What is Varicocele?
It is an abnormal enlargement of the group of veins located in the scrotum. This plexus of veins drains the testicles. The testicular blood vessels originate in the abdomen and travel down through the inguinal canal within the spermatic cord on their way to the testis. Upward flow of blood in the veins is ensured by small one-way valves that prevent backflow. Defective valves, or compression of the vein by a nearby structure, can cause dilatation of the testicular veins near the testis, leading to the formation of a varicocele. Collection of blood within the veins results in increased temperature within the testes causing decrease in efficiency of the sperms produced. This results in infertility or subfertility in males. The sperm count and motility is reduced and their shape is also altered. It usually occurs in the left testes, but may be present on both sides.
Symptoms of a Varicocele may Include:
The goal of treatment of the varicocele is to obstruct the refluxing venous drainage to the testis while maintainingarterial inflow and lymphatic drainage. Varicocelectomy is the most common surgical procedure for infertility in males.
There are several treatment options for varicocele, depending on symptoms and seriousness of the condition. If the varicocele is not causing any symptoms of pain and infertility is not an issue, no treatment is warranted. In cases of mild discomfort, the condition usually can be managed by wearing an athletic supporter or snug-fitting underwear during strenuous activity or exercise.
• Laparoscopic Varicocelectomy : Under general anesthesia, three small incisions (5mm each) are made in the abdomen. Varicoceles on the right or left or both can be approached. A thin tube with a camera at one end is inserted through one of the incisions. This is called as the laparoscope. The abnormal veins are identified. Small instruments are inserted through the other incisions and the abnormal veins are clipped and divided. The arterial and lymphatic supply is untouched, only the venous flow to the scrotum and testes is rerouted to normal veins.
Incompetent or absent valves in the spermatic vessels with blood backflow is the main cause for this condition. The defective valves are unable to prevent the backflow of blood. Structural difference between right and left testes makes the latter more vulnerable to this condition. Another cause is the compression of left renal vein between aorta and superior mesenteric artery with high pressure transmitted to the left internal spermatic vein. This interferes with normal blood flow in the spermatic veins. This is known as nutcracker syndrome.
Advantages of Laparoscopic Varicocele Surgery Over Other Techniques Include:
Surgery is completed within 45 minutes, even in the case of varicoceles occurring on both sides. Patient can be discharged a few hours after surgery and return to work is within 48 to 72 hours.
• Microsurgical or Open Technique Varicocelectomy : This is the trans-inguinal approach where a small incision is made over the groin. The distended varicocele veins are identified with the aid of an operative microscope and surgically ligated and divided. The use of an operative microscope, which offers up to 6 X magnification, is necessary to identify clearly the dilated veins and avoiding injury to artery and lymphatics. Blood flow is re-routed to normal veins.
• Embolization of Varicocele : Under mild sedation and local anesthesia, a small puncture is made at the groin skin. A fine catheter is passed into the underlying vein and followed into the testicular vein.
An x-ray dye is injected to map out where the problem is and where to embolize or block. By using coils or balloons, blood flow to the varicosed veins is blocked and is re-directed to other healthy pathways. The entire procedure can be completed within 2 hours and requires the expertise of interventional vascular surgeons.
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