Conservative and surgical removal of varicocele in men, before and after surgery

Varicocele is a varicose expansion of the vessels that make up the spermatic cord, namely the lobate plexus and the vein of the testicle.

This pathology is not rare among mature men and adolescent boys, as it occurs in about 16% of them.

In boys of an earlier age varicocele is much less common, but this does not mean that for them this disease is less dangerous.

Etiological factors and pathogenesis

Currently, the etiology of this pathology of the male reproductive system is ambiguous, due to the age features of the patients andthe anatomical structure of the spermatic cord and vessels in their composition.

The emergence of varicocele in children is often left-handed and is idiopathic, in adults it is secondary to the outcome of a different pathology. Very rare is the detection of dilated veins of the testicle on either side or isolated from the right, which is explained by the different inflow of the seminiferous veins from different sides.

In addition to the above-mentioned ethological factors, the literature contains information on the deficiency of the vein valve apparatus or the genetically determined absence of .

This leads to an increase in the reverse flow of blood through the vein of the testicle, and the lobar plexus overflows, undergoing varicose deformation.

Also noted are various variants of of admission of testicular veins to the renal veins and deficiency of venous walls of due to a reduction in the number of muscle fibers in them with replacement for connective tissue.

Separately, this etiological factor is considered, such as the weakness of the muscle that lifts the testicle.

In general, pathogenetic mechanisms of varicocele development are difficult and are subject to wide discussion among scientists and medical workers.

Symptoms and Diagnosis

Usually clinically the varicocele manifests a weak .There is an increase and decrease in the half of the scrotum, a slight sensation on the same side with an increase in walking or physical exertion, as well as sexual arousal.

If the pathology has acquired a pronounced character, then significantly increased in size of the scrotum may interfere with normal walking. The testicle of the affected side decreases in size.

Diagnostic measures:

• Inspection .The visual expansion of the venous plexus is revealed.
• Palpation of the .Nodes of the expanded veins of the plexus plexus, determination of the size and consistency of the testicle.
• Survey of .The doctor draws attention to the prescription of symptoms, the presence of trauma to the lumbar regions.
• US with doppleroscopy.
• Venography of ( retrograde renal and testicular, transcross, antegrade).
• Spermatogram of the .

Methods of treatment

The choice of how to treat varicocele directly depends on the degree of pathological process. In this regard, there is the following classification, based on the severity of the widening of the lobar plexus and trophic changes on the part of the testicles:

• 1 degree .Varicose enlargement is noted only when the patient is palpable, or when he is stressed in a standing position.
• 2 degree .Varicose veins are to be determined on palpation not only in the recumbent, but also in the sitting position of the patient. The testicle does not change.
• 3 degree .There are pronounced veins of the lobar plexus, a change in the size and consistency of the testicle, deviation of the spermatogram from normal values.

Varicocele therapy methods are divided into conservative and surgical species.

Conservative

This species involves the use of all treatments that exclude surgery. One of these methods is the initial independent therapy at home in accordance with the recommendations of a specialist.

As a urologist, this method of combating varicocele is not accepted as a documented form of , however, this kind of treatment can be regarded as preparation for the most effective surgical treatment and as recovery measures after it.

The independent preventive therapy at home includes :

• Refusal to stay in a sitting or standing position in the same position for a long time.
• Obstruction of muscular overstrain and ischemia.
• Obstruction of blood stasis in the vascular channel of the pelvic organs.
• Daily exercise, jogging in the morning, walking.
• Maintaining a healthy lifestyle.
• Abandonment of bad habits( nicotine addiction, alcohol).
• Control of rational and complete nutrition with the most balanced consumption of fruits and vegetables.
• Body weight control.

Conservatively varicocele is also eliminated with the help of pharmacological agents, however, this technique, like the previous one, does not use the high demand of .This is due to the impossibility of changing the pathogenetic mechanism of the development of the disease with the help of medicinal substances.

The following types of medicines are used to treat varicocele tablets:

1. Vitamins A, E, and C( as separate substances included in standard antioxidant therapy).
2. Antioxidant complexes in the form of 1 capsule twice a day, Tri-vivo plus 1 tablet daily before meals, Vitamax 1 capsule for 24 hours, Triovit 2 capsules daily for 2 months.
3. Pentoxifylline, which improves microcirculation in tissues( Agapurin in a dose of 100 mg twice a day, Arbiflex or Trental in the same dosage).
4. Protectors of the veins of the plexus plexus( Ginkor forte, Escuzan in a dose of 14 drops 3 times a day, Detralex in the form of 1 tablet for 2 divided doses per day).
5. Combination means( Ascorutin; Tocopherol).

The literature contains information on trials of the effectiveness of folk remedies, which has not yet been fully proven. Therefore use of folk recipes is rather a facilitating type of therapy for for a patient preparing for surgery.

The following tools are used:

1. Boiling 3 medium sized apples until completely soft and wrapping a plate with them in a towel, leave them for 3 hours. After grinding the mass and wiping it through a sieve. The resulting broth should be taken at 50 ml each day in the morning and evening hours.
2. Combine 1 tablespoon oak twigs, willow and chestnut, pour the resulting mixture with 1 liter of water. After boiling the mixture for 30 minutes, add 1 teaspoon of chamomile, St. John's wort and string to the resulting broth, stir and insist 12 hours. The medicine can be taken orally, but you should make it a little sweeter with the help of spoons with honey. We take 3 times a day, interrupting treatment for 1.5 weeks after 20 days of admission.
3. In the same proportions, mix dried chamomile, oak bark, chestnut and raspberry root. In 50 ml of boiling water, brew 1 tablespoon of the mixture and insist for 24 hours, filter. After taking 150 ml in the morning and evening.
4. Mix 1 tablespoon buds and sheets of wormwood and sour cream( you can milk).The resulting mixture is placed on gauze and apply daily as a compress to the site affected by varicocele. Treatment is conducted for 5 days, then we interrupt for 3 days and repeat the course again.

Types of surgical intervention

Surgical treatment is most preferable for patients with this disease. The aim of the surgical intervention in this case is to ensure the normalization of the blood flow by the termination of its retrograde orientation to the lobar plexus.

The following types of operations are performed:

1. Palomo operation with varicocele. The intersection of the spermatic vein and artery is performed, which negatively affects the normal trophism of the testicles. This type of intervention is applicable in patients who do not set the goal of maintaining fertility.
2. Operation Ivanissevich( open) for the removal of varicocele. The ligation is carried out with the help of two ligatures in the retroperitoneal cell space and the intersection of the segment of the inner spermatic vein isolated by the ligatures on the left.



3. Formation of testicular or testiculosafenic venous anastomosis .

   Indication for its conduct is the presence of severe renal hypertension of venous blood or an organic obstacle to the outflow of blood from the renal vein.

   With the first variant of anastomosis, the upper segment of the seed vein is transplanted to the internal iliac vein. In the second case, this upper segment is connected to the large subcutaneous femoral vein.

4. Embolization of the testis vein .A spiral or preparations that promote the formation of connective tissue are established. It can be used for relapse in a patient who underwent Ivanissevich's operation.
5. Seed vein cleansing from titanium braces for the removal of varicocele, the operation is performed under the compulsory control of a laparoscopic device.
6. Operations from the mini-access at which from a small incision in the projection site of the external inguinal ring( 1 cm in the indentation from the base of the penis).After isolation of the spermatic cord, the veins in its structure are bandaged with the calculation that the outflow of venous blood can later occur through the superficial venous system.
7. Microsurgical operation( revascularization) of of testis tissues with varicocele. Surgeons achieve normal blood circulation in the testicle due to vein transplantation of the testicle into the epigastric vein.

Attention! These photos show the testicles before and after the operation for treating varicocele in men, on video - as do the most frequent surgeries. Weak-eyed and persons under 18 years of age are not recommended to watch.

Demanding adequate treatment and correct diagnosis against the background of the scarcity of clinical manifestations, this disease is still not fully understood and causes controversy at many world scientific congresses.

Among the methods of treatment are conserved and operational ones, the latter being the most preferred among specialists. The patient with varicocele should be under the control of the andrologist and urologist even after successful surgical intervention, since the risk of reduction and loss of fertility remains always.

This video-video tells more about all the techniques of operating with this disease: