicocele are not sufficiently pronounced, or can you wait? How long will the wait last? What complications should be feared after surgery?
Although the patient is involved in resolving the issue of surgical intervention, the last word should always remain with the specialist. As a rule, a doctor can objectively weigh all the pros and cons of an upcoming operation, where expediency taking it into account, taking into account all the pros and cons factors, comes first.
Surgical methods of treatment are resorted to in the presence of the following indications:
- Sensations of discomfort and pain of any intensity, since even slight soreness can indicate the formation of microthrombi and inflammation in the dilated vessels of the plexus,
- Infertility due to a violation of spermatogenesis caused by varicose veins of the spermatic cord,
- A cosmetic defect that constantly injures the psyche of a man and as a result leads to a breakdown in sexual relations,
- For the prevention of infertility in childhood and adolescence, although there is no consensus on this issue.
Many experts adhere to their point of view and argue that varicocele cannot cause infertility and justify surgical treatment only in cases of spermogram deterioration. However, in some ways, the clinicians are still united: in the presence of both infertility and varicose veins of the plexiform plexus, surgical treatment of varicocele is carried out unambiguously. And then you can look for another reason, if the situation does not improve.
What else threatens varicocele?
In addition, you should always keep in mind the possible complications and consequences of varicocele, which include:
- Dropsy testicle (hydrocele), caused by the accumulation of fluid in the scrotum as a result of impaired lymph flow. This complication is most common after Ivanissevich’s surgery and is associated with ligation of the lymphatic vessels simultaneously with the testicular vein. With the occurrence of hydrocele, the patient is prescribed a puncture or reoperation,
- Relapse of the disease is more likely with open access and occurs in connection with the ongoing blood flow through the internal spermatic vein (incomplete cessation). When treating relapses, they usually resort to sclerotherapy,
- Testicular atrophy - the complication is so rare, so serious, that is, such a pathology is characterized by the fact that in the end the testicle, decreasing in size, loses its main function, which is unlikely to please a young man who wants to have children,
- Postoperative disease, when the epididymis overflows with blood. Such troubles more often occur after laparoscopic intervention,
- spermatic cord or perforation of the vascular wall,
- Allergic reactions to contrast medium characteristic of embolization.
Obviously, the most safe and least traumatic operation of Marmara, which, moreover, can be performed under local anesthesia and eliminate the negative impact of general anesthesia.
The last stage of preparation for surgery
When choosing a surgical procedure, the patient’s age and the presence of concomitant diseases are mandatory taken into account, especially during operations requiring general anesthesia, which in itself has contraindications and, of course, the severity of the pathological process. The presence of purulent and inflammatory foci, regardless of their location, is a direct contraindication to any surgical intervention! Diseases of the gastrointestinal tract also belong to the category of primary contraindications in the surgical treatment of varicocele.
Before surgery, the patient undergoes a mandatory examination in such cases, which includes:
- General analysis of blood and urine,
- Biochemical studies of blood serum (glucose, urea, creatinine, enzymes, bilirubin),
- ELISA HIV and syphilis,
- Prothrombin index, coagulability and duration of bleeding,
- Group affiliation for AB0 and Rhesus systems,
What and when you can eat and drink, how to cleanse the intestines and prepare psychologically - these questions seem insignificant only at first glance. With surgical intervention, every little thing is important, and therefore, the patient, once in the surgical department, should be under the "vigilant eye" and constant monitoring of health workers the day before and believe that everything will be fine with him.
Surgery to remove varicose veins of the plexiform plexus does not belong to the category of complex and heavy, so the hospital stay is short and the recovery period after surgery usually lasts no more than two to three months, during which the patient is released from physical exertion. In addition, he is strongly recommended to abstain from sex for 3 weeks , since the patient, having listened to unfounded allegations of a decrease in erection, wants to quickly see the opposite. Before discharge, the doctor usually focuses on such issues and patiently explains to the patient that surgical treatment of testicular varicocele does not affect “male abilities”. But then, after a period of abstinence, regular sex may be the best prevention of varicocele in men.
It is known that the digestive tract works very much on the vessels of the testicle, where constipation is the worst enemy of the veins, causing stagnation in them, therefore, special attention should be paid to the regulation of these processes. In addition, extra pounds will only hinder, which means that a full-fledged diet with a predominance of vegetables and fruits will be just the way.
Until it comes to active sports, the patient should not forget about the positive effects of good healthy sleep, which usually occurs after evening walks. And sports are not only possible, but also necessary, of course, after a three-month break, but preference should be given to swimming and athletics, but it is advisable to hide a mountain bike away. And it’s better not to ride a horse.
The most important point of preventive measures, which is mentioned at every visit to the doctor: bad habits should be eradicated once and for all! Every minute, the patient is ordered to remember that nicotine is especially harmful to the cardiovascular system in general, and to the venous vessels of the plexiform plexus, in particular.
For those who do not recognize surgery
Treatment of varicocele without surgery consists in using the healing properties of plants that nature gave and studied by the ancestors. After all, there were times when there was no current abundance of pharmacy drugs, and surgery did not stand at that height. Varicocele is not only the privilege of a modern man, the disease must have originated with a person, therefore, treatment with folk remedies for such a pathology was certainly reflected in the recipes of herbalists.
Infusions of a mixture of chamomile, chestnut, rue, willow bark, raspberry root and yarrow leaves not only drink 150 grams in the morning and evening, but also in the form of compresses on a sore spot.
It is believed that with varicocele Antonov apples help quite well.
Particularly popular in the treatment of testicular varicose veins are techniques for the combined use of infusions or decoctions of willow, oak and chestnut branches.
How to treat varicocele and how is the patient’s business, however, it is undesirable to launch the disease, if any. Another question, if there are no signs of varicocele, then, as people say, “you don’t need to bother”, because this disease is only subject to treatment when it manifests itself, and even that is mainly operative. However, for men with a hereditary predisposition, prevention still does not hurt, and folk remedies will help to cope with the problem.
10 days before the surgery, preparation for varicocele surgery begins, the proposed study is as follows:
- general examination of urine
- if necessary, it is recommended to definitely do an ultrasound of the scrotum or a contrast ultrasound according to the Doppler method, during which they get a complete picture of the situation,
- blood test, in particular for the Rh factor, sugar content, coagulability, general indicators,
- X-rays of light,
- testing for AIDS, hepatitis C and B
There are many types of operations for treatment: laparoscopy, traditional surgical intervention, according to Ivanissevich conducted directly with direct contact, microsurgical methods and innovative developments.
