Why does varicocele occur?
Blood from the testicle flows through the veins of the spermatic cord. Normally, the valves inside the veins only allow blood to flow upward. When the valve system is weak, the blood stagnates, the veins dilate and form a characteristic plexus.
The left-sided localization is explained by anatomy: the left testicular vein flows into the renal vein at a right angle and is longer, which creates higher pressure in the system. In addition, it can become compressed between the aorta and the superior mesenteric artery.
A separate situation is varicocele, which first appeared in an adult man, especially on the right, and does not disappear in the supine position. This requires examination of the abdominal cavity and retroperitoneal space, since it may be a consequence of compression of the vein by a space-occupying formation.
Degrees of varicocele
- Subclinical - determined only by ultrasound with Doppler, not detected during examination
- First degree - dilated veins can be felt only when straining in a standing position
- Second degree - veins can be felt in a standing position without straining
- Third degree - dilated veins are visible to the eye, the scrotum is deformed
Symptoms
- Most often, there are no complaints - varicocele is detected during a physical examination or examination for infertility
- Drawing, aching pain or heaviness in the scrotum, usually on the left
- Increased discomfort towards the end of the day, during physical activity, prolonged standing, or in the heat
- Reducing pain when lying down
- Visible tortuous veins in the scrotum
- Sensation of a “bag of worms” when palpating
- Reduction in testicular size on the affected side
- Deviations in spermogram detected during examination for infertility
Why is varicocele dangerous?
Vein expansion in itself is not life threatening. What matters is its effect on the testicle.
- Increased temperature in the scrotum, interfering with sperm maturation
- Stagnation of blood and accumulation of metabolic products that damage testicular tissue
- Oxidative stress with sperm DNA damage
- Deterioration of spermogram parameters: concentration, motility, structure
- Reduction in testicular volume, especially significant in adolescents
- Decreased testosterone production with long-term existence
- Chronic discomfort that limits physical activity
Diagnostics
- Inspection and palpation in standing and lying positions, with Valsalva maneuver
- Ultrasound of the scrotum with Doppler sonography - assessment of the diameter of the veins, the presence of reverse blood flow and the volume of the testicles
- Spermogram is a key analysis for deciding on treatment in adult men
- Hormonal profile for suspected decreased testicular function
- Ultrasound or CT scan of the abdominal cavity - for the first time varicocele in an adult, right-sided or not disappearing in the supine position
- Dynamic measurement of testicular volume in adolescents
When is surgery needed?
The presence of varicocele in itself is not an indication for intervention. The operation is considered in specific situations.
- Abnormal spermogram parameters in a man planning children with a clinically detectable varicocele
- Persistent pain and discomfort that impairs quality of life
- Retarded testicular growth in a teenager on the side of the varicocele
- Bilateral varicocele with abnormal spermogram
- Reduced testosterone levels associated with varicocele
- Cosmetic defect with a pronounced third degree - at the request of the patient after discussion
With subclinical varicocele detected only on ultrasound and a normal spermogram, surgery is usually not indicated. If there are no complaints and normal tests, observation is sufficient.
Operation methods
- Microsurgical varicocelectomy according to Marmar is a modern standard: dilated veins are ligated through a small incision under magnification, preserving the artery and lymphatic vessels; minimal relapse rate and dropsy
- Laparoscopic varicocelectomy - access through punctures in the abdominal wall; convenient for bilateral varicocele
- Open operations according to Ivanissevich and Palomo are historical techniques, today they are used less frequently due to the higher frequency of relapses and complications
- Endovascular embolization of the testicular vein - intervention under X-ray control without incisions
After surgery
- Limiting physical activity and heavy lifting for a period determined by the surgeon
- Wearing support clothing
- Moderate swelling and discomfort in the first days is to be expected.
- A control spermogram no earlier than three months later - there is no point in assessing the result earlier
- Control ultrasound as prescribed by a doctor
- Improvement in sperm parameters occurs gradually over several months
Where is varicocele operated on in Tashkent
A microsurgical operation requires an operating microscope and a surgeon proficient in this technique; The frequency of relapses and complications depends on this.
In Tashkent, microsurgical varicocelectomy and laparoscopic operations for varicocele are performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If surgery is being discussed in connection with planning children, take a fresh spermogram for consultation: without it, it is premature to make a decision about surgery. Clinic contacts are below on the page.
