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.
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.
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 veinAn 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.
1. Accurate identification of all the veins and avoiding injury to the artery and lymphatic vessels as the surgery is done under magnification during laparoscopy.
2. Varicoceles from both sides of the body can be corrected at the same time without needs for further surgical incisions.
3. Rapid recovery from surgery with minimal pain as the small 5mm wounds causes minimal trauma to tissue.Surgery is completed within 45 minutes, even in the case of varicoceles occurring on both sides ie with bilateral varicoceles. Patient can be discharged a few hours after surgery and return to work is within 48 to 72 hours.
4. Accurate identification of all the veins and avoiding injury to the artery and lymphatic vessels as the surgery is done under magnification during laparoscopy.
5. Varicoceles from both sides of the body can be corrected at the same time without needs for further surgical incisions.
6. Rapid recovery from surgery with minimal pain as the small 5mm wounds causes minimal trauma to tissue.
7. 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.
8. Complications are rare. Injury to abdominal organs can occur in less than 1% of cases. Testicular artery injury (1%) and hydrocele formation (1-5%) is not common. Improvement in sperm counts can be expected in 50%-70% of patients within 3 months. Overall pregnancy rates are between 10-20%.
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