History and causes of varicocele
The pathology of the veins (their varicose expansion) located in the scrotum and entwining the testes is called varicocele. Veins are tubes through which blood returns to the heart from body tissues. To prevent blood flow in the opposite direction, the veins are equipped with one-way valves.
When they for some reason cease to fulfill their functions, a countercurrent occurs. Blood builds up in a vein (especially when a person is standing) and bursts into it. This is called varicose expansion.
Varicocele in men surgery - when to start treatment
The testicles are surrounded by a whole system of small veins (plexiform plexus). Of these, blood enters the testicular vein (larger), and from there into the renal (left testicle) or the inferior vena cava (right testicle). The pressure in the renal vein is much higher than in the inferior vena cava. This fact explains why the veins of the left testicle undergo varicose enlargement.
Varicocele becomes a common cause of infertility in men. This is due to the fact that in the dilated veins blood accumulates, increasing the temperature of the testicle. As a result, their function is impaired (spermatogenesis). Less sperm are produced, and they are inactive.
The disease has several causes. Depending on the etiology, the following are diagnosed: primary (idiopathic) and secondary (symptomatic) varicocele. Idiopathic varicocele most often occurs due to a genetic predisposition and is manifested in adolescents during puberty.
At this time, there is an increased formation of the reproductive system, which requires increased blood supply. Increased blood flow makes the veins work with increased stress. If there are any pathologies in them, a malfunction occurs, which leads to varicose veins of the plexiform plexus.
Indications for the operation
Varicocele surgery is done in the following situations:
- detected changes in sperm production. During the study, a decrease in the number of sperm in the ejaculatory fluid was noted, their mobility was reduced, there is pus or blood,
- the man is disturbed by pain, which often manifests itself at the 2nd and 3rd stage of varicocele. At first, the pain is moderate. The pain occurs during walking, after physical exertion. In most cases, there is varicocele on the left of the testicle,
- the patient is not satisfied with the appearance of his scrotum,
- there is a decrease in testicle size.
If symptoms are absent, varicocele surgery is not prescribed.
Some doctors believe that with timely surgery, infertility can be avoided. At the same time, others assure of unjustified risk for the patient and advise to do without surgery, and periodically inspect a specialist and undergo an ultrasound.
Surgical treatment of varicocele is not performed in young men under 18 years of age. Based on the data obtained, in adult men relapses are much less likely to occur. Therefore, it is advised to be operated after physiological maturation.
When squeezing veins, a secondary disease can develop. It manifests itself due to a tumor, a cyst. The patient is in fever, blood appears in the urine, dull and stitching pain appears in the lower back. In the presence of a secondary disease, the cause of the disease is eliminated. Surgical intervention to remove varicocele is not necessary until the results of the treatment of the underlying ailment appear.
Prices for a surgical solution to the problem depend on the specialization of the clinic, where it is located and what method is chosen for the varicocele procedure.
Surgical method according to Ivanissevich
This procedure is one of the most common. It involves ligation of the vent of the testicular vein, having a direct approach to the inguinal area. The doctor makes an incision in the groin, secreting the plexus of veins.
The operation for the treatment of varicocele is performed under local anesthesia.In the case of exceptions or surgery, the child is given general anesthesia.
The mouth of the affected vein is ligated and crossed. Then the incision made is sutured in layers.
Using this method, there is a high threat of damage to the femoral artery and other formations that are present in the nerve and vascular bundles passing into the groin.
Methods for the operational solution of the problem are similar to each other. Only in this case, an incision is made over the inguinal duct. This makes it possible to reduce the risk of damage to the bundle of nerves and blood vessels. After a tissue incision, a testicular vein is available to the doctor. He bandages it and removes it. The operation takes place under both local and general anesthesia.
In both operations, a sterile dressing is always applied to the sutured wound. The patient is discharged for 2 days. Sutures are removed after 9 days.
What operation is effective for varicocele: the choice of doctors and men
Varicocele is a somatic disease of the genitals in men, characterized by hypertension of the veins of the plexus plexus at the site of passage of the spermatic cord.
The disease is diagnosed during puberty in adolescents, or at an older age in the presence of problems with spermatogenesis.
The following traditional and progressive types of varicocele removal surgery exist:
- direct impact
In the traditional way (using direct exposure), abdominal operations are performed according to the method of Palomo, Ivanissevich. The minimally invasive types of surgical intervention are referred to as progressive (the remaining three from the list).
Features of open intervention
Ivanissevich’s technique is one of the first introduced into surgical practice. However, it is considered the most traumatic.
- parallel to the inguinal canal, above the entrance, a layer-by-layer incision of 3-5 cm is made (skin, subcutaneous fat, fascia, cord lining),
- excretion of venous vessels of the plexiform plexus,
- ligation, excision of extended areas,
- stitching in layers.
Palomo surgery has a higher incision. In the inguinal region layered dissection. Through it penetrate into the retroperitoneal tissue, directly to the testicular vein, which is ligated and cross. The wound is sutured.
This type of operation with varicocele requires serious rehabilitation after it. During the first few hours, a cold is placed on the inguinal zone in order to prevent edema, the development of bleeding. After that, a sterile dressing is applied to the seam, which requires regular replacement.
During the first few days, the patient needs to use a suspensory to support the scrotum, to avoid tension of the abdominal muscles. After 7-10 days, you need to remove the stitches. Over the next six months, it is recommended to avoid increased physical exertion.
In the video clip, Ivanissevich’s operation with unilateral varicocele:
Progressive methods of surgical therapy
Microsurgical surgery for varicocele has the advantage that its injuries are significantly reduced, rehabilitation is short-term, and the occurrence of relapse is reduced to zero.
The progressive methods of surgical therapy for varicocele include:
- microsurgical varicocelectomy,
- laparoscopic surgery
- endovasal surgery.
Each method of intervention has its own characteristics, advantages and disadvantages.
Marmar's subingual microsurgical varicocelectomy is the most advanced technique used for varicocele.
Its essence lies in the ligation of the veins of the sub-inguinal zone related to the papillary plexus.
Today it is used more often than other methods.
Surgical manipulations are carried out using microsurgical instruments and a microscope in the following sequence:
- at a distance of 1 cm from the base of the penis, a skin is dissected (up to 3 cm), through which the seminal duct is separated,
- veins are excised at the site of expansion, then they are ligated,
- all layers are sequentially sutured.
