Features of bilateral surgery
Right-sided varicocele often goes unnoticed because it is less pronounced than the left one; it is detected by Doppler sonography of the scrotum. If the veins are dilated on both sides, both need to be operated on - otherwise the temperature of the testicles and the spermogram will not be completely normalized. Both sides are performed sequentially in one anesthesia through two inguinal approaches; this does not double the recovery time - the patient is discharged the next day and returns to work after 5-7 days. Spermogram control - after 3 and 6 months.
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.
