Varicocele is a fairly common disease that develops from the failure of the testicle vein. The disease manifests itself as an expansion of the veins of the spermatic cord.
About 20% of men suffer from this disease. In connection with the anatomical structure of the organ, mainly pathology is formed on the left side. Right-sided vein expansion may indicate the presence of neoplasms in the right kidney. ICD-10 varicocele disease code - I86.1
Surgery is often prescribed for treatment, since this is the best way to normalize sexual function and eliminate existing problems.
Causes of the disease
There are several reasons for the appearance of varicocele, among which it is necessary to highlight such as:
- congenital features of venous outflow;
- pathologies that provoke blood stasis in the pelvic organs;
- irregular sexual relations;
- frequent constipation;
- problems with the lumbar spine.
In addition, obesity and excess weight can provoke such a violation. It is very important to know what a varicocele looks like and what are the signs of the disease in order to timely recognize its course and take appropriate measures.
Manifestation of the disease
With varicocele, a pulling pain in the testicles in men is mainly observed, naturally, which occurs or intensifies in an upright position or during physical exertion. There may also be a decrease in the testis on the affected side. On palpation, veins in the scrotum are marked.
Often, varicocele is formed in adolescents during puberty and is almost asymptomatic. In this case, the disease is detected by accident, during a medical examination. Over time, the pathological process progresses, which can lead to testicular atrophy and infertility.
When surgery is required
Many are interested in what a varicocele is and when surgery is required. Intervention can be prescribed to a man at absolutely any age in order to fully preserve the possibility of fertilization. The operation is performed in the case of:
- testicular atrophy;
- bad spermograms;
- groin pain;
- changes in the size of the testicle.
In the presence of such signs, surgical intervention is required, during which the patient is ligated with veins passing around the spermatic cord, which causes the blood to flow in a completely different direction.
There are several varieties of surgery for varicocele, each of which has its own specific features. Early detection of the problem is important as it helps minimize the occurrence of complications.
Preparation for surgery
It is important to understand exactly what varicocele is and how the treatment of the disease is carried out and what are the features of preparation for surgery. Preparation for the intervention begins with a patient examination. This is required to exclude some chronic pathologies, in particular, such as diseases of the digestive tract and lungs. All this can negatively affect the course of the operation and the well-being of the patient.
Before the intervention, you need to stop the main reason that provokes stagnation of blood in the testicle. For each person, the main type of operation for varicocele is selected separately, which will help to fully preserve the man's reproductive abilities.
Initially, the doctor probes the scrotum of the patient to determine the severity of the pathology. Then an ultrasound diagnosis is required, which is combined with dopplerography. The patient is examined in a standing and lying position with a change in blood flow in these positions.
Urine analysis is also prescribed before and after physical activity, X-ray methods of investigation, study of the hormonal profile and many other types of examination. Immediately before the operation to remove varicocele, shave off the hair that will interfere. The doctor must notify the patient about how long the intervention will last and how it is carried out.
On the day appointed for the operation, you need to refuse food and drink, take a shower. In the case of taking medications for diseases of a chronic type, treatment is agreed with the doctor.
The main types of surgical intervention
Varicocele is a rather dangerous and complex problem that requires timely intervention so that various complications can be avoided. There are several types of operations, among which it is necessary to distinguish such as:
- Marmara operation;
- Ivanissevich;
- Paolo
- laparoscopy;
- laser treatment.
The best method is Marmara surgery, which involves replacing the affected vein with a healthy one. For this, doctors provide access to the desired area of the body without cutting the abdominal cavity. Microsurgical technique is the most sparing option for intervention.
The type of operation for varicocele is selected separately for each patient, depending on the particular course of the disease and the particular well-being.
Operation Palomo
To determine the peculiarity of treatment and the duration of recovery, you need to know how varicocele surgery is performed using various techniques. Palomo intervention is quite popular. It means performing a section of a vein affected by varicose veins. The manipulation of the inguinal canal is performed. The doctor immediately gets full access to the affected area, bandages and removes the dilated vein.
This will reduce the risk of injury to blood vessels and nerve endings. The operation is performed under local or general anesthesia. After the intervention, a suture is applied and a sterile dressing is fixed. A man is prescribed the next day, and the sutures are removed after 8-9 days.
Operation Ivanissevich
During this type of intervention, the existing lumen of the dilated vein is completely closed, performed under local anesthesia. With varicocele in children, the operation is performed under general anesthesia. In time, it takes 30 minutes. This type of treatment is considered more affordable. The essence of the technique is that the doctor cuts and bandages the left vein in the testicle. This helps to eliminate the main provoking factor, which leads to a reverse flow of blood into the plexus of the testes.
Initially, the doctor makes an incision of about 50 mm in length in the area of the inguinal canal, parallel to its entrance. Gradually, all tissue structures are cut, including also the wall of the inguinal canal. It contains the spermatic cord where dilated veins can be found.
A cord is drawn into the wound and an enlarged vessel is secreted. Then it is fixed and clamped in 2 places. The vessel is cut and ligatures are applied to the cut ends. Do the same with all the vessels that the doctor will remove. At the end of the operation, the wound is sutured layer by layer, and then a bandage of sterile material is applied.
In the case of Ivanissevich’s operation with varicocele, the postoperative period is longer, and the risk of complications is high. When performing all the manipulations, there may be damage to the femoral arteries and the development of many other formations in the inguinal canal. In addition, the disadvantages of such an intervention include a complete dissection of the abdominal wall.
The doctor prescribes pain and antibacterial drugs to the patient; a support bandage is also necessary to prevent stretching of the spermatic cord. Sutures are removed after about 9 days. For 6 months you need to avoid heavy physical exertion.
Such an operation is very popular, as it is used for varicocele in children and adults. The intervention does not require the use of special equipment, so it is carried out in all hospitals. However, there are certain disadvantages of this procedure, as there is a likelihood of developing dropsy of the testicle, as well as relapses of varicocele. Testicular atrophy is extremely rare, which is one of the most dangerous complications of surgery for varicocele (according to ICD-10 code - I86.1, as mentioned above).
Marmara Operation
This is a modern, minimally traumatic and effective treatment. The technique of Marmara surgery for varicocele is microsurgical ligation of the testicle veins. This technique also contributes to the treatment of infertility. Among the main indications for such an operation is:
- varicocele 2-4 degrees;
- infertility due to expansion of the veins of the testicle;
- pain and heaviness in the affected area;
- testicular reduction;
- violation of spermatogenesis;
- the presence of aesthetic defects in the scrotum.
The operation is performed under local anesthesia. To do this, a 2-3 cm skin incision is made in the inguinal region. The spermatic cord is separated from adjacent tissues and excreted. Then, using special equipment, the expanded veins are extracted and ligated. The spermatic cord is laid in its place, and the wound is sutured with a cosmetic suture. After complete healing, almost no trace remains.
Such an operation with varicocele is considered the most traumatic and safe method of treatment. Its duration is 30-40 minutes. Relapses after such a method of therapy are quite rare.
In the postoperative period, significant physical exertion and sudden movements should be avoided. For 1 month after the operation it is forbidden to have sex, and you also need to protect the incision area from friction. Underwear should be free and natural.
After 3 months, you need to pass a spermogram to assess the ability of sperm to fertilize. 6 months after the intervention, you can return to your usual lifestyle.
Endoscopic surgery
Such an intervention is prescribed if the patient has bilateral vein expansion. It belongs to the most sparing technique among all non-invasive operations. It proceeds with minimal injuries to the patient.
With varicocele, laparoscopy is performed using an endoscope and does not have significant differences from traditional intervention, except as a way to access the enlarged vessel. Among the main advantages you need to highlight such as:
- low injuries;
- low likelihood of relapse;
- good tolerance;
- high cosmetic effect.
Initially, the doctor makes an incision about 5 mm 10 mm above the navel, into which he then inserts a special needle through which gas is supplied to straighten the space. Then the needle is removed, the incision increases to about 10 mm and a trocar is inserted into it, which is a wider needle with a tube. This is a very important tool required for endoscopy.
A chamber is introduced through the trocar, through which gas continues to flow into the abdominal cavity using a special device, which additionally helps to regulate the gas pressure. Under the control of the telescope, 2 more holes are made. One of them is located on the side about 30 mm below the navel, and the second is slightly to the left and below the navel by 20 mm. They also insert trocars to introduce the required instruments. Thus, the surgeon gradually gets to the area of the operation.
Dilated veins stand out, their fixation is performed. They are pinched, cut and ligature seams or clips are applied. At the end of the operation, the abdominal cavity is sutured, and the instruments are removed. After gas removal, trocars are pulled out. Seams or a patch are applied to the hole, it all depends on their size.
Before excising the veins, it is very important to separate them from the lymphatic vessels to prevent the occurrence of scrotal edema. The patient in a hospital should be 1-2 days. After that, he can return to his usual life. In the postoperative period, the doctor may prescribe an anesthetic.
Operation by laparoscopy is prohibited if the patient has acute inflammatory processes or malignant tumors of the abdominal cavity.
Laser treatment
Laser surgery is a modern, less complicated technique that is performed without additional incisions in the inguinal region. It is performed using an intravascular endoscope. Thanks to the miniature camera, you can quickly locate the localized area of the affected vessel, which is then cauterized by the laser beam and is no longer involved in the general blood flow. When conducting treatment with this method, anesthesia can not be used.
One of the advantages of laser therapy is a quick rehabilitation period. In addition, the risk of complications or serious consequences can be minimized.
Endovascular embolization
A similar operation is carried out under visual control. To do this, an intravascular endoscope 2 mm thick is inserted through the femoral vein, which then advances to the testicle vein. Then it is examined using a radiopaque substance.
Sclerosant is injected into the enlarged part of the vein. This is the substance by which embolization of the lumen of the vessels occurs. A similar method of treatment is performed without the use of anesthesia, refers to minimally invasive techniques, takes much less time, and also has virtually no relapse and consequences.
Contraindications surgery
It is important to know how the operation is done with varicocele, as well as what are the contraindications for its implementation. In addition, mandatory consultation of the attending doctor is required.
Various methods of surgery may have a variety of contraindications. Open interventions are not performed in the presence of diseases in the stage of decompensation, as well as in the case of inflammation in the active stage.
Sclerosis is not carried out in the presence of such contraindications as:
- large anastomoses between vessels;
- increased pressure in adjacent veins;
- the structure of the vessels does not allow the introduction of a probe.
Endoscopic operations, in addition, are also not performed with previous interventions on the abdominal cavity. This is due to the likelihood of a violation of the clinical picture and medical errors.
Rehabilitation
After the operation, sexual relations are possible only at the end of the rehabilitation period, taking into account the characteristics of each person and the type of operation. In time, this time is approximately 3 weeks. After the operation, the libido remains at the same level.
To restore spermatogenesis, a man after surgery can be prescribed:
- zinc based dietary supplements;
- ointments with antibacterial effect;
- vitamin complexes;
- hormonal drugs;
- painkillers.
After the operation, you need to move as little as possible and rest more, do not wet the wound, therefore it is forbidden to take a bath for two weeks. With severe pain, ice can be applied. In the first few days, it is imperative to wear a bandage that helps to hold the testicles.
Possible complications
The operation can cause a wide variety of complications, which include:
- drawing pain in the testicles in men due to trauma to the nerve endings;
- relapse of the disease;
- vein thrombosis;
- inflammation;
- testicular size reduction.
Due to the inexperience of the doctor, there may be damage to the intestines and ureter. When injuring the lymphatic vessels, there may be swelling of the scrotum.
How does it affect military service?
Many believe that the varicocele and the army are incompatible concepts, but this is completely not so. A draftee with such a pathology may well be admitted to military service by decision of the doctor. You need to come to the draft board with documents confirming the presence of the disease. In addition, a full medical examination is prescribed to determine the course of the disease and correctly diagnose it.
Varicocele and the army are completely compatible concepts, however, it all depends on the stage of the disease. In the first stage, the conscript is admitted to military service, and in the 2nd stage, surgery is required and a delay of at least 6 months is given.
In the case of stage 3-4, it all depends on the characteristics of the course of the disease, as well as the success of the intervention. If the outcome is positive and after full recovery, the recruit may be called up for service again. The duration of the delay depends on many different factors, which is why the doctor makes the decision.
Varicocele is a dangerous disease that can lead to dangerous consequences, in particular, such as infertility, cancer, impotence. It is not recommended to self-medicate. That is why at the first signs of the disease you need to consult a doctor for advice.