Marmar varicocelectomy is performed under local or spinal conduction anesthesia. It is indicated for left-sided and right-sided pathology in men who have an active sex life. The advantages of this method are:
- lack of need for hospitalization,
- short duration of the operational process (not more than 40 minutes),
- fast full recovery (up to 5 days, the ability to conceive effectively - during the first few years),
- low percentage of relapses (about 1%) and complications.
With the endoscopic method with varicocele, the treatment takes place without an incision in the inguinal area. This is a modern method that is carried out using an endoscope. It has an optical assembly and minimum size tools at the end.
A laparoscope is inserted through a small incision into the abdominal cavity. Its intra-abdominal end is brought to the mouth of the testicular vein. Next, the doctor needs to clip the veins with a clip of titanium and cross it.
With varicocele, laparoscopic surgery is characterized by the presence of 3 scars in the navel. Since with endoscopy, 3 cuts are made, the size of which is 1 centimeter.
This treatment method less injures the tissue, scars after surgery immediately heal. When indicated to operate, general, intravenous or endotracheal anesthesia is used, due to the involvement of the abdominal cavity.
Laparoscopy is ideal for varicocele in men with bilateral lesions, which makes it possible to cross 2 testicular veins without making additional incisions.
Due to laser ablation, an incision in the inguinal region is not required. For surgery, you will need an intravascular endoscope. Thanks to fiber optics, the doctor finds a section of the dilated vessel. Further, it is necessary to coagulate and exclude it from the bloodstream from the inside using the laser beam. This method can take place without anesthesia.
The inguinal microsurgical intervention according to the Goldstein technique involves the isolation and ligation of veins (cremaster, testicular) related to the spermatic cord.
The sequence of operations:
- 1.5-2 cm incision in a section of a parallel arrangement of veins, near the spermatic cord,
- the allocation of the vas deferens, testicular arteries (with a decrease in pulsation, spray papaverine hydrochloride in the form of a 2% solution is used),
- ligation of large venous vessels with surgical sutures (polypropylene d Read also: What can and cannot be done after varicocele surgery
It is recommended to carry out the operation only in case of specific need. If there are no indications for surgery, then treatment can be dispensed with without surgical intervention.
Learn how laser cutting is performed, perhaps this will help you decide on an important step.
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The operation for varicocele performed by the Palomo method involves an incision of the testicular vein affected by varicose veins. It is carried out over the inguinal canal. The surgeon immediately gets access to the testicular vein, bandages it and removes it. This approach will reduce the risk of injury to the neurovascular bundle.
The most common treatment for varicocele in men is surgery according to Ivanissevich.
- It consists in ligation of the mouth of the testicular vein.
- At the same time, they reach it directly through the inguinal region, making a longitudinal-oblique incision, behind which the venous inguinal plexus is located.
- The mouth of the testicular vein is first ligated, and then cut.
- After surgery, the wound is sutured, connecting each layer, and then skin sutures are applied.
Before surgery, local anesthesia is performed. In some cases, general anesthesia is acceptable. However, it is worth remembering that Ivanissevich’s operation with varicocele can lead to consequences: damage to the femoral artery and other formations located in the neurovascular bundle of the inguinal canal.
This method of getting rid of the problem is better than the previous one, since it is gentle (no incisions are made in the groin). In this case, all the principles of laparoscopy are used.
With varicocele, a laparoscopic operation involves performing 3 small incisions (1 cm) in the abdominal cavity through which an endoscope or laparoscope with a camera and miniature instruments is inserted. Moving the instrument during surgery, it enters the mouth of the testicular vein, where clipping and subsequent cutting of the vein are performed using a titanium clip.
The disadvantage of laparoscopy is the inability to use local anesthesia, since the abdominal cavity is involved. In case of damage to both testicular veins (the occurrence of varicocele on the left and right), laparoscopic surgery for varicocele is the most optimal option.
This operation is carried out under visual control.
- To do this, an intravascular endoscope 2 mm thick is inserted through the femoral vein and is advanced to the testicular vein.
- Further, the course of the varicocele operation is as follows: the vein is examined using a radiopaque substance.
- Then, in its expanded part, sclerosant is introduced - a substance through which “gluing” (embolization) of the vascular gaps occurs.
- This method of treating the disease is carried out without anesthesia, is minimally invasive, takes less time, has virtually no consequences and relapses, and is well tolerated by the patient.
Why surgery is the only way out
Varicocele is a reason for surgery. The impaired outflow of venous blood due to damage to the valve is the reason for its stagnation. It provokes an increase in testicle temperature, which means overheating of the scrotum. Varicocele interferes with the normal development of sperm. It is necessary to operate, as infertility often becomes the sad result of a disease.
Men have practically no contraindications to the operation, however, in adolescence - from 13 to 16 years - it is dangerous to do it because of intense puberty. Such patients are recommended surgical intervention at the age of 18. It is easily tolerated, complications are very rare.
Consequences and Complications
Surgery for varicocele may be accompanied by the following complications:
- Neuralgic type of pain resulting from trauma to nerve endings.
- Relapse (recurring disease).
- Dropsy of the testis as a result of injury to the lymphatic vessels.
- Deep vein thrombosis due to hematoma in the puncture zone or the introduction of contrast.
- Inflammatory processes.
- Lymphatic edema is another consequence of surgery due to injury to the lymphatic vessels.
- Reducing the size of the testicle. Caused by affecting the seminal artery.
- Damage to the ureter or intestines due to the inexperience of the doctor.
After the operation has been done with varicocele, the man is fully restored usually within 3-6 months. Spermogram analyzes and indicators are gradually improving. With minimally invasive interventions, the risk of relapse is 2%, and traditional methods in 9% of cases are not able to protect against the repeated development of varicocele.
In general, the doctor's recommendations are the same after any method used.Typically, the patient is advised of the following:
- take a multivitamin complex,
- treat the wound with an antiseptic,
- if necessary, take painkillers,
- in some cases, an enema may be prescribed if there are digestive problems,
- during the first two days to rest, wear compression garments and keep the wound dry,
- within 1-2 weeks do not have sex, give up heavy physical exertion and visiting a bath or sauna.
Contrary to popular belief, a man’s sexual function does not undergo any changes after surgery. The duration of the rehabilitation period is determined by the doctor, after the completion of recovery it will be possible to gradually return to the usual way of life.
Side effects from surgery include pain, swelling, and redness of the skin in the groin and testicles in particular. If the rules of the procedure were violated by the doctor or by the patient himself, inflammation may occur against the background of an introduced infection, dropsy of the testicle, a decrease in the size of the testicle and thrombosis. To avoid possible negative manifestations, it is better to choose a reliable clinic and strictly follow all the instructions of the attending physician.
