Varicocele is the formation of enlargement (varicose) in the testicles. Varicose veins are usually seen on the legs and lower parts of the body. Varicocele disease, on the other hand, is the changes that occur in the testicles with the increase in fluid pressure in the testicular veins. It is the inability of the veins carrying the dirty blood coming out of the testicles in men to function well due to the disorder and thus not being able to carry the dirty blood inside the heart to the heart. Due to the dirty blood accumulating in these veins, the veins swell and become wrinkled. We call varicocele similar to the varicose veins that occur in the legs (especially in women) in the testicles.
Varicocele can cause the following negative situations that can be revealed in the spermiogram (sperm analysis) in the semen:
Decrease in sperm count
Impaired sperm motility
Sperm shape (morphology) deterioration
These negative effects are caused by the following mechanisms:
Increased temperature as a result of the accumulation of blood that cannot be expelled in the testicles
The harmful products that need to be removed from the testicles cannot be removed from the damaged vessels and return to the testicles (reflux)
Accumulation of dirty blood in the testicles.
How is varicocele diagnosed?
The most important method in diagnosis is an examination by an experienced urologist. The examination must be done standing up. Physical examination is the most valuable method. Varicocele is divided into 3 Stages according to examination:
Stage I: It is the mildest Stage and is palpable on outpatient examination only with maneuvers such as coughing/straining.
Stage II: It is understood in the palpation examination without the need to increase the intra-abdominal pressure in the standing examination.
Stage III: This is the most severe type and there are varicose veins visible on the foot.
It is revealed by feeling the varicose veins with the hand in cases that increase intra-abdominal pressure. The second step in the diagnosis is scrotal color Doppler ultrasonography in the presence of conditions that make the physical examination difficult. With this examination, it reveals the diameters of the sick veins, whether the dirty blood returns to these veins, and whether there is a loss of volume in the testicles.
Which patients benefit more from microsurgery?
Those with advanced varicocele (Stage II and Stage III varicocele)
- Those with normal/near normal testicular volume
- Patients with normal blood Testosterone, FSH values and low inhibin B values
Patients with normal genetic tests
Patients presenting early for infertility
Those with sperm count more than 5 million
- Patients without molecular disorders.
What should be the follow-up after varicocele surgery?
After varicocelectomy surgery, daily work can be done after 1 day of rest at home. After 1-2 weeks, sexual activation is allowed, after 2-4 weeks, heavy work and sports activities are allowed.
After varicocele treatment, the cases should be followed up regularly at regular intervals. Pre-puberty patients are followed up in the urology outpatient clinic with routine examination and examination once a year, and adult patients with sperm analysis every 3 months until they have a child. Even if it is not possible to have a child after varicocele surgery, assisted reproductive treatment methods such as vaccination or in vitro fertilization are also beneficial.