Varicocele treatment in Turkey
The male reproductive system makes, stores, and moves sperm. The scrotum is the sac of skin that holds the testicles, where sperm and testosterone are made in the testicles. Sperm mature as they move through a coiled tube (the epididymis) behind each testicle. Sperm travel to the prostate from each epididymis using a tube called the vas deferens. When ejaculation, semen mixes with sperm in the prostate to form semen. The semen travels through the urethra and exits from the end of the penis.
The spermatic cord carries the vas deferens, the testicular artery that carries blood to the testicles, and the plexus: a group of veins that drain blood from the testicles. The testicles need a certain body temperature less than the basic body temperature for the production, maturity and function of sperm perfectly.
The body temperature in the scrotum is about 5 degrees lower than the temperature of the abdomen or pelvis. The latter is due to the presence of the pigtail, which acts as an opposite heat exchange، and cooling the blood in the testicular artery before it enters the testicles. This helps to keep it at the body temperature needed to produce good quality sperm. When these veins enlarge, as is the case in varicocele, it leads to a high temperature of the testicles and thus leads to decrease in sperm production and work in addition to decrease the ability of fertility.
What is a Varicocele?
A Varicocele occurs when the veins inside the scrotum (the sac of skin that holds the testicles) enlarge. These veins are called the Pampiniform plexus. Out of a hundred males who suffer ten to fifteen varicoceles, it’s like getting varicose veins in your leg.
A Varicocele occurs when the glial plexus veins in the scrotum become enlarged. These veins are similar to varicose veins (twisted, swollen veins located in the leg).
Varicocele is formed during puberty. They can grow larger and you may notice them more over time. Varicocele is more common on the left side of the scrotum.
Varicocele can be present on both sides at the same time, but this is rare. About 10 to 15 men out of 100 suffer from varicocele.
In most cases, varicocele do not case any problems and are harmless. Often, a varicocele can cause pain, or problems having children or one testicle grows slower or shrinks.
A varicocele rarely causes pain, but if it does, the pain may be:
- Worse when standing or during physical exertion
- It varies from severe to mild
- It decreases when lying on your back.
- It gets worse as the day goes on
Varicocele often passes unnoticed. But the doctor may notice it during the medical examination. However, an individual should see a doctor if they noticed:
- Any changes in the size, shape, or appearance of the testicles.
- Fertility problems
- Swelling in the scrotum
- Veins that appear unusually large or twisted
One explanation for a varicocele is that the valves in the spermatic cord, which carry blood to and from the testicles, stop working properly.
The one-way valves in the veins must always allow blood to flow towards the heart. Defective valves can disrupt blood flow, causing blood to pool instead of moving smoothly, and this blood buildup causes blood vessels to dilate.
As with any other organ, the disruption of blood flow can eventually prevent it from working properly. Varicoceles can be classified as follows:
- Pressure type: the spermatic vein is filled with blood, which leads to the appearance of varicocele of the first degree.
- Shunt type: severe accumulation causes damage to the spermatic vein and other veins, which leads to a varicocele of the second or third degree. The left testicle is likely to be affected. However, even if only one side has a varicocele, it may affect sperm production on both sides.
In some cases, a varicocele can lead to complications:
infertility is the most serious complication that can occur. This may happen because the increase amount of blood in the area raises the temperature of the testicles.
Between 35 and 44 percent of men with primary infertility suffer from a varicocele. Primary infertility occurs when the couple fails to conceive pregnancy within 12 months of trying.
A varicocele affects 45 to 81 percent of men with secondary infertility. This happened when a couple has been able to get pregnant at least once but then no longer able to.
- Retraction of the testicle:
Varicocele can lead to testicular atrophy or shrinkage. Sperm-producing tubes make up the bulk of the testicle. If damaged, the testicle may become smaller and softer.
- Hormonal imbalances:
When cells react to increased stress, a change in hormones can occur. There may be higher levels of the hormone (LH). This hormone is present in both men and women, but it is higher in women. There may also be normal to abnormal levels of testosterone.
There are three degrees of varicocele:
- Grade1: the smallest type, this is not visible, but can be felt by a doctor if he uses a Valsalva Maneuver.
- Grade2: this is not visible, but can be felt without Valsalva resonators.
- Grade3: Varicocele is visible.
Varicocele is found through self-examination of the scrotum or during a doctor’s routine examination. It has been described as a “bag of worms” because of its shape. Urologists often check for the presence of a varicocele while the patient is standing. You may be asked to take a deep breath, hold it and descend while the urologist feels the presence of the scrotum above the testicle. This technique is known as “Valsalva Maneuver”.
Allows the urologist to find any enlarged veins. The urologist may order an ultrasound of the scrotum. Ultrasound uses sound waves to create a picture of what’s inside your body.
The signs of varicocele through ultrasound are veins that are more than 3 mm wide with blood flowing in the wrong way during the Valsalva Maneuver
Ultrasound can also show the size of the testicles. These are useful in determining how to deal with teenagers. Ultrasound is not required if problems are not felt during the physical examination.
Other possible tests include: semen analysis and hormone tests to detect high FSH and low Testosterone level. This can be done if the doctor suspects that there is a dysfunction in the testicle.
Varicoceles are not usually dangerous, but if there is any change in shape, size or consistency in the genital area, it is important to see a doctor.
Surgery used to treat varicocele
There are many ways to preform varicocele surgery, It all involves blocking blood flow in the sucker plexus. The surgery is performed under general anesthesia. The two most common surgical techniques are:
- Microscopic Varicocele: using this technique, the surgeon makes 1 cm incision above the scrotum. Using a microscope, the surgeon connects all the small veins and preserves the vas deferens, testicular arteries and lymphatic drainage. The operation takes from 2 to 3 hours to complete and the patient will be discharge from the hospital in the same day.
- Laparoscopic Varicocelectomy: with this technique, the surgeon inserts thin tubes into the abdomen and performs a vein ligation. Since there are fewer veins to be connected in the abdomen, the procedure is shorter and takes approximately 30-40 minutes to complete. The patient will be discharge from the hospital in the same day.
- Percutaneous Embolization: the radiologist inserts a tube or catheter into the body through the neck or groin. Instruments are passed through the tube, and the surgeon uses coils or chemicals to block the vein by scarring it. This is a minimally invasive intervention. It can be performed on an outpatient basis, and the recovery time is relatively short.
These procedures are relatively safe but, as with any surgery, there are some risks, including:
- Artery damage
- Testicular atrophy
- Bruising, swelling, or fluid buildup in the area.
- Abdominal pain
In rare cases, thrombosis may occur in the renal vein. This can affect the kidneys and may need more surgery.
Sometimes, the veins that pass through the blood also become enlarged after surgery, which requires further treatment.
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