How long does the testicle intervention last?
The only way that allows you to completely rid the patient of the disease is surgery. All other methods only prevent the further development of pathology and relieve symptoms. However, doctors do not prescribe surgical intervention in every case, since sometimes conservative therapy can be dispensed with.
There are 4 stages of varicocele development:
- The man does not notice the symptoms, the disease can be diagnosed only with the help of ultrasound.
- On examination, the urologist can palpate the dilated veins, while the patient is in a standing position, an additional Valsalva test can be used.
- Pathology is felt in any position, a test is not required.
- The dilated veins are visible to the naked eye.
As a rule, to remove a varicocele, an operation is prescribed only at the last two stages of development, since it is during this period that pathological changes can occur that affect the fertility of a man. In the first two stages, surgery is usually not required, the doctor prescribes the patient to take medications, physiotherapy and a regular examination to keep the situation under control.
To remove varicocele, the readings may be as follows:
- There is a chance of developing infertility. A spermogram is performed to study the quality of sperm, and if it decreases, the doctor strongly recommends surgical treatment of varicocele.
- The patient constantly feels pains that are not stopped by conservative treatment methods.
- A man does not like the appearance of a changed testicle.
- There is a decrease in the testicle in size and other complications of the disease.
In any case, the decision about the need for the operation is made by the attending physician, however, the patient may insist on the desire to get rid of the disease if he is afraid of possible complications. The opinions of urologists and surgeons are divided: some believe that the operation must be carried out in any case to avoid infertility, others argue that this is an unjustified risk, and it is better to monitor the course of the disease.
There are contraindications to the operation, it is not performed until the limiting factors are completely eliminated. These include:
- the presence of serious cardiovascular diseases that limit the possibility of any operations,
- exacerbated chronic diseases,
- infectious diseases accompanied by fever,
- acute inflammation
- diseases that affect blood coagulation,
- cirrhosis of the liver.
The patient will need to take tests and undergo an instrumental examination, which the doctor will prescribe. This is done to identify all existing absolute and relative limitations on surgical intervention. Also, a specialist may postpone the procedure if the patient has concomitant diseases.
In most cases, the operation is carried out in the second and third stages. Impact is assigned only for a number of indications. The reason for the surgery is the following negative changes:
- the danger of torsion of the paired gland,
- violation of the outflow of blood from the scrotum,
- a significant change in the shape of the scrotum,
- platelet accumulation in damaged tissue,
- rupture of the beam wall with the formation of a subcutaneous bruise.
An operation with varicocele is prescribed if there is a danger of torsion of one of the paired glands. Torsion is carried out when the testicle rotates along its axis in the opposite direction. In this case, the spermatic cord, which holds the gland, is compressed. The body ceases to receive the necessary nutrients and atrophies.
The support of a loved one is very important during therapy
The main complication accompanying the pathology is a violation of the outflow of blood fluid from the scrotum. Blood in large quantities accumulates in the membrane of the gland and cavity of the scrotum. Liquid causes an increase in testicular temperature. Overheating is fraught with a complete loss of reproductive function. If the specialist noted a gradual increase in blood in the scrotum, the patient needs urgent surgery.
An alarming symptom is an increase in the scrotal sac. In this case, a man may experience a buildup of blood or the formation of a hematoma. With this symptom, doctors immediately perform surgery.
Improper blood circulation is accompanied by a gradual accumulation of platelets in the damaged area of the vascular tissue. Platelets are highly adhesive. Compounds of other trace elements are attached to the surface of these cells. Bonding particles form blood clots. Blood clots form over the entire length of the beam.
With varicocele, the beam walls gradually become thinner. A thin section of tissue can rupture at any time. The fluid is discharged into the cavity of the scrotum or into the peritoneum. Blood forms a hematoma. Further withdrawal of blood into the cavity is dangerous for the patient's life. The presence of one of the listed symptoms should cause anxiety among doctors. Confirmation of the testimony is accompanied by an operation. Also, the intervention is carried out for aesthetic reasons.
Varicocele is performed using several methods. To this end, the following methods are used:
- Ivanissevich methodology,
- Palomo's way,
- Marmara Method
- Laparoscopic intervention,
- testicular vein revascularization,
- the introduction of a special drug substance.
All these interventions have a common goal. The task of specialists is to prevent further rotation of the blood in the affected area. When choosing a variety, the frequency of relapse should be considered. You also need to understand that each technique has a specific recovery period. A man should discuss all these subtleties with the surgeon before starting the operation.
Modern medicine is quite successfully struggling with this pathology.
This method of treating an ailment is considered the least effective. It was used as therapy until other methods were developed. According to Ivanissevich, the surgeon must ligate all the small vessels that carry blood to the genital gland.
For penetration on the right side of the lower peritoneum, the doctor makes a deep incision. Its length can reach 5 cm. All bundles of small fibers are removed through the wound. During one intervention, the surgeon must bandage all available bundles. For this reason, local anesthesia is used to avoid complications.The operated field is cut off with a special medicine that eliminates sensitivity for up to two hours.
Ivanissevich’s methodology has many negative aspects. With this method of treatment, 40% of patients develop re-lesion. This feature completely depends on the experience of the doctor. If one of the bundles is not subjected to dressing, the disease continues to develop.
Also, according to Ivanissevich, there is a risk of damage to the testicular aorta. In this case, the sex gland ceases to receive the necessary nutrition. Due to a lack of nutrients, the testicle ceases to function properly. There is a decrease in the production of healthy germ cells. Deterioration of spermatogenesis is fraught with the development of infertility.
After the operation, recovery occurs within a month. Due to the presence of multiple complications, many modern clinics have abandoned this method. This technique is found in small private medical centers.
Using the Marmara method eliminates the need for severe injury to the patient.
For any suspicious symptoms, consult a doctor immediately
The operation is performed under local anesthesia. To penetrate the spermatic cord, the doctor makes two punctures in the upper part of the trunk of the penis. Through punctures, the specialist gets access to the affected tissue. Ligation is carried out in the upper and lower parts of the affected vessel. After ligation, negative tissue is excised. Healthy tissues are held together.
If necessary, small sections of fibers carrying blood to the testicle and spermatic cord are also removed. After the procedure, a cosmetic suture is applied to the puncture. The patient remains under observation for 5-6 hours. After this time, the man can leave the clinic.
When using the Marmara method, contraindications are taken into account. It is not used in the presence of high sensitivity to the components of the anesthetic drug. Also, the method is not recommended in patients with diabetes mellitus or an acute form of the inflammatory process.
The advantage of this method is the complete restoration of reproductive function. Complications are detected in two% of patients. There is also a low risk of developing repeated lesions of the vaginal bundle.
Laparoscopy is a modern type of surgical intervention. For laparoscopy, special equipment is used that minimizes the risks of unwanted complications. A laparoscope allows a specialist to carefully examine the condition of all inguinal vessels. For this reason, this method is applied at any stage of the disease.
The operation is accompanied by complete anesthesia. The duration of the procedure is 15–20 minutes. The duration of the intervention decreases in the third stage of the disease. It should be understood that laparoscopy is a complete operation. The man remains under observation in the hospital for two days. If the patient does not reveal complications, he is discharged for home recovery.
Diagnosis of varicocele
Feeling the scrotum A mandatory procedure that allows you to determine the severity of varicocele. Ultrasound (ultrasound). Ultrasound is always combined with dopplerography (a technique for determining the quality of blood supply) of the renal vessels (arteries and veins) and testicular vein. The examination is carried out in the patient's standing position (orthostasis) and lying down (clinostasis) with a measurement of the blood flow gradient in these positions. necessarily conduct a test of Valsalva:
- The increase (varicose expansion) of the testicular vein in size with the vertical position of the body.
- In the position of the body, the lying vein decreases (decreases in size).
With varicocele of the first degree, the diameter of the testicular vein becomes 2 millimeters more than normal and a positive (up to 3 seconds) reflux is determined.Strongly expressed reflux indicates a more severe stage of the disease.
Ultrasound also allows you to determine the hemodynamic variant of varicocele, as well as to identify renal venous hypertension (if any).
- General urine analysis before and after exercise (march test). A positive march test - the appearance of a small amount of red blood cells in the urine (microhematuria) and the presence of protein in the urine (proteinuria) speaks for renal venous hypertension.
- X-ray methods. X-ray methods include:
- Antegrade phlebotesticulography or retrograde renal phlebography - these research methods are performed after preliminary administration of a contrast medium into the scrotum veins.
- Study of the hormonal profile - includes the concentration of testosterone, estradiol, prolactin, FSH (follicle-stimulating hormone), LH (luteinizing hormone).
- Semiological study (seed study) - in most patients, pathospermia is detected (a decrease in the number of motile forms of sperm and an increase in the number of pathological forms) of varying degrees.
Surgery for varicocele: what types of operations exist and how to do them
Varicocele of the testis (expansion of the veins) with dropsy has a specific configuration - the plexiform plexus. Varicocele is the most common cause of male infertility. In 95% of cases, the expansion of the left testicular vein is observed, since the outflow of blood from the system of the left renal artery into the testicular vein is carried out at a right angle, which creates high pressure on the venous valve system. Increased hydrostatic pressure overcomes the resistance of the valvular apparatus, so there is stagnation of the venous testicular system on the left.
Operation varicocele - Photo 1
Statistics claim that varicocele is a common disease. It affects about 16% of men on the planet, but is detected only in patients who turn to specialists because of infertility.
There are no pronounced symptoms with pathology, so you should carefully listen to your health. The only manifestation of the pathology can be pulling pain in the scrotum after physical exertion, walking, lifting weights.
Indications for surgery for varicocele :
- Scrotum over 2 degrees,
- Hypogonadism with an increase in one testicle relative to another by 20%,
- Dropsy with impaired spermatogenesis,
- Relapse after a previous operation,
The tactics and scope of surgery are determined by the surgeon after a thorough examination of the patient. Before the intervention, a damaged vein must be identified and the nature of stagnant changes proven.
Varicocele types of operations in men :
- Laser coagulation is performed by cauterizing the damaged area with a laser. Intervention is carried out by an intravascular endoscope. Fiber-optic technology coagulates the site of damage. With the help of laser beams, a damaged vein is switched off from the general bloodstream. Manipulation is carried out without anesthesia,
- Endovascular embolization - is carried out using a thin endoscope (about 2 mm thick), when the varicose nodes are contrasted through the femoral vein. Then, a sclerosing drug, which glues the lumen of the vessels, is introduced into the lesion sites.
The above operations relate to a number of intravascular. They are less traumatic, but are performed only when it is impossible to quickly remove varicose veins, as they are accompanied by a large number of complications.
Varicocele surgery can be performed in the following cases :
- The patient is in pain. They begin to appear at the 2-3 stages of the disease, at first they are insignificant. Unpleasant sensations intensify when walking, after physical exertion. Note.In the vast majority of cases, varicocele of the left testicle develops, so the pain most often has the same localization,
- The testicle begins to decrease in size,
- Identified violations in sperm formation. During the study, it was found that in the seminal fluid the number of sperm cells is reduced, their motility is reduced, there is blood or pus,
- The patient is not satisfied with the appearance of the scrotum.
In the absence of symptoms, surgery for varicocele can also be recommended. Some doctors believe that timely surgical intervention can help prevent infertility. Others believe that this is an unjustified risk, and are advised to limit their observation through periodic examinations and ultrasound.
Important! Operations with varicocele up to 18 years are usually not performed. According to statistics, in adulthood after surgery, relapses occur much less frequently - re-development of varicocele. Therefore, it is better to carry it out after puberty.
Vein compression can lead to the development of the so-called "secondary varicocele." It occurs as a result of a tumor, cyst, or other formation. In this case, the patient is concerned about fever, blood in the urine, dull or stitching pain in the lumbar region. With secondary varicocele, the cause of the disease must be eliminated, vein truncation surgery is not required until the results of therapy of the underlying pathology are manifested.
The cost of varicocele surgery
Operation varicocele is not included in the list of services of the type "high-tech assistance" for which funds are allocated. On the website of some clinics it is indicated that they work with compulsory medical insurance and VHI, but in the first case we are talking only about the discount that a client who can contact them can get or a refund of part of the money spent.
Operation varicocele - Photo 2
The cost of the operation depends on the chosen technique and region. In provincial cities of central Russia, the price for an open surgical intervention starts from 5,000 rubles, in Moscow - from 8,000 to 10,000 rubles. Approximately the same amount of sclerotherapy will cost.
Microsurgical intervention (according to Marmar) will cost at least 20,000 - 30,000 rubles. Laparoscopic surgery will cost a little less - 15,000 - 25,000 rubles. Prices are based on local anesthesia, if the patient prefers general anesthesia, he will have to pay separately - 7,000 - 10,000 rubles.
