1) Definition of varicocele
A varicocele is an abnormal stretching and twisting of the venous network (vein) above the testicles.
Its prevalence is rare under the age of 10, but it is 15% in young men and 20-40% in infertile men. For those who are secondary infertile, i.e. not already having a child, the prevalence is as high as 70%.
90% of cases are on the left side, and in 10% of cases they are bilateral. The reason for this phenomenon is the length of the vein that empties blood from the left testicle into the renal vein, as well as the more vertical angle than the right side. By reading the following article, learn about the procedure, methods, complications, and everything related to varicocele surgery in Iran, Shiraz, Tehran, and Mashhad.
The reason for their creation is a violation of venous drainage or failure of the venous valves of the testicles.
There are different theories about the mechanism of testicular damage, the most important of which are:
An increase in testicular temperature, a decrease in blood flow and oxygen supply, or the transport of substances and metabolites from the kidneys and adrenal glands to the testicles, or a combination thereof.
Varicoceles can reduce testicular growth and eventually shrink the testicle. Also, by affecting the sperm, it will reduce their motility and number and change their morphology (appearance). Varicocele does not directly affect sexual ability and does not cause premature ejaculation.
In a patient with infertility and varicocele, in addition to examination and history, there should be at least two or three semen tests to make a determination. Due to the sensitivity of the test, it must be performed in our reliable and advanced laboratory in Iran, which is specialized in this test.
Examination should be done manually and in the standing position first and then in the supine position to determine whether or not the varicocele would be significantly reduced by lying down, and if not, ultrasound of the abdomen and pelvis should be performed for further investigation. At the time of examination, the veins may be visible like a varicose vein, or they may be felt like a bag filled with cream, or they may be felt, indicating the severity of the varicocele.
In diagnosing varicocele, clinical examination is the first and last word, and ultrasound is used for cases where examination is difficult, such as obese patients or mild cases. Of course, a color Doppler or ultrasound may be used to confirm recurrence (return of blood to the testicles) after the operation.
Varicocele classification
- Grade 3: The veins appear when standing
- Grade 2: veins are visible while standing
- Grade 1: The veins can be felt when pressed
Subclinical varicocele: which cannot be felt by examination, but is detected by ultrasound.
In which cases varicocele need treatment?
First of all, considering that many patients are anxious and anxious when diagnosing varicocele, I have to point out that varicocele is a benign disease, but there is no drug treatment, and the only treatment method is surgery, which will be explained later.
The decision to have the surgery depends on various factors, such as the severity of the varicocele, the patient’s age, and fertility status (marriage and having children or not). In cases where the patient has grade 2 or 3 varicocele and suffers from infertility, varicocele removal surgery is required. If the varicocele is related to a sperm test disorder, the operation should still be done (that said, there should be at least two or three sperm tests to make a decision).
Treatment of varicocele in Iran and the city of Shiraz by microscopic method
As mentioned, varicocele has no medical treatment and the only treatment method is surgery. Treatment methods are either surgical incisions or embolization (sending clots) through the skin.
- As mentioned, varicocele has no medical treatment and the only treatment method is surgery. Treatment methods are either surgical incisions or embolization (sending clots) through the skin.
- The method of inguinal surgery is almost the same as the first method, but it is performed without a microscope and therefore has more complications (9-16% recurrence and 3-39% hydrocele).
- The retroperitoneal surgical method, which is performed with an incision higher than the previous method. 11-15% recurrence and 7% hydrocele may occur.
- Laparoscopic surgery method, which is performed by making about three holes in the abdomen and sending gas into the abdomen to create enough space for the operation. However, in this method, there is a possibility of damage to the large vessels or intestines, bladder, etc. Although it is uncommon, it does exist. Hydrocele is 5-8% and its frequency is less than 2%, and there is potential for artery damage.
- Percutaneous embolization method, in which a blood clot, coil, or other synthetic and artificial material is sent into the veins locally through the veins on the side of the thigh. This method requires a radiologist skilled in this field and sophisticated equipment. The frequency is 4 to 11%. This method is recommended in cases where the varicocele recurs more than twice.
Care before and after varicocele surgery in Iran
After a decision is made about the operation, routine blood tests and sperm examination are performed, the hair in the operation area is shaved the night before or the morning of the operation. From 12 noon the night before the operation, the patient does not eat anything. The operation is performed with general anesthesia or anesthesia from the back (the spine) according to the patient’s condition and the anesthesiologist’s discretion. The duration of the operation depends on various factors and averages 30 to 40 minutes.
The patient will be discharged the same day or tomorrow morning and will have medical rest for at least 7 to 14 days. Preferably sexual intercourse from the seventh day onwards.
What is the home treatment for varicocele?
The home treatment options for varicocele from the point of view of our doctors in Iran are:
- There is no cure
If a varicocele does not cause fertility problems and does not bother you, you may not need treatment.
- Routine changes in life
For example, avoid certain activities that cause you pain and discomfort. Use tight-fitting underwear or a scrotum that can reduce symptoms from exercising or standing for long periods of time.
- Use Ice Pack
Placing an ice pack on the testicle can help reduce symptoms. To protect the testicular sac, do not apply ice directly to the testicular skin. Wrap the ice pack in a towel and apply it to the affected testicle for 15 minutes at a time.
- Pain relief
Over-the-counter medications such as acetaminophen or ibuprofen can relieve minor testicular pain.
For information and guidance, contact the experts of Ariana Medical Tourism in Iran on WhatsApp.
