Laparoscopy or microsurgery
Laparoscopic access crosses the testicular vein above the inguinal canal, where it is represented by one or two trunks - the operation is quick and well tolerated. However, at this level it is more difficult to preserve the lymphatic vessels (risk of hydrocele 3–7%) and not to damage the artery, and small collaterals in the inguinal canal remain, so relapses occur in 3–5% versus 1–2% with microsurgery. Laparoscopy is chosen for relapse after Marmara surgery, obesity, the need for simultaneous abdominal surgery, and also at the request of the patient in the absence of fertility problems. Requires general anesthesia.
When is surgery needed?
- varicocele with deterioration of spermogram (decreased concentration, motility, morphology) and infertility in a couple;
- pain, heaviness, discomfort in the scrotum, increasing with exercise and in the evening;
- reduction of the testicle on the side of the varicocele (especially in adolescents);
- decreased testosterone levels due to varicocele;
- varicocele II–III degree in adolescents with testicular growth retardation.
Asymptomatic grade I varicocele with a normal spermogram is usually only observed.
Microsurgical varicocelectomy (Marmara operation)
It is considered the “gold standard” for infertility: through a small incision in the groin area (2-3 cm), the surgeon, under an operating microscope with 10-15x magnification, isolates the spermatic cord, finds and ligates all dilated veins, preserving the testicular artery and lymphatic vessels. This accuracy gives the lowest percentage of relapses (1–2%) and complications (hydrocele less than 1%). The operation lasts 40–60 minutes under spinal or intravenous anesthesia; discharge on the same or next day.
Laparoscopic varicocelectomy
It is performed through three 5–10 mm punctures in the abdominal wall under general anesthesia: the testicular veins are intersected high in the retroperitoneal space. The method is convenient for bilateral varicocele - both sides are operated on at the same time, as well as for relapse after other operations. Recovery is fast, the cosmetic result is good; the risk of relapse and hydrocele is slightly higher than with microsurgery, therefore, in case of infertility, Marmara surgery is often chosen.
Preparation and recovery
Before the operation: consultation with a urologist-andrologist, ultrasound of the scrotum with Dopplerography (confirms the degree and side), spermogram (starting point for control), standard tests and ECG, in case of general anesthesia - consultation with an anesthesiologist. The day before - a light dinner, 6-8 hours on an empty stomach.
After surgery: moderate pain for 2–3 days, relieved with painkillers; 1–2 weeks support underwear; work - after 3-5 days, sports and heavy lifting - after 3-4 weeks, sex life - after 2-3 weeks. Improvement in sperm count is assessed after 3 and 6 months, since the sperm maturation cycle takes about 3 months.
Results
After varicocelectomy, sperm parameters improve in 60–70% of men, and the pregnancy rate in a couple within a year is 30–40%. Scrotal pain resolves in 80–90% of patients. In adolescents, surgery allows the testicle to catch up with the healthy one in growth. Relapse after microsurgery occurs in 1–2% of cases.
Treatment of varicocele in Tashkent: where they operate
In the clinics below, varicocelectomy is performed by urologists-andrologists with experience in microsurgery - Marmara surgery (including bilateral) and a laparoscopic option are available, there is an in-house spermogram, ultrasound with Doppler and hospitalization. Prices are indicated according to the official price list of the clinic; Anesthesia and examination are paid separately.
