When is it better to operate on varicocele? Surgery for varicocele: what types of operations exist and how are they done? Stages of the disease and indications for surgery

Varicocele or varicocele spermatic cord a fairly common disease that affects 17% of men on the planet. The danger lies in the development of infertility due to pathological processes occurring in the scrotum, the main thing being an increase in temperature, which disrupts the course of spermatogenesis. The disease is completely treatable exclusively by surgery.

However, with surgical removal of varicocele in men, consequences after surgery are possible, although with a low degree of probability. This can be either a relapse or side effects associated with a violation of the integrity of nearby tissues or a violation of the rules of rehabilitation.

What complications may there be?

The repeated occurrence of the same disease is called relapse. occur when reflux in the veins is not eliminated or there is minimal blood circulation through deformed vessels, which can be either an error in the preparatory diagnosis or incorrect actions of the surgeon. Simply put, if the blood flow in varicose vessels is not stopped, then the varicocele is not cured and will appear again.

In children, the consequences of varicocele after surgery are more common due to the developmental characteristics of the body, and in adults, 90% of them are associated with mechanical errors during surgical treatment, for example, when the doctor pays too much attention to the cosmetic component.

However, he may make a smaller incision or tighten the vein insufficiently. Postoperative complications are typical for persons exposed to constant physical activity (loaders, athletes).

The table below shows the incidence of relapses and complications. But the given data are somewhat relative, since methods are constantly being improved, new minimally invasive methods of therapy are appearing, and there may be options with a combination of treatment options.

Possible complications with in various ways surgical correction

It is also worth paying attention to changes in data taking into account the social status of patients and geographical location. If we compare the general statistics for cities with a population of over a million with the statistics for the entire country, it turns out that in major cities postoperative cases are recorded less frequently.

This is due to the presence of modern clinics equipped with high-tech surgical instruments, which allow examination and surgery to be carried out at a very high level using the latest developments in medicine. In the provinces, unfortunately, there are no such opportunities, and the income of the population does not allow spending significant funds on treatment.

Re-development of the problem

Today, there are no surgical techniques that would guarantee the absence of complications and relapses with absolute accuracy. At the same time, the successes of modern medicine have reached such a level that the likelihood negative consequences is only a few percent. Compared to classical techniques using access through open incisions, the risks are reduced significantly, for example, when using microsurgical access technology.

At overall assessment the probability of relapse of all operations performed, without taking into account the technique and age criterion of patients, statistical data is ambiguous and ranges from 10% to 40%. At the same time, there is a clearly visible correlation between the patient’s age and the risk of complications.

They occur more often in adolescents than in those men who were operated on after the age of 22, i.e., after the end of puberty. But if we consider the problem from the perspective of preventing possible infertility, then when surgical treatment is delayed with reference to age parameters, the risks of loss of fertility become higher.

Therefore, the decision on whether to carry out an intervention will largely depend on early and accurate diagnosis, taking into account an individual approach to each specific patient. And do not forget that when varicocele is destroyed in men, the consequences after the operation are unlikely.

Very important. Regular monitoring of the disease status both before and after surgical treatment should be carried out by the attending physician until the birth of the desired number of children.

What are the causes of

If surgical correction carried out correctly without errors or injuries neighboring organs, subject to preliminary accurate diagnosis, then in this case there should be no complications, provided that the rules of rehabilitation are followed by the patient himself.

If we estimate the probability of relapse when eliminating varicocele without taking into account classical abdominal techniques, we get a figure that does not exceed two percent. Now let's figure out what are the prerequisites for the occurrence of these two percent.

Insufficient visualization

It is not always possible for a doctor to remove or ligate all diseased vessels, and there are objective reasons for this. With varicocele, a network of small collateral veins and small-diameter anastomoses forms around the testicle. During surgery, even with good equipment, it is not always possible to identify all varicose veins.

Problems with visualization sometimes occur due to the fault of the doctor, when he ligates the wrong vessels. These may be healthy veins located nearby.

Relapse after sclerotization

With vein sclerotization, negative consequences are extremely rare, however, there are cases when the sclerosant (the component blocking the vessel) is displaced from the desired place, there is insufficient coverage in the diameter of the blocked testicular vein, or it dissolves altogether.

Thus through varicose vein blood begins to circulate again. To eliminate relapse, repeated surgery the same deformed vessel.

Note. The described reasons often happened in the past, but today the practice of performing the operation is more advanced, and their percentage has decreased.

Technical violations

This refers to errors made when working with veins, and this is not always the fault of the surgeon. In case of inaccurate diagnosis during the preparation of the operation, manipulations may be performed in the wrong place or with the wrong vessels.

In addition, technical errors include insufficiently tightened veins when ligating them, poor incision depth, installation of a occluding agent in the wrong place, and so on. In connection with the above, it is clear how important accurate diagnosis. For this purpose, ultrasound or endoscopic methods are used, which play a vital role in the preparation and subsequent correct implementation surgical treatment.

Important. Careful diagnosis of veins affected by varicose veins before surgery significantly reduces the risks postoperative complications.

It should be noted that it is inappropriate to save money on carrying out additional diagnostics, because the price is not so significant compared to the costs of re-correction, not to mention the temporary and psychological losses.

How to recognize health problems?

Consequences after surgery for testicular varicocele occur not only due to the fault of doctors. The patients themselves may not adhere to the rules during the recovery period during rehabilitation, contrary to what they were given detailed instructions about permitted actions and restrictions. Depending on the operating technique, returning to your usual way of life will take time and the necessary deadlines must be met.

In the first days or even weeks, everything will again depend on the type of treatment. Pain will be present, but will soon pass. However, if the pain intensifies or other symptoms appear that clearly indicate inflammatory processes The doctor should be notified immediately.

The main symptoms of the developed complication are:

• severe increasing pain in the scrotum;
• redness and swelling of the sutures;
• swelling of the scrotum;
• discharge from wounds of cloudy lymph with an unpleasant odor;
• visually noticeable or palpable enlargement of blood vessels;
• loss of sensation in some areas, often on the inner thigh;
• temperature increase.

Be carefull. At the first symptoms indicating complications, you should consult your doctor. You should not hope that the problem will go away on its own. The sooner a relapse is diagnosed, the easier it will be to treat.

