Treatment of varicocele abroad
Varicocele is a disease manifested by abnormal veins of the botryoidal plexus. This is the most common cause of male infertility. This pathology occurs among 4-8% of men, most of whom, approx 80%, do not have any complaints. Most often, varicocele is diagnosed between the ages of 15 and 25 years of age.
The disease requires surgical treatment, the aim of which in most cases is to maintain or restore male reproductive function.
Causes of Varicocele
Varicocele develops because of the backflow of the blood from the reinal vein into the cluster-shaped plexus via the testicular vein.
There are primary and secondary forms of varicocele. Primary varicocele develops due to congenital absence of the valves in the testicular vein. Secondary occurs due to increased pressure in the renal vein. This results in damage to the valve apparatus of the testicular vein.
Causes of secondary varicocele forms are:
- Congenital anomaly of the left renal vein structure
- Nephroptosis (abnormal kidney mobility)
- An increased pressure in the pelvis (varicocele most often occurs among those who are often engaged in physical labor)
- Compression (squeezing) of the left renal vein by the tumour or the aorta (when aneurysm occurs)
The primary form of varicocele is much more common. It only affects the left testicle. For the secondary form, the expansion of the veins on both the left and right is characteristic.
Varicocele - Symptoms
The main symptom of varicocele is visually or sensory obvious veins expansion in the cluster-shaped plexus. Stages of the disease are:
- Stage 1 – the expansion can be detected when touched
- Stage 2 – veins expansion is observed visually
- Stage 3 – the expanded veins go lower than a testicle
Other symptoms, noticed only among certain patients:
Pain in the scrotum is noted among 35% of patients. It may occur or be aggravated during physical activity
Complaints on drawing pain in the lower back or groin are placed by 20% ??of patients
Blood in urine. Gross hematuria (urine pink color) or microscopic hematuria (red blood cells in the urine detected at microscopies) is observed among 10% of patients
Effects on the reproductive function
40% of patients with infertility show signs of varicocele of different degrees of severity. This is the most common cause of impaired fertility among males up to 50 years.
Factors that contribute to infertility together with varicocele are:
Constant overheating of the scrotum. Testicles are located outside the pelvic cavity, precisely because the sperm need to mature at a temperature lower than the body temperature. As a result of violation of spermatogenesis semen quality is deteriorating: amount of ejaculate is reduced, sperm concentration and motility.
Violation of the blood-testis barrier provokes immunological infertility. As a result of sperm antigens occurrence in the bloodstream the sperm antibodies begin to form and destroy or immobilize male sex cells.
Testicular atrophy appears when the testicles are significantly reduced in size. This deteriorates the quality of sperm, which becomes unsuitable for fertilization. Hormones levels can be violated: testosterone and gonadotropins levels are changing (FSH).
Varicocele - Diagnostics
In most cases it is possible to establish the diagnosis with a physical examination. Varicose veins of the cluster-shaped plexus are easily palpated. The easiest way to identify them is an upright position of the patient and while straining (pelvic muscle tension). In the horizontal position the veins can become invisible if varicocele is of mild severity.
Instrumental and laboratory methods can be used for diagnostics:
Selective phleborenotesticulography, tonometry, duplex scanning. The retroperitoneal vessels are examined and their diameter is determined. With this, the blood flow velocity is estimated, pressure in the left renal vein (normally it does not reach 10 mm Hg) is also measured. Instrumental diagnostics is necessary to determine the stage of severity of a varicocele as well as its cause.
Semen analysis and MAR-test are used to assess men's reproductive function. Quality and quantity of semen are defined. MAR-test is carried out in the framework of extended semen analysis. It is aimed at the diagnosis of immunological infertility. This diagnosis is when a large number of sperm antibodies are attached to sperm.
Treatment of Varicocele abroad
Varicocele can only be treated with the help of surgery. Indications that require surgery are:
- Pain in the scrotum worsening the male’s life quality
- Testicle atrophy
- Infertility, if future kids are planned
Several groups of surgeries are used to restore the normal blood flow:
Excision or ligation (ligation) of vessels of the testicle. Both open and laparoscopic surgery can be applied here.
Endovascular interventions. Operations are conducted with access through the blood vessels under the X-ray control. The goal of surgery is the occlusion (blockage) of a blood vessel with the cessation of blood flow through it.
Different types of the operations are used:
- Transfemoral retrograde sclerotherapy is conducted when a substance damaging the endothelium is introduced inside the vessel. As a result, vessel walls fuse together and the blood flow through it ceases.
- Embolization of different kinds - balloon, spirals, combined.
- Occlusion with the help of physical methods - electrocautery (burning), the use of hot contrast fluid.
Creation of vascular anastomoses is conducted with the use of microsurgical interventions aimed at creating additional artificial venous outflow tract from the testicle.
Choice of surgery is based on the characteristics of the disease, and economic feasibility.
When left-sided varicocele has to be treated (most cases) endovascular techniques are usually used because they are inexpensive, less invasive and do not require long-term rehabilitation.
When right-sided varicocele has to be treated, open surgery is normally conducted, as in this case, the normal process of blood flow recovery is more difficult.
Laparoscopic intervention is the most expensive technique, so it is mainly used for the two-sided varicocele treatment. Microsurgical procedures for the formation of vascular anastomosis are normally used for severe hypertension in renal vein (with secondary varicocele) treatment.
Varicocele - Prognosis
Prognosis for the fertility in the case of timely surgical treatment is favourable. Most patients regain the fertility after 6-12 months, if there is no other infertility factor, in addition to a varicocele.
Adverse prognostic factors:
- Long duration of varicocele
- The presence of multiple trunks of the spermatic vein
- Testicular atrophy
- Development of immunological infertility
If the natural fertility is not restored within 12 months after surgery, the patient has to use additional treatment methods or overcome infertility by assisted reproductive technologies (artificial insemination or IVF intrauterine).