- Ivanissevich's operation - from 4,000 to 115,000 rubles,
- Laparoscopic excision of the testicular vein - from 5,000 to 188,500 rubles,
- Marmara operation - from 11,100 to 246,600 rubles,
- Embolization of varicocele - from 12850 to 46000 rubles,
- Operation Palomo - from 16800 to 108100 rubles.
Is varicocele required? If a young man wants to maintain or restore his fertilizing function, then surgical treatment is indispensable. The operation can not be done if the problem of paternity for a man at the moment and in the future is irrelevant.
Indications for varicocele surgery
Timely operations with varicocele on the testicle contribute to the elimination of negative conditions for sperm maturation. They are carried out in a surgical clinic. Depending on the method of surgical intervention chosen by the doctor, they can be performed both under general anesthesia and under local anesthesia.
With varicocele, the indications for surgery are the presence of a varicocele, which is accompanied by a violation of the function of spermatogenesis, pulling pain in the groin and along the spermatic cord, either during sports and lifting weights, or constant, as well as an increase in the scrotum. These signs correspond to 1 and 2 degrees of the disease. The operation can also be performed up to 18 years, if there are initial signs of testicular atrophy.
Operations with varicocele - types
How is varicocele surgery done? For varicocele surgery, there are several types of surgical interventions - classic and modern. These include:
- Operation Ivanissevich,
- Operation Marmara,
- Laparoscopic surgery
- Operation Palomo,
- Microsurgical method.
Each of these types has its own indications and contraindications, its advantages and disadvantages.
Varicocele treatment without surgery
Treatment of varicocele without surgery is possible, but only with the goal of normalizing the work of the ovaries, correcting the disturbed hormonal background. Dropsy of the ovary is accompanied by a violation of spermatogenesis and infertility. In older men without symptomatic, it is irrational to remove the dilated veins of the testicles, since the return of reproductive function by surgery is not a rational step. At home, such patients take antioxidants and venotonics (phlebodia) to prevent the destruction of testicular tissue, preserving the tone of the venous wall.
Conservative treatment of varicocele without surgery is carried out for young people until they are 18 years old. Only after the formation of the reproductive sphere is dropsy therapy carried out. Before maturation of the reproductive organs, surgery on the genitals is not performed, since after the procedure, there is often a violation of the formation of the testicles, slowing their growth. The task of conservative treatment in this case is to prevent the progression of the disease.
Treatment of varicocele in men without surgery can be carried out at home with folk remedies only if the person has refused manipulation. This approach is not rational, since conservative methods cannot restore the tone of varicose veins. There are cases of religious beliefs regarding manipulations on the genitals, so some patients refuse the procedure.
How long does varicocele surgery last? This may depend on which procedure you need to complete. But as usual, any simple operation lasts about 30-50 minutes, in some cases it is from 1 hour to 3 hours.
What is the operation for
If you find a varicocele, the bases for surgery are:
- Testicular atrophy (change in consistency, size reduction).
- Pain in the scrotum and groin.
- Bad spermogram.
- The second and more degree of the disease.
An operation done on time by our specialists gives a chance to recover spermatogenesis.
Types of operations
All operations performed in the clinic are similar to the removal of the affected veins, however, the methods are different. The effectiveness of the operation, the degree of injury, and subsequent complications depend on the methods used. The complexity of any operation is to maintain venous blood flow during the removal of diseased veins.
- Ivanissevich’s operation is characterized by frequent complications and relapses. The affected veins are ligated in a single block. There is a high risk of ligation of the testicular artery, this can disrupt spermatogenesis. The incision is made in the iliac region. The recovery period after surgery is quite long. Today, such operations are almost not done, it is yesterday.
- Laparoscopic (endoscopic) surgery: a modern method in which small punctures of the abdominal wall are performed, instruments and a laparoscope (endoscope) are inserted there. An artery is isolated, titanium brackets are placed on the veins or bandaged with surgical thread. General anesthesia is used. There are practically no postoperative relapses. You can check out in a day.
- Marmara microsurgery has few complications, the incision length is small, the cosmetic effect is high (the seam is located below the line of wearing underwear).The testicular artery is secreted, then all the veins (large and small) of the plexiform plexus are ligated (there are about 6 of them in this part of the spermatic cord). The operation does without trauma to the spermatic lymphatic vessels, and the risk of dropsy is sharply reduced. Local anesthesia is used. This is the most highly effective operation performed by the clinic specialists.
The consequences of the operation
Very rarely, after surgery, the following complications are observed:
- Damage to the ileal artery.
- Infectious inflammation in the wound.
- Dropsy of the testicle.
- Atrophy, testicular hypertrophy.
Postoperative pain in the testicle is more common. If they are, you should go to the clinic.
What types of varicocele removal operations are there?
The operation to remove varicocele is indicated for varicose veins of the spermatic cord, as this is the main cause of infertility in men. Therefore, surgical treatment must be carried out at the very beginning of the formation of a testicular tumor.
Due to the expansion of the veins, the normal blood supply to the tissues of the testis and the process of thermoregulation are disturbed. The sperm count is reduced, and they are no longer so mobile. In most cases, the left side is affected, although bilateral pathology is sometimes found.
The course of the disease in a teenager may be asymptomatic, therefore, an indication for surgery to remove a varicocele may be data obtained as a result of a Valsalva test, an ultrasound scan or palpation of the vaginal plexus. The effectiveness of treatment depends entirely on the degree of the disease and the chosen technique. If necessary, the patient is prescribed a biopsy of the testicle.
- pain in the groin,
- swelling of the testicle.
The technique of surgical manipulation depends on the size of the testicle and the age of the patient. Before starting treatment, it is necessary to prepare for testicular surgery with varicocele in order to avoid serious complications and consequences.
In order to have an idea of how the operation is performed with varicocele, it is necessary to consider all the main methods of surgical intervention used today.
- Laparoscopic intervention technique - characterized by high efficiency and is less traumatic. During the intervention, it is possible to intraoperatively determine the number of branches of the internal testicular vein, make their resection, while not touching the artery, which makes the occurrence of relapse impossible. During the operation, the patient is under general anesthesia. The discharge of patients after surgery occurs the very next day.
- Microsurgical operation - this technique is performed using local anesthesia, taking several hours in duration, is highly effective, but some complications and relapses are possible. For such an intervention, a specialized microscope is required.
- X-ray endovascular operation - X-ray control is used to perform it, under which the testicular veins are clogged. Being minimally invasive, the operation is not highly effective.
