Methods of treatment varicocele

Among men with infertility, varicocele is found in 30 - 40% of cases, therefore treatment of this disease is an important social problem.

Varicocele of the first stage can be tried to be cured conservatively. It is enough to improve the outflow of venous blood from the pelvic:

• eliminate bloating and or chronic constipation,
• Kholodov baths scrotum,
• limit physical activities associated with the stress of the abdominal wall, limiting prolonged standing,
• not recommended for riding a motorcycle and bicycle,
• certainThe use of suspensions on the scrotum, as well as dense underwear in the form of smelts, benefits.

Conservative treatment, unfortunately, is ineffective and, in most cases, varicocele has to operate. However, if you approach the issue formally, then the operation will have to be subjected to a third of the male population of reproductive age. Therefore, there indications for surgical treatment of varicocele :

• presence of pain in the scrotum.
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• Male infertility, caused by a decrease in the reproductive qualities of sperm.
• Significant cosmetic defect.
• In adolescents - reduction in size, or stunting of testicles.
• Two-sided varicocele.

Options for surgical treatment

1. Blocking from the outside or inside the vein of the testicle. In this case, additional ways of outflow of venous blood are revealed, as a rule, these are superficial veins of the scrotum.

• Ivanisevich's surgery is the very first( almost 100 years old) and the most developed surgical technique. A cut is made in the iliac region( slightly lower than with appendicitis), the vein of the testicle is excreted and bandaged.
• Operation Marmara - a small incision is made on the abdomen at the base of the penis, where the vein is bandaged.
• Endoscopic operation. In the abdominal wall, 3 punctures are made, for an optical device and two instruments. A vascular bundle of testicles is allocated and the vein is bandaged or pinched by special staples.
• Endovascular surgery. Through the vein of the thigh, a special catheter is inserted into the vasculature, under X-ray control it is brought to the testicle vein, which is blocked from the inside.

Advantages of this type of operations:

• good handles and understanding of techniques,
• minimum volume of operation, simplicity of execution,
• lower cost of treatment,
• shorter rehabilitation period,
• to perform intervention under local anesthesia( not applicable to endoscopic surgery).

Disadvantages of vein ligation:

• High recurrence rate, according to different data up to 30%.The reason is that the venous system of each person is very individual. The outflow of blood from the testicle can be carried out through several veins, and if the surgeon does not notice additional venous branches, the varicocele will reappear.
• Not the physiology of the technique. After the vasoconstriction, the outflow of blood from the testicle ceases. The opening of new venous tracts takes up to a week, during this period there are pains in the scrotum, and if they were before surgery, then these pains are greatly amplified.

2. Microsurgical revascularization of the testis. A cut is made in the lower abdomen, a varicose dilated vein of the testicle is excreted and removed. In its place, the epigastric vein is sewn, through which further outflow of blood will take place. Advantages

techniques:

• bloodstream immediately restored in the testis, and not in a week, and therefore, no pain in the scrotum,
• lower incidence of relapse.

Disadvantages:

• high complexity of the operation,
• higher cost of treatment,
• big trauma intervention, therefore, a greater period of rehabilitation,
• venous thrombotic risk of a new path.

Microsurgical revascularization procedure is more preferred if varicocele accompanied by pain in the scrotum or if the operation is performed for infertility.

Complications of surgical treatment

In addition to the already described relapse and pain in the scrotum, after the operation, the appearance of hydrocele( dropsy testicles) is possible. The cause is damage to the lymphatic drainage from the testicle. This complication is most typical for open operations.

Forecast

The earlier the operation is performed, the better its result. If treatment is carried out at adolescence, it is possible to completely restore the endocrine and reproductive properties of the testicle. The operation performed after 30 years, as a rule, has only a cosmetic effect.

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