When might it happen

Most complications appear a day or two after the operation - disturbances in the functioning of organs in the event of damage will not take long to appear. And if in the first days everything is fine and the patient does not complain about anything, then a positive prognosis can be given with a high degree of confidence.

However, relapses can occur after a significant period of time, which is extremely rare. Therefore, it is important to regularly visit your doctor for monitoring recovery process. Early diagnosis when suspected re-development disease will be the best preventive measure.

Treatment of complications

There is no clear answer as to which method should be used to eliminate the consequences of varicocele surgery. Everything will depend on many factors and individual characteristics.

In case of relapse, the essence of the operation will not change and will consist in excluding diseased vessels from the blood flow of the feeding testicle, which must communicate with venous system only with the help healthy blood vessels. If there is a complication, the treatment depends on its type.

Here are some examples:

1. Hydrocele or hydrocele of the testicle. It occurs when lymphatic vessels close to the testis are injured, and lymph begins to accumulate in the scrotum due to a violation of its outflow, as shown in the photo. Treatment consists of punctures or surgery to restore the correct circulation of lymph;
2. Testicular atrophy. Formed when blood vessels are damaged or other factors cause trophic disturbances. Prompt restoration of proper blood flow is required;
3. Loss of sensation. If the operation damages nerve tissue. Depending on the nature of the damage, treatment can be either surgical or medicinal; in some cases, the innervation is not restored completely or partially.

If a relapse occurs, the patient is examined using ultrasound to diagnose the extent of the disorders. A large number of specialists in the field of urology believe in optimal ways the use of endovascular surgical techniques, preferring them to microsurgical and laparoscopic methods.

But the choice will largely depend on the following factors:

• technical capabilities of the clinic;
• surgeon skills and preferences;
• the type of operation after which the relapse occurred;
• individual characteristics of the patient;
• financial capabilities of the patient.

While there are many operating techniques available, few are used to correct the problem. Below is a short description of the main methods.

Operation Ivanissevich or Palomo

Previously almost the only way elimination of varicocele, but today is losing popularity due to high trauma, long recovery period and high relapse rate. Due to their simplicity and low cost, these methods are still widespread in the provinces and small towns where there are no clinics with modern equipment.

Relapse is eliminated in the same way as varicocele - by excision and ligation of diseased vessels. Of the techniques used today, leading urologists least recommend the Palomo and Ivanissevich operations.

Interesting to note. A case cannot be considered a relapse when, when operating on a varicocele using classical open-cavitary techniques, it is not the testicular veins that are mistakenly ligated, but, for example, muscle tissue, since the varicose vessels in this one remained intact.

Laparoscopy

Elimination of relapse is carried out using microsurgical instruments and a stethoscope, which are inserted into the peritoneum through small holes. The operation is a minimally invasive technique, has a short recovery period and is well tolerated by patients.

At first, you should limit physical activity. Sexual activity is allowed after three to four days if there is no pain. According to statistics, the majority of men who eliminated varicocele using laparoscopy completely restored their sperm reproductive parameters.

Endovascular sclerosis

Perhaps the most The best way treatment of recurrent varicocele. The only downside is the additional radiation exposure to the patient. x-rays, since all manipulations performed by the surgeon are monitored in an anti-orgaphic way. Naturally, this requires special equipment, which is not available in all clinics.

Through a micro-incision, a sclerosing substance is delivered into the vein, causing adhesion of the vascular walls, due to which the blood flow completely stops, and the diseased vein resolves over time. The therapy does not involve injury to nearby tissues, so treatment achieves high results when approaching absolute indicators(about 98%). The rehabilitation period takes the shortest possible time (see).

Bypass surgery

In simple words, this is sewing one vein to another. In the case of varicocele v. testicularis is shunted into nearby vessels, for example, into the femoral vein. The advantage is that blood flow is restored immediately and in full, so this is justified with physiological point vision.

But there are also significant disadvantages that make this technique less popular. It's all about high probability the occurrence of thrombosis in the bypassed vessel. Another disadvantage is the duration (about 1.5 hours), which exceeds the time of other operations.

Prevention of complications

Depending on the method of surgical treatment, the terms and conditions of rehabilitation may be different. The most inconvenient thing in this regard will be abdominal surgery, carried out according to Ivanissevich’s method, where is the term full recovery can take up to six months.

If the regimen is violated, there is a significant risk of complications. More details about them are shown in the video in this article.

To prevent the development of undesirable consequences of treatment, the table contains basic recommendations and advice.

Conclusion

Modern methods of treating varicocele are characterized by minimal risks of developing postoperative complications and relapses. Undesirable consequences most often appear in the first few days, but it is possible that the disease may reoccur after some time.

Today there are no methods that guarantee the absence side effects. Risks are reduced by high-quality diagnostics, the skill and attentiveness of the doctor, and the patient’s compliance with the rules of rehabilitation. Visits to the clinic and regular medical examinations should be considered as an important and integral prevention of the development of negative consequences after surgical treatment.

Varicocele is a disease that is an enlargement of the veins in the scrotum and spermatic cord. It does not pose a threat to the patient's life, but it affects fertility and is the cause of infertility in men. There is also conservative method deliverance, but in what cases does surgery become the only option when treating varicocele?

Is it possible to cure varicocele without surgery?

Varicocele can be treated non-operatively, but in this case you need to know that only hormonal background and testicular function. This treatment is prescribed to young people under 18 years of age and older patients who do not intend to have children. They are prescribed antioxidants and venotonics to maintain the tone of the venous walls. It is dangerous for young people to undergo surgery before they reach adulthood, because... in this case, there is a slowdown in the growth and formation of the testicles, and the risk of relapse increases. Conservative therapy prevents the disease from progressing. However, there are cases when patients childbearing age for one reason or another, they refuse surgery for varicocele and are treated only with tablets or folk remedies.

Subclinical and first stages of the disease do not require treatment. In the subclinical stage, veins on the testicle cannot be detected by palpation, only by ultrasound. In the second stage, the veins can only be felt in a standing position. In these cases, it is enough to take simple measures against blood stagnation: give up alcohol, normalize bowel movements, maintain regular sex life, moderate physical activity. Such simple steps can help eliminate varicose veins of the scrotum and prevent the disease from progressing. Elderly patients may benefit from wearing a jock strap. If the disease is in the second stage, you can feel the veins while standing, lying, or sitting. Surgical treatment in this case is indicated in the presence of pain. The third stage is characterized by the fact that dilated veins become visible.

Doctors recommend that varicocele surgery be performed in men with the third stage of the disease.

There are contraindications to surgical treatment:

• High blood sugar, liver cirrhosis. In this case, the functions of the organ may be impaired and will not recover without treatment;
• If there is severe inflammation;

In these conditions, open surgery is contraindicated. Operations using an endoscope, in addition to the above factors, are not performed if the patient has previously undergone surgery in the abdominal cavity. There are also contraindications to sclerotherapy:

• The presence of anastoses (bridges) between the vessels. Use of an adhesive drug may affect normal arteries;
• High pressure in the renal and other nearby veins;
• The veins have a special crumbly structure that will not allow insertion of a probe.

In all other cases surgical treatment Varicocele in men is performed based on the patient’s medical history, complaints, and stage of the disease.

What is needed before the procedure

Preparation for varicocele surgery includes a number of tests and examinations that must begin a week before the scheduled time:

• Complete blood count, blood group and Rh factor test, coagulogram, sugar level;
• Blood test for hepatitis B, C, HIV infection;
• Urine examination;
• X-ray examination of the lungs;

In addition, doctors need to know the cause and exact picture of the disease. For this, a simple ultrasound or Doppler (using contrast) is prescribed.

On the day of surgery for varicocele, it is advisable not to consume food or water. You need to take a shower, shave your pubis, scrotum and stomach clean. If the patient is taking any pills, it is necessary to consult a doctor on this issue.

Types of operations

Statistics show that in almost one hundred percent of cases the varicocele is localized on the left. Only 2 percent of the disease occurs in right side, or a bilateral lesion is diagnosed.

All surgical actions are divided into two large groups from a technological point of view:

• Surgery on varicocele, in which the recocaval shunt (anastomosis) is not removed. The shunt is a kind of bridge between the veins on the testicle and causes congestion;
• Excision of the anastomosis.

Today, the second method is recognized as more effective and is used more often.

Depending on the nature of the disease, stage, as well as age and needs, the doctor determines the type of operation to eliminate varicocele.

Ivannisevich's operation. This method was one of the first to be developed, and today it is considered the least effective, because Almost half of patients experience relapses of the disease. The procedure is performed under general anesthesia. The incision is made on the left side iliac region, its length reaches 5 cm. Next, all veins are crossed, and the wound is sutured. The disadvantage of the technique is that there is a risk of missing blood vessels, which will cause the disease to make itself felt again. The doctor may make a mistake in the form of ligation of the testicular artery, which will result in a disruption of spermatogenesis.

Removal of varicocele according to Ivannisevich is considered the most traumatic, and the healing period can reach three weeks.

Operation Palomo. At its core, it is an improved method of the Ivanisevich operation. The incision is made slightly higher than with the first method, and the vein is ligated in the retroperitoneal tissue.

Laser ablation. Modern technology allows treatment without incisions or anesthesia. With the help of an endoscope, coagulation of blood vessels occurs.

Operation Marmara. The results show that this type Operations for varicocele are recognized as the most effective and have a number of advantages compared to the previous two:

• The length of the incision is only 2-3 cm, the size is close to the incision during laparoscopic surgery;
• A small percentage of complications, as well as relapses of the disease;
• Short recovery period after intervention;
• Localization of a small scar where underwear was worn, which is a good cosmetic effect.

The operation to remove varicocele in this way begins with identifying the testicular artery, then finding large and small veins. After the procedure, the patient will be able to go home within 7 hours.

Microsurgical revascularization. The positive aspect of this method is physiological effect in the form of normalization of blood circulation in the scrotum immediately after the end of the operation. A 5 cm incision is made in the lower abdomen, followed by removal of the testicular vein, which runs from the testicle to the renal vein. After this, the epigastric vein is sutured to the renal vein. These manipulations are performed under general anesthesia.

Laparoscopic surgery. This method is modern, minimally invasive, and most effective in the treatment of varicocele. The probability of recurrence is only 2%. Instruments and a laparoscope are inserted into the patient under general anesthesia through small punctures (5mm). Next, using the image provided by the laparoscope, the veins, as well as the artery of the testicle, are found, after which they are ligated with surgical thread, or titanium staples are applied to them. Duration 15-45 minutes (time may vary slightly based on how the surgery is going). It is noteworthy that more late stage the disease will take less time, because varicocele grade 2 or 3 is more pronounced. The advantages of this method include surgery. After laparoscopy, the patient is required to stay in the hospital for about two days.

Endovascular embalization. Pierced femoral vein, using a catheter, a sclerosing substance is delivered into the testicular vein, due to which the blood circulation of the vein stops. Surgery for varicocele is performed in this way under X-ray control. It is considered an ineffective method due to the high probability of relapse of the disease.

Postoperative period

Regardless of the method used to remove varicocele, there are general recommendations for the rehabilitation period:

1. In men who have undergone the procedure, it is necessary to reduce the tension in the tissues of the spermatic cord and scrotum. For this, a suspensor is used. The bandage is worn for several days after surgical intervention.
2. The first 2-3 days is necessary careful care behind the wound, avoid getting any moisture - it is important to keep it dry.
3. You must abstain from any sexual intercourse for three weeks after the procedure. After this period has expired there may be discomfort during the process.
4. After elimination, you must protect yourself from physical activity and exercise for about a month. After endoscopy, loads are resolved a little earlier.
5. Three months after surgery, a spermogram is taken to ensure that reproductive function is restored. If the test results are not good, you should consult an andrologist so that he can prescribe treatment to improve fertility after removal of the varicocele.
6. In order to reduce the overall load on the body, after the procedure it is worth sticking to a gentle diet for some time, and also giving up alcohol, because. its use affects the functioning of the kidneys.

It is worth noting that even if all the rules are followed during rehabilitation, recurrence of the disease is possible. The reason for this may be a missed pampiniform vein or branch. In addition, inflammation, infection, deep vein thrombosis, hypertrophy, and testicular atrophy may develop.

Among the most common is hydrocele.

This disease is characterized by the accumulation serous fluid in the testicles. This is facilitated by poor blood circulation, which can be caused by varicocele surgery. There are cases when a series of operations are performed until all dilated veins are ligated. Men who have undergone this procedure experience discomfort at first, which quickly passes. But if the pain persists for a long time, you should seek help from a doctor.

Of course, the question of whether surgery is needed is decided on an individual basis, based on the stage of the disease and other associated factors, and is decided by the patient together with the attending physician. However, it has been proven that approximately half of cases of varicocele, which were treated surgically, provide a good chance of conceiving children. A large percentage of male infertility is due to this disease. In addition, the sooner the operation is performed, the better the recovery process goes, and the faster reproductive function is restored.

In contact with

Varicocele: causes, signs, degrees, removal

Until varicose veins of the spermatic cord manifest themselves, the patient may not be aware of it, because the symptoms of varicocele may be subtle not only at the beginning of its development. Here, as one is lucky, the disease, as a rule, does not progress after puberty. Often pathology is detected during some examination or in connection with the passage medical commission conscripts. Sometimes developing events make a person still worry and seek help from medicine. After all, appearing, although from time to time, nagging pain and a feeling of heaviness in such intimate place, suggestive of some kind of pathology.

Considering the age of those who have such “happiness”, the issue of the consequences of varicocele (impact on the functional abilities of the entire organ) always comes first. Will illness prevent full family life and will it affect reproductive function?

Degrees and causes of varicocele

According to various classifications, varicose veins of the spermatic cord are divided into 3 or 4 degrees (in particular, Wikipedia indicates 3 types or degrees). Depending on whether the author takes into account the zero degree, when the pathology is just emerging and is detected only with, but is not determined by palpation.

However, not everyone runs for ultrasound, so it’s better to start the classification with 1st degree varicocele, when dilated veins can be detected by touch, however, only in a standing position and. If the pathological process goes further, then further diagnostics does not even require additional devices and determines the following “achievements” of varicose veins:

• Varicocele 2 degrees can be detected visually, where dilated veins are clearly visible, but the testicle itself has not changed in size;
• Varicocele 3 degrees characterized by pronounced varicose veins and testicular shrinkage, which may change its consistency.

Of course, many young people are interested in why such a “misfortune” happened to him, which can force him to “go under the surgeon’s knife,” but the causes of varicocele are no different from those of other types:

1. The anatomical structure of the testicular vessels, genetically programmed;
2. Hereditary predisposition to varicose veins, which appear either in the father or in the mother at least for lower limbs, at least in another place;
3. Excessive physical activity(loads associated with strength sports, cycling and horse riding);
4. Thrombosis of the renal venous vessels.
5. Work that requires long periods of standing in an upright position.

The mechanism of occurrence of varicocele in men is also typical for other types of this pathology and consists in the failure of the venous valves, leading to stagnation of blood in the testicular veins, which, accumulating, dilates the vessel, which contributes to the development of testicular varicocele.

“Dangerous” age and upcoming surgery

The pathological process usually prefers left side, however, it can be bilateral or chooses the localization site on the right. The disease begins early or may even be congenital, due to the characteristics anatomical structure testicular vessels, but in children, as a rule, it does not manifest itself, unless its presence may be indicated by Blue colour left scrotum ( due to the peculiarities of the venous outflow structure, more than 95% of cases occur on the left side).

Asymmetry circulatory system explains why varicocele often occurs on the left. (The vein of the right testicle directly flows into the inferior vena cava, the vein of the left testicle into the left renal vein)

With the onset of rapid growth and puberty, the frequency of varicocele increases, and in adolescents it can not only manifest itself, but also be diagnosed to a certain extent. A pathology discovered during any examination often leads to shock not so much because of its presence, but because of the impossibility of treating varicocele with any method other than surgery. Although, it should be noted that surgery is far away not always mandatory.

Many young men live a long time with a disease that is asymptomatic, have children and do not worry about anything, and by the age of 40 it sometimes goes away on its own. In most cases, this is precisely the variant that is characteristic of varicocele.

Some men, to avoid intervention, carry out treatment of varicocele without surgery by wearing a special device for the scrotum, which raises the testicle and is called jockstrap. They say that a jockstrap is very helpful for those who want to engage in cycling and horse riding, but signs of varicose veins are an obstacle to their favorite activities. And others even use the “testicle pouch” solely for the purpose of prevention.

The disease, however, does not occur in the same way for everyone and does not always have only favorable prognosis in terms of conservation reproductive function. It is known that varicose veins of the testicle may cause to his atrophy as a result of sclerotic changes and ischemia, which will inevitably entail spermatogenesis disorder with a sad result called male infertility. Varicocele can lead to the fact that the testicle, where the sperm develops, finds itself in an unfavorable environment, which has completely unsuitable conditions for the full development of germ cells.

In cases where the pathology requires surgical intervention, no pills or lotions will help. In such a situation, you should not hope for luck, but should, after weighing all the pros and cons, choose the most optimal method of surgical treatment, because nowadays surgery for varicocele is a common occurrence and has several varieties.

Patient's right to choose

In addition to the choice of surgical method, the question of the average cost of surgical intervention for varicocele also often worries both the patient himself and his parents, if he has not yet reached the age to make independent decisions. Go to government medical institution for two weeks and make do with little material costs? Or contact to a commercial clinic, spend five days in comfortable conditions with food and return home without varicocele, having paid for everything about everything thousand 100 Russian rubles?

However, this is an average price, where each method has its own cost, so you can think and decide, and first get acquainted with the main characteristics of the proposed surgical interventions.

Operation Ivanissevich

Ivanissevich’s operation is the “oldest”, tested many times, they say it is not 100% effective, but at a price that is approximately 30 thousand rubles, is the most accessible. The essence of the intervention is to ligate and remove damaged veins and stop the reverse flow of blood, which is carried out under local anesthesia or under general anesthesia. Surgery is performed using open access.

Ivansevich's operation - ligation of the spermatic veins above the level of the testicles

The downside of the operation is the likelihood of relapse and the continued risk of accidental ligation of the testicular artery, which will subsequently lead to impaired spermatogenesis. Obviously, in fact, there is no special accident here, there is only the unprofessionalism of the surgeon and poor quality as a result, so you shouldn’t be especially afraid of it, the main thing is to choose the right doctor and clinic;

Marmara method

Microsurgical operation using the Marmara method is currently one of the most popular and preferred, since does not require penetration into the abdominal cavity, is low-traumatic, practically does not cause cosmetic defects, complications and relapses. Its cost starts from 35-40 thousand rubles, if the intervention is unilateral, but when operations are performed on both sides, they are considered independent of each other and assessed in 70-120 thousand rubles;

Laparoscopic varicocelectomy

Laparoscopic varicocelectomy is considered the most effective and only method in case of bilateral dilatation of the veins of the spermatic cord. The next day after surgery, the patient can go home and begin business as usual and concerns, the rehabilitation period is quick and easy, cosmetic defect absent.

The operation is carried out by puncturing the front abdominal wall under general anesthesia, and the surgeon monitors the progress of the operation using optical equipment in real time on a monitor. The laparoscopic method practically does not cause relapses and reduces the risk of ligation of the testicular artery to zero. The indication for endoscopic intervention is the presence severe pain in the scrotum, manifestation of relapse, infertility, elimination of a cosmetic defect, a combination of several clinical signs of varicocele. The average cost of such an operation is approximately 50 thousand rubles.

Alternatives

Embolization of the spermatic cord refers to endovascular manipulations and is considered almost non-surgical methods that do not involve incisions, sutures and general anesthesia, the patient after the procedure does not even spend the night in the hospital, but goes home, where he spares himself for several days, avoiding physical activity. However, the price of such “light” intervention is the same as with normal operation and depends on the clinic, region and doctor’s qualifications.

Photo: embolization for varicocele. The embolic coil stops blood flow through the affected vein.

Taking into account the doctor's opinion

Is it worth going for surgery if the symptoms of varicocele are not severe enough, or can you wait? How long will the wait be? What complications should I be wary of after surgery?

Although the patient participates in deciding the issue of surgical intervention, the last word should always remain with the specialist. As a rule, the doctor can objectively weigh all the pros and cons upcoming operation, Where expediency its implementation, taking into account all the pros and cons, comes first.

Surgical treatment methods are used if the following indications exist:

1. Feelings of discomfort and pain of any intensity, since even minor pain may indicate the formation of microthrombi and inflammation in the dilated vessels of the pampiniform plexus;
2. Infertility as a result of impaired spermatogenesis caused by varicose veins of the spermatic cord;
3. A cosmetic defect that constantly traumatizes a man’s psyche and, as a result, leads to a breakdown in sexual relations;
4. For the prevention of infertility in childhood and adolescence, although there is no consensus on this issue.

Many experts adhere to their point of view and argue that varicocele cannot cause infertility and justify surgical treatment only in cases of deterioration in sperm count. However, in some ways, clinicians are still unanimous: in the presence of both infertility and varicose veins of the pampiniform plexus, treatment of varicocele surgical method carried out unambiguously. And then you can look for another reason if the situation does not improve.

What else threatens varicocele?

In addition, you should always keep in mind possible complications and consequences of varicocele, which include:

• Hydrocele of the testicle(hydrocele), caused by the accumulation of fluid in the scrotum as a result of impaired lymphatic drainage. This complication most often occurs after the Ivanissevich operation and is associated with ligation of the lymphatic vessels simultaneously with the testicular vein. If hydrocele occurs, the patient is prescribed a puncture or a repeat operation;

• Relapse of the disease is more possible with open access and occurs due to the continued flow of blood through the internal spermatic vein (incomplete cessation). When treating relapses, sclerotherapy is usually used;
• Testicular atrophy- a complication that is as rare as it is serious, that is, such a pathology is characterized by the fact that ultimately the testicle, decreasing in size, loses its main function, which can hardly please young man who wants to have children;
• Postoperative illness, when the epididymis becomes overfilled with blood. Such troubles occur more often after laparoscopic surgery;
• spermatic cord or perforation of the vascular wall;
• Allergic reactions to contrast agent, characteristic of embolization.

Obviously, the Marmara operation is the safest and least traumatic, which, moreover, can be performed under local anesthesia and eliminates Negative influence general anesthesia.

Video: a specialist’s opinion on varicocele

The last stage of preparation for surgery

When choosing a surgical intervention, the patient’s age, the presence of concomitant diseases, especially during operations requiring general anesthesia, which in itself has contraindications and, of course, severity pathological process. The presence of purulent and inflammatory foci, regardless of their location, is a direct contraindication to any surgical intervention! Diseases of the gastrointestinal tract are also among the primary contraindications for surgical treatment of varicocele.

Before surgery, the patient undergoes a mandatory examination in such cases, which includes:

• General blood and urine analysis;
• Biochemical studies of blood serum (glucose, urea, creatinine, enzymes, bilirubin);
• ELISA-HIV and syphilis;
• Prothrombin index, coagulability and duration of bleeding;
• Group affiliation according to the AB0 and Rhesus systems;
• Electrocardiogram;
• Fluorography.

What and when you can eat and drink, how to cleanse the intestines and prepare psychologically - these questions seem insignificant only at first glance. During surgery, every little detail is important, and therefore the patient, having entered the surgical department, the day before must be under the “vigilant eye” and constant supervision of medical workers and believe that everything will be fine for him.

Video: presentation on the treatment of varicocele

Prevention of relapse

Operations to remove varicose veins of the pampiniform plexus are not classified as complex and difficult, therefore the hospital stay is short and the recovery period after surgery usually lasts no more than two to three months, during which the patient is freed from physical activity. In addition, he is strongly recommended to abstain from sex for 3 weeks, since the patient, having heard a lot of unsubstantiated allegations about decreased erection, wants to quickly be convinced of the opposite. Before discharge, the doctor usually emphasizes Special attention on such questions and patiently explains to the patient that surgical treatment of testicular varicocele does not affect “male abilities.” But then, after a period of abstinence, regular sex can become the best prevention varicocele in men.

It is known that the work of the digestive tract greatly affects the vessels of the testicle, where constipation is the worst enemy of the veins, causing stagnation in them, therefore special attention should be paid to the regulation of these processes. Besides overweight will only get in the way, which means complete diet with a predominance of vegetables and fruits will be just right.

Until it comes to active activities sports, the patient should not forget about the positive impact of good healthy sleep, which usually occurs after evening walks. And it is not only possible, but also necessary, to engage in sports, of course, after a three-month break, but preference should be given to swimming and athletics, but it is advisable to hide the mountain bike away. And it’s better not to sit on a horse.

The most important point preventive measures, which is mentioned at every doctor’s visit: bad habits must be eradicated once and for all! Every minute the patient is instructed to remember that nicotine is especially harmful cardiovascular system in general, and venous vessels pampiniform plexus, in particular.

For those who do not recognize surgery

Treatment of varicocele without surgery consists of using medicinal properties plants that nature gave and studied by our ancestors. After all, there were times when the current abundance of pharmaceutical drugs did not exist, and surgery was not at such a high level. Varicocele is not only a privilege modern man, the disease most likely originated with humans, so the treatment of such pathology with folk remedies was certainly reflected in the recipes of herbalists.

Infusions from a mixture of chamomile flowers, chestnut, rue, willow bark, raspberry root and yarrow leaves are not only drunk 150 grams in the morning and evening, but also applied as compresses to the sore spot.

It is believed that Antonov apples help with varicocele.

Techniques that are especially popular in the treatment of testicular varicose veins are: joint application infusions or decoctions of willow, oak and chestnut branches.

How and how to treat varicocele is up to the patient, but it is undesirable to let the disease progress, if it exists. Another question is, if there are no signs of varicocele, then, as people say, “you don’t have to worry too much,” because this disease can only be treated when it manifests itself, and even then, mainly surgically. However, for men with a hereditary predisposition, prevention still won’t hurt, and folk remedies will help you solve the problem.

Video: varicocele in the “Health” program

Surgery to remove varicocele is indicated for varicose veins veins of the spermatic cord, as this is the most important cause of infertility in men. Therefore, surgical treatment must be carried out at the very beginning of the formation of a testicular tumor.

Indications for surgical treatment

Due to the expansion of the veins, the normal blood supply to the testicular tissues and the process of thermoregulation are disrupted. The number of sperm decreases and they become less mobile. In most cases it is affected left-hand side, although sometimes bilateral pathology occurs.

Varicocele can be congenital and usually begins very early, but does not manifest itself in childhood. First Clinical signs begin to occur as the child grows older (in adolescence).

The course of the disease in a teenager may be asymptomatic, so the indications for surgical removal of varicocele may be the data obtained as a result of the Valsalva maneuver, ultrasound examination or palpation of the pampiniform plexus. The effectiveness of treatment depends entirely on the degree of the disease and the chosen technique. If necessary, the patient is prescribed.

Surgery to remove varicocele is needed if the following symptoms are present in a teenager or adult man:

• pain in the groin;
• feeling of discomfort;
• swelling;
• testicular swelling.

The technique of surgical manipulation depends on the size of the testicle and the age of the patient. Before starting treatment, it is necessary to prepare for testicular surgery for varicocele in order to avoid serious complications and consequences.

Advice: The earlier the disease is detected, the sooner treatment will begin and the risk of developing serious complications will decrease. Therefore, when the slightest sign or concerns, you should consult a doctor.

Preparing for surgery

Preparation for surgery begins with laboratory examination patient. It is needed to exclude certain diseases: chronic diseases, lung pathologies, problems with the gastrointestinal tract. All this can affect the course of the operation and the patient’s condition.

First of all, you need to take a general urine and blood test, blood test for creatinine, Rh factor and group. An analysis for the prothrombin index and an electrocardiogram is also prescribed. The doctor is obliged to familiarize the patient with information about how long the operation will take and the methodology for carrying it out.

Before performing surgery to remove varicocele, it is necessary to establish the main cause that causes blood stagnation in the testicle. Also, depending on this, the type of operation is selected that will help preserve the man’s ability to fertilize. Immediately before surgery, the hair growing in the area of ​​the surgical field is shaved.

Types of operations

Today, there are different types of testicular surgery to remove varicocele. Among them are the most important:

• Marmara operation for varicocele;
• laparoscopic varicocelectomy;
• laser surgery;
• Ivanissevich operation.

The Marmara microsurgical operation is the best method for replacing a diseased testicular vein with a healthy vein. To do this, doctors provide themselves with mini-access to the required area of ​​the body, without penetrating the abdominal cavity. The microsurgical technique is considered the least traumatic among all other techniques, since it almost never causes the appearance of cosmetic skin defects.

Also, microsurgery has the lowest risk of relapse and serious complications. Its advantages include a quick recovery period and low invasiveness.

Microsurgical manipulation does not require mandatory hospitalization of the patient in a hospital and can even be performed on an outpatient basis. The preparatory period is standard, as for all other surgical interventions.

Progress of Operation Marmara

The patient is given an anesthetic injection, which has an anesthetic effect. The anesthesiologist decides how much anesthetic to administer based on the patient’s total weight and age. Next, the surgeon makes a small incision in groin area no more than 2-3 cm. After the swollen vein is found, it is bandaged, stitched and crossed. This helps normalize blood flow and relieve negative symptoms varicocele.

During microsurgery, Marmara may occur in rare cases. accidental damage nerve ending in the groin or bleeding. The recovery period is only 3 days, and the stitches are removed already 8-10 days after they are applied. The only disadvantages of this technique include the high cost, because special tools and expensive optics are used.

During the postoperative period, it is recommended to avoid severe physical activity and sudden movements. You cannot have sex for one month and you must protect the incision area from friction. Underwear should be natural and not tight.

After three months, you should take a spermogram in order to assess the ability of sperm to fertilize. Six months after treatment, you can return to your normal lifestyle.

Advice: The doctor must decide which types of surgical interventions to prefer from all available ones, taking into account the patient’s age and individual problem.

Progress of Ivanissevich's operation

This type of treatment for testicular varicocele is considered cheaper. The essence of the method is to cut and bandage left vein in the testicle. This helps eliminate the main negative factor that causes backflow of blood into the plexus of the testes.

During the Ivanissevich operation, the lumen of the varicose vein is completely closed under local anesthesia for adults. For children, surgery is usually performed under general anesthesia. It takes about 30 minutes.

Postoperative period in this case, it is longer, and the risk of complications is quite high. During all manipulations, the femoral artery and other anatomical formations in the inguinal canal may be damaged. In addition, the disadvantages include complete dissection of the abdominal wall and penetration into the abdominal cavity. The patient will be unable to work for several months. There remains a chance of relapse, which is about 40%. The advantages of Ivanissevich’s operation include the absence of the need to use special equipment and the ability to perform it for everyone.

Laparoscopic surgery

The most non-invasive operation is considered to be laparoscopic, which occurs with minimal trauma to the patient. In this regard, it carries a lower risk of complications than other types of surgical interventions, which often cause bleeding or the formation of infiltrates. After using the laparoscopic technique, the patient does not receive a cosmetic defect, since the seam remains almost invisible.

Endoscopic varicocelectomy is performed in cases where the patient has bilateral dilatation of the veins of the spermatic cord. Incisions are made in the navel, left and right iliac region. Their size very often does not exceed 1 cm. Endoscopic devices, instruments and an endoscopic television camera pass through them. Therefore, the doctor can monitor the progress of the operation and, if necessary, adjust his actions.

Disadvantages include the high cost of the operation and the need for general anesthesia. The postoperative period usually takes about 3 days, after which the patient is discharged. The doctor tells him when he needs to come to have the stitches removed, how many days it will take to complete the stitches, etc.

Laser surgery

Laser treatment of varicocele is one of the most modern methods solutions to this problem. To do this, there is no need to make an incision in the groin area, and all manipulations are performed using an intravascular endoscope. Fiber optics helps to find the exact area of ​​vessel dilation and coagulate it under the action of a laser beam. After this, it is switched off from the general bloodstream.

The advantages of this type of intervention include the absence of the need for anesthesia and a quick rehabilitation period. You can also highlight the minimal risk of complications or serious consequences. Operations for varicocele have significant differences from operations for or. Only a doctor can answer the question of how long the rehabilitation period will take and what the cost of surgery to restore the testicle will be.

Contraindications

Not all patients can undergo surgical treatment of the testicle, as there are certain contraindications. Laparoscopic surgery cannot be performed if the patient has already undergone such an intervention earlier or if he has a malignant tumor. Microsurgical surgery should not be performed if the patient has diabetes or severe cardiovascular pathologies.

Before undergoing surgery to remove testicular varicocele, the patient must undergo a thorough examination so that the doctor identifies the exact cause of the disease. After this, it will be possible to select the optimal type of surgical intervention, taking into account the individual pathology, the patient’s age and his financial capabilities.

Video

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult your doctor!

13.09.2017

Varicocele is a male disease in which the veins in the spermatic duct dilate. The pathology begins in adolescence and may not manifest itself throughout life. Signs that may indicate a disease are lumps on the scrotum, pain in the groin.

The danger of the disease is infertility, so it is advisable to cure it. If nothing bothers the person, the doctor may decideis surgery neededin this case, but you can get rid of the pathology surgically. The intervention is well tolerated, and complications are rare.

Indications and contraindications for surgery

When planning an operation, the doctor takes into account the man’s health status, his age and desire to have children. To choose a treatment method, it is important to determine the stagetesticular varicocele. There are 4 of them, each stage has its own symptoms:

1. Enlarged veins can be detected by ultrasound.
2. If the man is standing, the doctor may feel the veins in the pampiniform plexus.
3. In any position of the patient, the doctor can palpate the deformed veins.
4. Swollen vessels are visible to the naked eye.

The earlier it is carried outsurgical treatment of varicocele, the greater the chance of maintaining the ability to conceive; infertility threatens last stage diseases.

The operation is prescribed according to indications:

• the process of sperm formation is disrupted - examination indicates that there are few sperm in the seminal fluid, they move poorly. There is blood/pus in the fluid;
• appearance of the scrotum (tubercles and swollen veins) does not suit the patient;
• worries pain syndrome. Pain begins from stage 2-3 of the disease. During the resting stage, the pain is insignificant and increases with walking and physical activity;
• testicular size decreases.

If there are no symptoms or indications, some doctors consider surgery necessary as a way to avoid infertility. If nothing worries you, you can not have surgery, but limit yourself to observation by a doctor so as not to miss the deterioration of the condition.

The operation is performed upon reaching 18 years of age. Statistics confirm that relapses do not often occur in adulthood.

If the patient is diagnosed with a secondary one, developing due to a cyst, tumor or other formation, then the disease must be eliminated, and then thesurgical treatment of varicocele.

In addition to indications for surgical intervention There are a number of contraindications. For example, open operations are not performed if:

• ailments in the stage of decompensation (diabetes, cirrhosis);
• inflammatory processes in the acute stage.

A contraindication to endoscopic intervention is a history of abdominal surgery.

There are a number of contraindications for surgical intervention

Sclerosis is not performed if:

• large anastomoses between vessels, due to which the adhesive substance can get into healthy arteries and veins;
• increased pressure in adjacent veins;
• crumbly nature of the veins, which does not allow the use of a probe.

Preparation for varicocele surgery

No matter which one you choosetechniquesurgery, the patient must be prepared for surgery. 10 days before the scheduled day, diagnostics are needed:

• TAM and blood (for coagulation, group, sugar and general);
• fluoroscopy of the lungs;
• ECG;
• tested for hepatitis and HIV.

Before the operation, the patient must undergo tests

In addition to the above studies, you need to undergo an ultrasound scan of the scrotum with contrast so that the doctor has the full picture vascular condition. If necessary, other studies are prescribed.

On the day of surgery, you cannot drink or eat in the morning; the patient takes a shower. The abdomen and pubis should be shaved. If the patient is taking medications for chronic diseases, he should tell the doctor about it. There is no need to worry, if the patient needs it, the surgeon will tell youhow is the operation performed?what he will do and why,how long does the operation take?and rehabilitation period.

Varicocele surgery options

Distinguish different methods carrying out operations, the classification of which is based on the technique and method of access to the veins. If we consider technology, there are operations with excision and with preservation of the caval bridge (shunt). This shunt is a bridge between two testicular veins. Because of it, the blood stagnates.

The type of operation is chosen depending on the form of the disease

Another classification is based onHow is varicocele surgery performed?(what access). Based on this, three types of intervention are distinguished:

• endovascular sclerotherapy;
• laparoscopic intervention;
• open treatment optionVaricocele, types of operations- Palomo, Marmar or Ivanissevich method.

During the operation, veins are not removed - the vessels remain in place. The affected veins are either ligated or glued together (sclerosed).

Endovascular sclerotherapy

This type of intervention is considered minimally invasive. The essence of the method is gluing dilated vessels. Hospitalization is not required; the procedure is performed in an angiography room under local anesthesia. As soon as the anesthesia takes effect, the doctor makes a puncture in the wall of the vein on the right thigh, inserts a probe to assess the condition of the blood vessels and deliver a special substance to the site of the vein lesion.

Endovascular sclerotherapy can only be performed on initial stages diseases

A 3% thrombovar solution is used as a special substance that can glue blood vessels together. After sclerosis, contrast is injected into the vessels and it is observed whether the diseased area of ​​the vein is visualized. If not visualized, thensurgery to remove varicocelewas successful. At this stage, the probe is removed and a bandage is applied to the puncture.

On the day of the operation, the man is discharged home and given recommendations. Sclerotherapy is carried out in the initial stages of the disease, when there are no obvious symptoms.

Laparoscopy

Passes under the general or local anesthesia. The second option is often used. After anesthesia, the surgeon makes a puncture in the navel area and inserts a trocar through it - a needle with a tube. Abdomen is filled with gas so that nothing interferes with the doctor’s manipulations. A tube with a camera and light is placed into an opening in the peritoneum to monitor the progress of the operation.

Laparoscopy is one of the methods of combating varicocele

The surgeon makes 2 punctures in the peritoneum and inserts instruments. It is necessary to isolate the lymphatic vessels and arteries so as not to damage them as a result of the procedure. The affected varicocele veins are ligated, then the instruments are removed, and the punctures in the peritoneum are sutured or sealed.

If surgery to remove varicocele on the testiclewas carried out under local anesthesia, the man can be discharged home on the same day or the next. After applying general anesthesia, you are discharged after 3-7 days. The success of the operation is assessed using ultrasound.

Operation Marmara

It is a microsurgical intervention with a low degree of invasiveness. The progress of the operation is monitored using a microscope. Suchvaricocele surgerydoes not require general anesthesia, but if the patient insists, general anesthesia may be used.

Operation Marmara
can be performed under local anesthesia

The patient may experience a feeling of warmth and slight tingling. During the procedure, the surgeon makes a small incision above the pubis, reaches the spermatic canal and ligates the damaged vein. Then a seam is made, which will be almost invisible over time; after a week you need to come back to remove the threads.

Ivanissevich and Palomo method

Both elimination methodsvaricocele in menpractically no different. The Ivanissevich procedure is performed under both local and general anesthesia. The essence of the procedure comes down to ligation of dilated veins. The surgeon makes a 6-10 cm long incision above the pubis, spreads the muscles to the plexus of the testicle, and separates the lymphatic vessels. Then it grabs and ligates the affected varicocele veins. The final stage of the operation is suturing the muscles and tissues.

The method for eliminating varicocele by Ivanissevich and Palomo is very similar to each other

During an operation using the Palomo method, the essence of the actions is the same, but the incision is made higher, so the surgeon receives great review. As a result, the likelihood of relapses is reduced, but the risk of damaging the artery that supplies blood to the seminal canal increases. This blood vessel is located next to the pampiniform plexus and is therefore damaged.

Forecast

After surgery, patients recover quickly. With minimally invasive operations, the possibility of relapse is reduced to 2% of cases, with the Ivanissevich technique - to 9%.

In 45% of cases, after the operation, the spermogram is normalized, and in 90% of cases its indicators improve. In older patients age group indicators are worse, which is due to age-related changes body.

Rehabilitation after varicocele surgery

After any type of surgery, the patient will have a recovery period. To normalize spermatogenesis, the following is prescribed:

• Dietary supplement with zinc and selenium;
• vitamins;
• hormonal drugs short courses under the supervision of a doctor;
• antibiotic ointments for treating postoperative wounds;
• painkillers.

• On days 1 and 2 after surgery, keep the wound dry. You can apply ice to plastic bottle to relieve pain;
• rest more, do not exercise physically;
• wear a testicular support bandage;
• within 2 weeks after the operation you should not overwork and take a bath or have sex.

When the recovery period is over, the doctor determines the possibility of returning to sexual activity. So that a man does not experience pain and pulling sensations during and after sexual intercourse.

Some men believe that a vein remaining in the scrotum is a sign of unsuccessful surgery. Actually this is not true. The vessels are not removed from the scrotum, but blood circulation through them is stopped if they are damaged. A previously diseased vein may be noticeable and palpable for about 6 months.

Complications

After the operation, a complication arises; no one is immune from this. And although the risk is not that great, you need to know what you can expect after the intervention. The doctor will inform you about this, but the complications are:

• inflammatory process. It is characterized by a number of signs and is detected on a control ultrasound. Treated with medications;
• neuralgic pain. Occur if damaged nerve endings. Such pain is difficult to stop, but you can try. Physiotherapeutic procedures and acupuncture are prescribed;
• lymphatic edema. Observed if damaged as a result of surgery lymphatic vessel. Treatment may include wearing compression garments;
• hydrocele. Dropsy occurs in the testicle due to damage lymph nodes. Treatment – ​​wearing a bandage;
• testicle reduction. This is a complication, the reason lies in damage to the spermatic artery, this situation is difficult to stop;
• . Treated surgically;
• damage to the urinary tract or intestines. This development of events occurs in inexperienced surgeons;
• blockage of deep veins. happens due to a reaction to contrast or internal hemorrhage in the puncture area.

Varicocele can leave a serious mark on a man’s health and lead to complications.

To summarize the above, it should be noted that varicocele is a pathology that can lead to serious health problems. The main consequences of varicocele are impotence, infertility, and cancer.

You should not self-medicate, as this will worsen the course of the disease. As soon as the first signs of varicocele appear, you should immediately make an appointment with a doctor.