- Open operations that are traditional - such techniques include the operations of Ivanisevich and Palomo. A somewhat outdated option for surgical intervention. Differs in traumatism, a high frequency of complications and relapses. The healing process is long. It is performed under local anesthesia.
After surgery for varicocele, sex is possible after the rehabilitation period, taking into account the characteristics of each organism and the type of operation, in time it is about three weeks. After surgery, sex usually remains at the same level.
In addition, there may be cases when, after surgery, varicocele occurs bleeding, a postoperative wound becomes infected, and there is dropsy of the testicle. In almost all cases, patients recover quickly, the pain goes away. If the pain still manifests itself, it is necessary to consult your doctor.
- Varicocele is a disease inherent in young people.
- It is necessary to observe the rules of prevention so that, if necessary, do not miss the early diagnosis of varicocele.
- This is the correct distribution of physical activity, avoiding constipation, periodic visits to a urologist.
An unsuccessful operation with varicocele is fraught with complications. The body reacts to some of them very quickly. One of these consequences is lymphostasis. Often, on the first day, pain and swelling appear on the side of the scrotum where the operation was performed. The reason is trauma to the lymphatic vessels. Violation goes away on his own if the operated man constantly wears a bandage.
Ivanissevich’s technique sometimes provokes dropsy of the testicle - hydrocele. This happens due to a disturbed outflow of lymph. The result is filling the scrotum with lymph fluid. Pathology is often not found during examination, and after a while it also disappears. In severe cases, surgery is needed to eliminate hydrocele.
Severe pain syndrome sometimes persists for several months, but the proportion of such cases is small - only 3-5%. Damaged nerve endings cause neuralgic pain, which goes away very reluctantly. In these situations, physiotherapy and acupuncture are used.
If the enlarged veins remain after the operation, then recurrence of varicocele is possible, although such cases are rare. The condition requires repeated treatment, however, far from all types of surgical intervention are allowed for a recurring disease.
Varicose veins are found not only on the lower extremities, but also on the external genitalia of men and women. In men, this disease is called varicocele. The most effective method of therapy for this disease is surgery, namely laparoscopy. Varicocele successfully passes after such an operation.
Life after surgery
For several days, not even a slight physical activity is shown. With hard physical labor will have to wait six months. It is advisable to wear a suspension for several days, this reduces the degree of tension in the scrotum and spermatic cord. After three to five months, sperm must be examined, because an improvement in its characteristics indicates a successful and efficient operation.
Varicocele is a disease that is an expansion of the veins in the scrotum and spermatic cord. For the patient's life, it does not pose a danger, but it affects fertility and is the cause of infertility in men. There is a conservative method of getting rid, but in what cases, when treating varicocele, is surgery the only possible option?
Is it possible to cure varicocele without surgery
It is possible to treat varicocele with the non-operative method, but in this case it is necessary to know that in this way only the hormonal background and testicular functions are restored. Such treatment is prescribed for young people under 18 years of age and elderly patients who are not going to have children. They are prescribed antioxidants, venotonics to preserve the tone of the venous walls. It is dangerous for young people to have surgery before they reach adulthood, because in this case, there is a slowdown in the growth and formation of the testicles, as well as an increased risk of relapse. Conservative therapy does not allow the disease to progress. However, there are cases when patients in childbearing age for one reason or another refuse surgery with varicocele and are treated only with tablets or folk remedies.
The subclinical and first stages of the disease do not require treatment. In the subclinical stage of the vein on the testicle, it is impossible to detect with palpation, only on ultrasound. In the second stage, veins can be felt only in a standing position. In these cases, it is enough to take simple measures against blood stasis: give up alcohol, normalize stool, lead a regular sexual life, moderate physical activity. Such simple actions can help eliminate varicose veins of the scrotum and prevent the disease from progressing. Elderly patients will benefit from wearing a suspension. If the disease is in the second stage, you can feel the veins in a standing position, lying, or sitting. Surgical treatment in this case is indicated in the presence of pain. The third stage is characterized by the fact that dilated veins become visible.
Doctors advise to definitely operate on varicocele in men with the third stage of the disease.
There are contraindications for surgical treatment:
- Increased blood sugar, cirrhosis. In this case, the functions of the organ may be impaired and cannot be restored without treatment,
- If there is severe inflammation,
In these conditions, open surgical operations are contraindicated. Operations with the use of an endoscope, in addition to the above factors, are not performed if the patient has previously undergone surgery in the abdominal cavity. There are also contraindications to sclerotherapy:
- The presence of anastosis (jumpers) between the vessels. The use of a glued drug can affect normal arteries,
- High pressure in the renal and other closely located veins,
- A special friable structure of the veins, which will not allow to enter the probe.
In all other cases, surgical treatment of varicocele in men is carried out on the basis of the patient's history, complaints, stage of the disease.
What is needed before the procedure
Preparation for varicocele surgery includes a number of tests and examinations that must be started a week before the appointed time:
- General blood test, test for blood type and Rh factor, coagulogram, sugar level,
- A blood test for hepatitis B, C, HIV infection,
- X-ray examination of the lungs,
In addition, doctors need to know the cause and exact picture of the disease. For this, a simple ultrasound, or doppler (using contrast) is prescribed.
On the day of surgery for varicocele, it is advisable not to eat food and water. It is necessary to take a shower, completely shave the pubis, scrotum and stomach. If the patient takes any pills, you need to consult a doctor on this issue.
Causes of varicose testicular veins
The causes of varicocele are divided into two types: primary and secondary. Primary include venous insufficiency, manifested in the weakness of the venous walls and valves, to the secondary all other factors whose action causes an increase in blood pressure in the testicular veins, which leads to the development of venous insufficiency. The result of these causes is the development of varicose veins and deformation of the scrotum veins. Let us consider in more detail how this happens.
Varicocele has several stages, ranked according to the degree of varicose vein deformation. The earliest is called subclinical or preclinical because the disease is at the stage of formation, it is latent, has no signs, and it can only be detected using ultrasound diagnostics, which is rather difficult in the absence of symptoms.
At this time, the venous valves cease to fully close, there is a reverse of the blood. This phenomenon is called reflux. It leads to an increase in intravascular pressure and adversely affects the functional activity of the testes since steroid hormones produced by the adrenal glands are delivered to the testicles with a reverse blood flow.
Need to know.In childhood and adolescence, for the development of varicocele, the presence of factors causing an increase in venous pressure is not necessary since venous insufficiency has a genetic predisposition and is inherited. Therefore, if there were cases of varicocele in the family, it is important to undergo regular medical examinations for young men before the end of puberty.
