Abnormal enlargement of veins carrying dirty blood from the testicles (the veins of the arteries) is the curative, i.e. variculation. This vein enlargement begins at a young age and can be progresswith the effect of gravity. Varicocele is the most common and treatable cause of male infertility.
Mild levels may not have any clinical manifestations. It can lead to deteriorating in the scrotum (the bag that enveloping the testicles), pain (which hits the inner part of the leg in the groin), sperm count and movement.
What is the incidence of varicocele?
Varicocele is generally seen in 15-20% of males after puberty (puberty) and approximately 40-50% of males presenting due to infertility.
The veins on the left side are connected at a more perpendicular angle to the main vein where the dirty blood is spilled, and the veins on the left side are slightly longer. Therefore Varicocele is usually seen on the left side (85%). The ratio of the right testis is around 15%. Both testis can be seen. Varicocele on one side can also affect other testicles.
VARICOCELE and INFERTILITY
Although Varicocele is not fully known as to how it is caused by infertility, there are some theories. Dirty blood accumulated from the veins to the varicalized arteries; Increase in temperature and increase in testicular pressure. This is due to decreased oxygen in enlarged veins and kidney, from the adrenal gland back to the fugitive; The accumulation of some metabolic products in a high proportion negatively affects sperm production. As a result, the sperm number and movement is decreased.
Symptoms of varicocelic;
• Pain in the testicles (pain hitting the inner part of the leg and the groin)
• Swelling and fullness sensations in the testicles
• Shrining in testicles
• Visible enlarged veins
• Enlarged veins from the hand
Diagnosis of Varicococin:
Varicocelic diagnosis is physical examination. It is diagnosed as a classic by hand examination. The veins (veins) that have become enlarged and curling are felt. It is confirmed by Color Doppler ultrasonography (USG). In cases where physical examination is difficult sometimes, color Doppler ultrasonography can help.
Ranking of Varicocele:
• Subclinical Varicocele: Can not be detected by physical examination and determined by ultrasound.
• Grade 1 Varicocele: No symptoms while resting, detected by a push (Valsalva +).
• Grade 2 Varicocele: Collector veins are dealt with by examination (can be palpable).
• Grade 3 Varicocele: varicocelic (visible), which can be visibly noticeable from the outside.
After the diagnosis of Varicocele, Spermiogram (semen analysis/sperm assay) should be taken care of. Before the Spermiogram, the patient should have 3-4 daily sexual fasting. If the production of sperm is damaged, the sperm's movement, number and structure are seen to decrease. In more than half of the varicocele, disorders of spermiogram are monitored.
Sometimes the sperm count can be very low. In these cases, some hormones should be looked at (FSH, LH, testosterone, prolactin...) and have another systemic disease (thyroid, diabetes, cholesterol, etc.).
Replacing the missing patients with hormone disorder; The number of sperm is increased and infertility can be cured.
Although very rare; Sperm production in the testicles, but no sperm may be found in the Spermiogram. In this case, occlusion is investigated in semen ducts. By using endoscopic or microsurgical methods, this obstruction can be opened and the child may have normal sexual intercourse.
Varicocele is the most improved cause of male infertility with treatment. The treatment of varicocele is surgery. However, it is wrong to perform surgery on the patient with every varicocele. Therefore, Varicocele surgery (varicocelectomy) should be applied to appropriate patients by experienced specialists in this regard with appropriate time and technique.
WHO DOES VARICOCELE SURGERY DO?
• Varicocelli male with infertility complaint (with Spermiogram disorder)
• If Varicocele is shrinting in the testicles; If a testicle is shrinded by another or if both testicles shrink
• Patients with very severe pain (not responding to pain relief and scrotal elevation)
It is a surgery that lasts approximately 30-60 minutes, when the varicalized balls are connected and the connection is canceled. It can be done with general, spinal or local anesthesia with a 2 cm incision in the inguinal region.
In the surgery, the veins (internal, external spermatic veins and cremasteric vein) should be connected; Most importantly, the sperm duct (vas deferens) should be protected from testicular arteries (testicular artery) and lymph vessels that carry clean blood. If the artery is connected, the testicle shrining; If the lymph vessels are connected, there may be complications such as hydroflooding (swelling by collecting fluid between the testicular membranes).
In the light of all this information, the most appropriate method of varicocelectomy surgery is microsurgery varicocelectomy with microscopy. The success rate of microsurgery varicocelectomy performed by experienced people is very high and the probability of postoperative complications is minimal. (Except for some special cases, I always do varicocele surgery with microsurgical technique.)
Varicocele is not repeated after successful microsurgery varicocele surgery.
Spermiogram after varicocele surgery 3. 6. and the 12th. Month. Approximately 70-80% of patients have improved sperm production. Pregnancy rates are between approximately 50-70% after the operation of patients with infertile due to varicocele.