Varicocele, one of the main reasons for male infertility, is the transformation of the veins in the testicle into a varicocele structure. This damage to the vein structure causes problems, such as irregular temperature, toxin accumulation in the testicles, and testicle blood flow disorders. Thus, sperm and testosterone production is disrupted. Varicocele, which is likened to a varicose vein in the testicles, occurs in 1 out of every 5 adult men, and 40% of men with male infertility have varicocele. Varicocele is progressive and may damage testicular development and lower a man’s chances of having a child. Varicocele surgery (microsurgical varicocelectomy) is used to eliminate these risks.
What is Varicocele? Why does This Happen?
Varicocele is the swelling and expansion of the veins in the scrotum on the testicles. Varicocele is a type of vascular disorder that can occur beginning in adolescence. This is the most common male infertility problem and is especially prevalent among young men. While almost half of all men who want to have children have varicocele, 40% of men who cannot have their second child, which is referred to as secondary infertility, experience this problem. Varicocele often occurs on the left testicle and is detected as a pipe-like venous structure. Treatment isn’t necessary if there are no complaints. The answer to why varicocele happens is not clear. The most common reason for this is the perpendicular angle between the vein of the left testicle and the kidney veins.
What are the Symptoms of Varicocele?
Varicocele, which is a leading reason for male infertility, does not exhibit many symptoms other than a visual change in the veins. It is often found with tests and examinations after infertility complaints. The symptoms rarely appear as pain. When instances of pain do occur, this pain can have a wide spectrum. Pain might increase while standing or exercising, and pain can be mild to severe. Advanced varicocele is identified with a worm-like look outside the testicles. The left testicle might be swollen. It is important to talk to a urologist and andrologist about suspected varicocele when there are swollen testicles, pain, a mass, changes in testicle size, or problems with having a child. These symptoms might signal diseases other than varicocele that need emergency interventions.
How is Varicocele Treated?
The best method for diagnosing varicocele in men is a physical examination. Varicocele is evaluated with 3 grades.
- Grade 1: This is the mildest form of varicocele. This grade is identified during pushing when standing or coughing.
- Grade 2: These varicocele cases are identified with a physical examination.
- Grade 3: This is the advanced stage, and varicocele is visible when standing.
The difference between testicle size and shape is considered after grading. Spermiogram (semen analysis) is performed to determine its effect on the sperm count and quality. If there is a problem with sperm values, surgical treatment can be recommended.
If sperm values are normal, a supporting treatment and antioxidant agents can be applied. However, lifestyle changes do not work for patients diagnosed with varicocele and sperm parameter disorders. The only solution for these patients is a surgical operation.
What is Varicocele Surgery (Microsurgical Varicocelectomy)?
Varicocele surgery is performed to correct the increased blood flow from the expanded testicle to normal levels. This operation, called varicocelectomy, is performed by clamping or closing the expanded veins. The success rate of microsurgical varicocelectomy is high, as it is performed by making a small incision from the groin area to reach the problematic testicle vein. Since the surgery is performed using a microscope, the veins can be clearly found, and the arteries and lymph nodes are not damaged.
Microsurgical varicocelectomy enables the surgeon to reach all problematic veins, and relapse can be decreased to 1%. This surgery provides a 60–80% correction for sperm values and increases the chances of pregnancy. The complication risk is almost zero. However, surgery must be performed by a specialist.
How is the Surgery Performed?
Varicocele disease, which is one of the main causes of male infertility, can be completely corrected with microsurgical varicocelectomy. This operation is performed as an open surgery under general or local anesthesia. In this operation, the urologist/andrologist will reach the problematic vein in an inguinal or subinguinal way.
Sometimes, an incision can be made to the abdomen. The surgical microscope is inserted from these small incisions, and the problematic veins are clamped or tied with the help of the microscope. This operation will guide blood flow from problematic veins to normal veins.
Thus, healthy blood flow will be restored. The surgeon who performs varicocele surgery must be trained in the microsurgery field and have experience. An incorrect operation might lead to complications that can cause organ loss.
Who can Undergo Varicocele Surgery?
Not all varicocele patients require surgery. Although varicocele is detected with Doppler ultrasound, it must also be visible during the physical examination. The best candidates for microsurgical varicocelectomy are as follows:
- Patients with damaged sperm parameters,
- Men with secondary infertility problems and varicocele diagnoses,
- Patients with a difference of at least 2 cc between the right and left testicles,
- Patients with a vein diameter above 3 mm during colored Doppler ultrasound,
- Patients with soft testicles.
The best benefits of microsurgical varicocelectomy are yielded for the following:
- Grades 2 and 3 varicocele,
- Patients without any genetic test problems,
- Patients with 5 million or more sperm,
- Patients consulted for male infertility,
- Patients without molecular disorders,
- Patients with a normal testicle size,
- Patients with normal testosterone, FSH, and blood values and low inhibin B values.
Process After Varicocele Surgery
Patients can go back to their daily routine after resting for 1 day following the varicocele operation.
The pain is mild but can last for a couple of days or a week. Patients might need to use painkillers after the operation. Patients must avoid sexual intercourse for 2 weeks and heavy work or exercise for 4 weeks. Patients who have undergone microsurgical varicocelectomy must have regular doctor’s examinations. Semen analysis is recommended once every year for adolescents and once every 3 months for adult males until there is pregnancy.
Even if a natural pregnancy does not occur after the operation, the operation will contribute to increasing the chances of insemination and in vitro fertilization-assisted reproductive techniques. However, the best effects can be seen after 9 months since sperm production takes time. Up to 60% recovery for sperm parameters has been detected after microsurgery varicocelectomy.
Varicocele Surgery Price
Varicocele, which causes infertility, leads to severe pelvic pain and decreases testosterone levels. Furthermore, testicle shrinking can cause dissatisfaction among couples by threatening the quality of sexual life. One of the most frequently asked questions by men who think they are suitable for microsurgical varicocelectomy is the price of varicocele surgery. The hospital selected for the operation, the team, which testicle has the problem, the method, and the tests before the operation can differ, and it is not possible to give an exact price for varicocele surgery.