The appearance of the first signs indicates the progression of the disease and its transition into a clinical form. In the beginning, a man feels mild periodic pains of a dull or pulling nature, which initially rarely occur and usually after significant physical exertion, weight lifting or sexual contact.
These are the symptoms of the first stage of varicocele, in which the inflammation of the veins is still insignificant and they are not only not visible visually, but simply detecting the scrotum is not enough to determine them. It is possible to establish the presence of a disease during physical diagnosis only during a Valsalva test.
Its essence is that during palpation, the patient strains the abdominal press or deliberately coughs while the doctor can detect tension in the veins. For a more accurate diagnosis, the patient is always referred for ultrasound diagnostics using Doppler, which will allow to measure the diameter of the vessels in the places of vein expansion and establish the intensity of reflux.
The data obtained are important not only for clarifying all aspects of the disease state, their value lies in the fact that, based on the obtained primary data, it is possible to monitor the course of the disease and monitor the situation in the recovery period after surgical treatment.
Subclinical and first degrees of varicocele are least dangerous for male health, therefore, at this period of the development of the disease, it is possible to use drug and alternative medicine to stabilize varicose veins and maintain spermatogenesis at the proper level.
But at the subsequent stages, extremely unfavorable conditions are created for the functioning of the testes and even for their anatomical integrity, therefore, the diagnosis of the second and especially the third stage of varicocele is a direct indication for immediate surgical intervention.
It is characterized by persistent pain in the scrotum, which can be either periodic or prolonged. They arise not only after physical exertion, but also at the end of the day. At this stage, on palpation, the inflamed veins are already clearly identified, but only in an upright position, lying down, they subside.
The use of a Valsalva test is not required. Visually, veins can appear in the scrotum, which indicates the progression of the disease and its possible transition to the third degree. Sperm analysis shows a significant deterioration in the process of gamete formation.
The most dangerous and easily diagnosed third stage. In the scrotum, a copious plexus develops from inflamed veins, which are clearly distinguishable visually due to which the scrotum acquires a bluish tint. Due to insufficient blood circulation, its tissues, as well as the histological structures of testicles, experience problems with trophism and gas exchange, therefore the scrotal skin changes, the diseased testicle becomes smaller and sags.
The pain is constant and quite severe. Laboratory tests show a strong decrease in the synthesis of steroid sex hormones and spermogram deterioration, which requires an urgent operation to eliminate varicocele. For a full understanding of what is the negative impact on a man’s body in the next section, we briefly dwell on the consecration of this issue.
Harm to male health caused by varicocele
It does not pose a significant danger to the patient’s life and poses a major threat primarily to the reproductive system, and also has a negative effect on endocrine processes, which in turn changes the general hormonal background, decreased sexual desire and potency. Table 1 shows the negative consequences that develop due to varicose veins of the spermatic cord and epididymis.
Table 1. Diseases associated with the development of varicocele:
|Pathology||What caused her appearance|
|Total or partial loss of fertility||An increase in the total area of veins in the scrotum due to varicose veins leads to hyperthermia. Violation of histological structures provokes autoimmune reactions and the death of sperm.|
|Testicular tissue degradation||Slowing blood circulation, impaired nutrition and respiratory function, stagnant processes, the accumulation of active chemicals negatively affect the cellular structures of the testis|
|Testicular atrophy||Hypoxia in the third degree of varicocele can lead to severe degradation of the histological structures of the testis|
|Lowering blood testosterone levels||In Leydig cells, synthetic activity decreases due to hypoxia, testicular atrophy, as well as when steroid hormones are thrown with venous blood reversal during reflux|
|Potency and libido reduction||With a reduced synthesis of male sex hormones, 90% of which are produced in the testes, not only the intensity of spermatogenesis decreases, but also “male strength”.|
|the operation does not require special surgical equipment, |
Varicocelectomy from subingual microaccess according to Marmara’s technique
The technique is essentially similar to the abdominal operations mentioned above, but a different technique is used. The whole operation process takes place under optical zoom, therefore, a special microscope should be installed in the operating room, as an alternative, surgeons use special magnifying glasses.
This allows the doctor to significantly more correctly perform manipulations during ligation of veins, while nerve and lymph fibers, as well as the testicular artery, are highly likely to remain intact. At the same time, not only the seed vein is suppressed, but also its collectors, which significantly reduces the risk of relapse.
Subingual access involves an incision in the area of the external inguinal ring at a distance of about one centimeter from the base of the penis, therefore, to get to the veins of the spermatic cord, the peritoneal muscle tissue is not damaged, and this shortens the rehabilitation period.
After dissection, a small surgical hole is formed no more than 4 centimeters, veins are removed through it, which can be examined better in length than with classical methods.Before ligation, all other vessels and tissues are necessarily secreted and laid aside, which eliminates their injury.
After ligation and suppression of all found inflamed veins, the wound is sutured. Sutures are usually removed after a week, and if the seam is cosmetic, it will resolve itself.
Thus, the operation technique for varicocele allows not only to effectively treat varicose veins of the plexus, but also significantly reduce the recovery time. During treatment, hospitalization is not required, and the patient is at home on the evening of the day of surgery. Pay attention to table 3, where the distinguishing features of this technique are indicated.
Table 3. The positive and negative sides of varicocelectomy according to the Marmara method:
|Characteristics of the operating technique|
Laparoscopic or endoscopic surgery
They began to use in surgical practice recently, about 30 back. His appearance made a truly significant erosion in medicine since it became possible to operate without dissection of the tissues of the abdominal cavity, and the accuracy of the manipulations done increased significantly.
A laparoscope is a tube with a microcamera and a source of cold lighting at the end, which allows you to display the image on the monitor screen, so the doctor can not only track all the work in real time, but also increase the resulting picture, take screenshots, etc.
With this method, general anesthesia is done so the patient will have to go to the hospital for several days. In order to facilitate manipulations and expand the area for the surgeon's actions, carbon dioxide is pumped into the peritoneum, and micro-instruments and a laparoscope are introduced through three small holes (the largest hole in the navel is 10 mm, and the other two are 5 mm to the left and right in the iliac region)
There are many advantages to this type of operation, which is explained by more detailed visualization, the ability to examine vessels on both sides over their entire length
Sick veins are sought and ligated with micro-tools. The whole process lasts an average of about an hour and a half, after which the patient is delivered to the ward. As a rule, there are no problems after anesthesia, since postoperative complications are unlikely and the man leaves the clinic on the second or third day. More details about all the nuances are indicated in table 4.
Table 4. The positive and negative sides of laparoscopic surgery: