From this article you will learn: why with varicocele surgery is the only method of treatment, the types of surgical interventions for this disease. Indications and contraindications to them, their pros and cons.
Contents of the article:
- Why the operation is the only output of
- Types of operations, indications and contraindications to them
- How everything happens: preparation and course of intervention
- Possible complications
- Life after surgery
- Prognosis
Varicocele is a pathology in which the veins of the testicle expand as nodes, wriggle and overwhelmed with blood. The reason for this is an increase in pressure in the system of testicular veins due to a reverse reflux of the larger veins( renal, inferior hollow) into which they flow.
Click on photo to enlarge The operation allows you to interrupt this reflux by dressing, crossing or removing the dilated veins. Such intervention completely eliminates the problems and consequences associated with varicocele, restoring the man full health. Treatment is not complicated and is performed by urologists or surgeons in all urological and surgical hospitals.
Why the operation is the only way out
The causes and mechanisms of varicocele development are purely mechanical in nature - the affected testicle( seed) vein is unable to provide venous blood outflow from the testicle due to:
- lesions of valves located inside the lumen and responsible for making the blood advanceonly in one direction - from the testicle up into the larger veins;
- presence of obstruction or pressure increase( venous hypertension) in those large veins into which the seminal cells flow, which complicates the blood flow in them and causes venous congestion;
- weakness and flabbiness of the walls of the vessels.
All this leads to the fact that the blood not only does not flow away from the testicle, but accumulates in its venous plexuses due to the reverse reflux from the large vascular trunks. In venous congestion, sensitive genital tissue loses its normal structure, the ability to produce full-fledged seminal fluid and hormones.
The mechanism of blood circulation in healthy and varicose veins. Click on the photo to enlarge As the varicose veins of the testicle become not blood vessels, but a pathological repository for it, the only way to solve the problem is to break the vicious connection between them, which will eliminate the reflux and stagnation of blood. This is the purpose of the varicocele operation. It implies the allocation, dressing, intersection or complete removal of the main stem of the seminiferous veins above the level of their branching into small branches that form intertwined plexuses.
Thus, the pathological stagnation of blood in vessels and testicles will be eliminated without damage to the circulation. Venous outflow from the scrotum will occur through the system of other vessels, since the spermatic vein is the main, but not the only way for blood flow. Moreover, in conditions of stagnation and increased pressure in the spermatic vein, additional outflow pathways at the time of surgery are already well formed and will continue to form in the postoperative period.
Surgical treatment in 80-85% is performed on the left varicocele. This is due to the fact that the left ovarian vein falls into the renal, and the right - into the lower hollow. Due to the anatomical location, the angle of branching and other features of the left renal vessels, the pressure in them is increased. Therefore, the left-sided localization of varicocele prevails over the right-sided.
Comparative diagram of the structure of healthy testicle vein and affected varicocele Types of operations, indications and contraindications to them
There are two main types of surgical interventions for varicocele:
- Classic - through the incision( Ivanissevich's operation).
- Minimally invasive - through punctures( endoscopic, microsurgical and endovascular).
Operation Ivanissevich. Click on the image to enlarge 
Endovascular surgery to remove varicocele. Click on the photo to enlarge
The purpose of all methods is the same - to eliminate the discharge of the testicle vein, overlapping its lumen. There are ways to achieve this goal.
The table describes the features of classic and minimally invasive( sparing) operations:
| Operation characteristics | Classical intervention | Minimally invasive |
|---|---|---|
| Incision | 2-3 to 5-7 cm( depends on the physique of the patient) | Not needed, 2-3 skin piercings 1cm |
| Operation time | From 10-15 to 30-40 minutes | About 15-20 minutes |
| Narcosis | Intravenous or local | Deep with breathing apparatus |
| Extract | On day 3-5 | On day 2-3 |
| Pain after operation | Moderateor expressed, is removed by usual painkillers | Easy or absent |
| Indications | Varicocele 2-3 degrees | Varicocele of any degree( 1-2-3) |
| Relapse possibility | 10 to 20% | No more than 2-3% |
| Scar | Small,unobtrusive | None |
| Price( depends on the clinic) | From 250-300 to 650-700 y.i.e. | From 450-500 to 10,000 y.e. |
All operations on varicocele have common contraindications, which are always temporary. It can be:
- exacerbation of chronic diseases;
- acute, infectious or purulent processes in the body;
- decompensation of internal organs( renal, cardiac, pulmonary, hepatic insufficiency);
- decreased or increased blood clotting;
- severe anemia.
How everything happens: preparation and course of intervention
Any operation to eliminate varicocele is performed in a planned manner. This means that patients are firstly examined comprehensively, and only after that a decision is made about the possibility of intervention, the optimal method is chosen.
How to prepare
The preparation consists of the standard preoperative measures:
- Standard and additional examination( general clinical blood and urine tests, biochemistry, coagulation and blood group, ECG, scrotal and abdominal ultrasound with Doppler amplification, lung X-ray).
- The choice of the operating urologist or surgeon and hospitalization in the urological or surgical department.
- The last meal of the night before, on the morning of the day of surgery, is forbidden to eat and drink.
- In the morning before the operation, it is necessary to empty the bladder, carefully shave the inguinal areas and stomach.
Analgesia
The decision on the method of anesthesia is taken by the attending physician in conjunction with the patient, depending on the type of operation. If it is a question of laparoscopic intervention, then the only option is anesthesia, which will be performed by an anesthesiologist. In this case, a catheter is inserted into the vein, through which drugs are introduced that immerse the patient into anesthesia. During the operation, breathing is maintained by an artificial ventilation device through an endotracheal tube installed in the trachea.
Classical operation of Ivanissevich can be performed either under local anesthesia or under mild intravenous anesthesia. In the first case, the operated region is cured by local anesthetics( lidocaine, novocaine), and the patient does not feel pain, although it is conscious. Intravenous anesthesia immerses in a state of anesthetic sleep, but does not violate self-breathing and does not require artificial ventilation of the lungs on the apparatus.
Stages of classical intervention
Operation Ivanissevich
- Skew incision of skin in the left ileal region.
- Dissection and separation of soft tissues under the skin.
- No penetration into the abdominal cavity, since the spermatic vein is located retroperitoneally.
- Isolation in the retroperitoneal cellulose of the expanded seed( testicle) vein, its excision for several centimeters. Crossed ends of the vessel are bandaged with a non-absorbable thread.
- Before ligation of the lower end of the vein, the remaining blood in the varicose dilated plexus of the testicle must be squeezed out.
- Layer stitching of the wound. The skin can be sutured with a cosmetic intradermal suture. This method will achieve maximum cosmetic effect and make the scar imperceptible.
Classical operation using the Ivanissevich method. Click on the image to enlarge Laparoscopic operation
Elimination of varicocele by laparoscopic procedure occurs as follows:
- Piercing the abdomen and injecting air into its cavity. This is necessary in order for the organs to move away from each other, rather than close the location of the dilated veins.
- Introduction of a laparoscopic video camera and two other instruments through separate punctures of the abdominal wall in the navel and lower lateral abdominal areas.
- Under the control of the image on the monitor, which is output from the video camera, 2-3 cm of vein are extracted and cut off using tool-manipulators, the ends of which are pinched by special metal clips.
- Extraction of tools, overlapping skin punctures one cosmetic suture.
Laparoscopy for varicocele Possible complications of
Despite the relative simplicity of performing varicocele surgery, it can lead to postoperative complications and failures. Most often it is:
- Dropsy testicle - an increase in size due to edema and fluid accumulation in the scrotum.
- Bleeding, bruising, suppuration of a postoperative wound.
- Atrophy of the testicle - a decrease in size, a decrease in the function of the operated testicle.
- Pain syndrome in the area of postoperative scar.
Do not be afraid of surgical intervention because of the possibility of complications, because they occur very rarely, not more than 1-2% of the operated.
Life after operation
Below are the answers to the most important questions regarding the postoperative period in the operation for the varicocele of the testicle.
When you can get up and walk
If the procedure was performed under local anesthesia, after 2-3 hours you can try to get up and walk within the ward. In case of anesthesia, it is best to wait at least 6 hours. If attempts to get up and walk are accompanied by dizziness and weakness, it is better to just sit on the bed and try again after a while. Usually by the evening most patients go without difficulty.
How much the wound hurts, and how to relieve the pain.
. After laparoscopic surgery, pain is almost nonexistent, and after the classic it can be mildly expressed, intensified with the tension of the abdominal wall( coughing, twisting of the trunk, walking).In any case, they can easily be removed with the use of pain medications: Dexalgin, Ketoprofen, Ketanov, Ibuprofen, etc.
. Wound care and joint removal.
. Wounds must be covered with a light gauze bandage. It is desirable to change it daily, treating the wound with antiseptics( Alcohol, Betadine).The optimal time for the removal of stitches is 7-8 days after the operation.
Extract home
If the patient feels well and there is no sign of complications, after laparoscopic intervention, he can be discharged for 2-3 days, and after the classical - after 3-4 days.
Sex and pregnancy planning
Sexual relationships are resolved after 3 weeks. The optimal time for pregnancy planning is more than 6 months after the operation.
Going to work and playing sports
The operated men are considered temporarily incapacitated and are on sick leave for 2 weeks after laparoscopic surgery and 3 weeks after the classical. Heavy work and playing sports are excluded for 1 month after laparoscopy and 2-3 months after Ivanissevich's operation.
Forecast
The operation to eliminate the varicocele of the testicle is relatively simple, reliable, and most importantly, the only method of treating this disease. In general, it is possible to eliminate it permanently in 90%.The probability of recurrence( after 5-10 years) depends on the method of intervention: in the classical technique - 20%, for laparoscopic - 2%.Functional results in the form of improved motility of spermatozoa are noted in 90-95%, complete recovery occurs on average in 50-60%.Abandonment of surgery sooner or later results in a breakdown in the structure of the testicle and infertility in 100% of cases.
