Varicocele is a fairly common disease that develops from the insufficiency of the testicular vein. The disease manifests itself in the form of an expansion of the veins of the spermatic cord.
Approximately 20% of men suffer from this disease. In connection with the anatomical structure of the organ, the pathology is mainly formed on the left side. Right-sided varicose veins may indicate the presence of neoplasms in the right kidney. Varicocele disease code according to ICD-10 - I86.1
Surgery is often prescribed for treatment, as this is the best way to normalize sexual function and eliminate existing problems.
Causes of disease
There are several reasons for the appearance of varicocele, among which it is necessary to highlight such as:
- congenital features of venous outflow;
- pathologies that provoke stagnation of blood in the pelvic organs;
- irregular sexual relations;
- frequent constipation;
- problems with the lumbar spine.
In addition, such a violation can be provokedobesity and overweight. It is very important to know what a varicocele looks like and what are the signs of the disease in order to recognize its course in a timely manner and take appropriate measures.
Disease Manifestation
When varicocele is mainly observed pulling pain in the testicles in men, naturally, which occurs or increases in an upright position or during physical exertion. There may also be a decrease in the testicle on the side of the lesion. On palpation, there is an expansion of the veins in the scrotum.
Varicocele often develops in adolescents during puberty and is almost asymptomatic. In this case, the disease is detected quite by accident, during a medical examination. Over time, the pathological process progresses, which can lead to testicular atrophy and infertility.
When surgery is needed
Many are interested in what a varicocele is and when surgery is required. Intervention can be prescribed to a man at any age in order to fully preserve the possibility of fertilization. Operation is performed in case:
- testicular atrophy;
- bad sperm;
- pain in the groin;
- changes in testicular size.
If these signs are present, a surgical intervention is required, during which the patient is tied off the veins passing near the spermatic cord, which causes the blood to flow in a completely different direction.
There are several types of surgery for varicocele, each of whichhas its own specific features. Early detection of the problem is important to minimize the occurrence of complications.
Preparation for surgery
It is important to understand exactly what a varicocele is and how the disease is treated and what are the features of preparing for surgery. Preparation for the intervention begins with the examination of the patient. This is required to exclude some chronic pathologies, in particular, such as diseases of the gastrointestinal tract and lungs. All this can negatively affect the course of the operation and the patient's well-being.
Before the intervention, you need to stop the main cause that provokes stagnation of blood in the testicle. For each person, the main type of surgery for varicocele is selected separately, which will help to fully preserve the reproductive abilities of a man.
Initially, the doctor probes the patient's scrotum to determine the severity of the pathology. Then ultrasound diagnostics is required, which is combined with dopplerography. The examination of the patient is carried out in a standing and lying position with a change in blood flow in these positions.
Urine analysis before and after physical activity, X-ray methods of research, study of the hormonal profile and many other types of examination are also prescribed. Immediately before the operation to remove the varicocele, the hair that will interfere is shaved off. The doctor must notify the patient about how long the intervention will last and how exactly it is carried out.
On the day appointed for the operation, you needrefuse food and drink, take a shower. In the case of taking medications for chronic diseases, the treatment is agreed with the doctor.
Main types of surgery
Varicocele is a rather dangerous and complex problem that requires timely intervention in order to avoid various complications. There are several types of operations, among which it is necessary to highlight such as:
- Operation Marmara;
- Ivanissevich;
- Paolo;
- laparoscopy;
- laser treatment.
The best method is the Marmara operation, which involves replacing the affected vein with a he althy one. To do this, doctors provide access to the desired area of the body without an incision in the abdominal cavity. The microsurgical technique is the most gentle intervention option.
The type of surgery for varicocele is selected separately for each patient, depending on the characteristics of the course of the disease and the characteristics of well-being.
Operation Palomo
To determine the peculiarity of treatment and the duration of recovery, you need to know how the operation of a varicocele is performed using various techniques. The Palomo method is quite popular. It implies the execution of an incision affected by varicose veins. Manipulation is carried out over the inguinal canal. The doctor immediately gets full access to the affected area, bandages and removes the enlarged vein.
This will reduce the risk of injury to blood vessels and nerve endings. The operation is carried out underlocal or general anesthesia. After the intervention, a suture is applied and a sterile dressing is fixed. The man is discharged the next day, and the stitches are removed after 8-9 days.
Operation on Ivanissevich
During this type of intervention, the existing lumen of the dilated vein is completely closed, performed under local anesthesia. When varicocele in children, the operation is performed under general anesthesia. It takes 30 minutes in time. This type of treatment is considered more affordable. The essence of the technique is that the doctor cuts and bandages the left vein in the testicle. This helps eliminate the underlying trigger that causes backflow of blood into the testicular plexus.
Initially, the doctor makes an incision about 50 mm long in the region of the inguinal canal, parallel to its entrance. All tissue structures are gradually cut, including also the wall of the inguinal canal. It contains the spermatic cord, where dilated veins can be found.
A cord is pulled into the wound and an enlarged vessel is released. Then it is fixed and clamped in 2 places. The vessel is cut and ligatures are applied to the cut ends. They do the same with all the vessels that the doctor brings out. At the end of the operation, the wound is sutured layer by layer, and then a sterile dressing is applied.
In the case of Ivanissevich's operation for varicocele, the postoperative period is longer, and the risk of complications is high. When performing all manipulations, there may be damage to the femoral arteries and the development of many other formations in the inguinalchannel. In addition, the disadvantages of such an intervention include a complete dissection of the abdominal wall.
The doctor prescribes painkillers and antibacterial drugs to the patient, you also need to wear a support bandage to prevent stretching of the spermatic cord. The stitches are removed after about 9 days. Heavy physical activity should be avoided for 6 months.
This operation is very popular, as it is used for varicocele in children and adults. The intervention does not require the use of special equipment, so it is carried out in all hospitals. However, there are certain disadvantages of such a procedure, since there is a possibility of developing testicular dropsy, as well as recurrence of varicocele. Extremely rarely, testicular atrophy appears, which is one of the most dangerous complications of surgery for varicocele (ICD-10 code - I86.1, as mentioned above).
Operation Marmara
This is a modern, minimally traumatic and effective method of treatment. The technique of the Marmara operation for varicocele consists in microsurgical ligation of the testicular veins. This technique also contributes to the treatment of infertility. Among the main indications for such an operation is:
- varicocele grade 2-4;
- infertility due to dilated testicular veins;
- pain and heaviness in the affected area;
- testicular reduction;
- impaired spermatogenesis;
- presence of aesthetic defects in the scrotum.
The operation is performed under local anesthesia. For this, in the groin area is doneskin incision 2-3 cm. The spermatic cord is separated from adjacent tissues and removed into the incision. Then, with the help of special equipment, dilated veins are isolated and tied up. The spermatic cord is placed in its place, and the wound is sutured with a cosmetic suture. After complete healing, almost no traces remain.
Such an operation for varicocele is considered the most traumatic and safe method of treatment. Its duration is 30-40 minutes. Relapses after this method of therapy are quite rare.
In the postoperative period, significant physical exertion and sudden movements should be avoided. For 1 month after the operation, it is forbidden to have sex, and you also need to protect the incision area from friction. Underwear should be loose and natural.
After 3 months, you need to take a spermogram to assess the ability of sperm to fertilize. You can return to your usual lifestyle 6 months after the intervention.
Endoscopic surgery
This intervention is prescribed if the patient has bilateral varicose veins. It belongs to the most sparing technique among all non-invasive operations. Proceeds with minimal trauma to the patient.
With varicocele, laparoscopy is performed using an endoscope and has no significant differences from traditional intervention, except as a way to access an enlarged vessel. Among the main advantages, it is necessary to highlight such as:
- low trauma;
- low chance of relapse;
- good portability;
- high cosmetic effect.
Initially, the doctor makes an incision about 5 mm by 10 mm above the navel, into which he then inserts a special needle through which gas is supplied to straighten the space. Then the needle is removed, the incision is enlarged to about 10 mm, and a trocar is inserted into it, which is a wider needle with a tube. This is a very important tool required for endoscopy.
A chamber is inserted through the trocar, through which gas continues to flow into the abdominal cavity using a special device that additionally helps regulate gas pressure. Under the control of the telescope, 2 more holes are made. One of them is located to the side about 30 mm below the navel, and the second is slightly to the left and 20 mm below the navel. Trocars are also inserted into them for the introduction of the required instruments. Thus, the surgeon gradually gets to the area of the operation.
Dilated veins are exposed and fixed. They are clamped, cut and superimposed ligature sutures or clips. At the end of the operation, the abdominal cavity is sutured, and the instruments are removed. After removal of gas, trocars are pulled out. Stitches or plasters are applied to the hole, it all depends on their size.
Before excision of the veins, it is very important to separate them from the lymphatic vessels in order to prevent swelling of the scrotum. The patient should stay in the hospital for 1-2 days. After that he canreturn to normal life. In the postoperative period, the doctor may prescribe pain medication.
Laparoscopic surgery is prohibited if the patient has acute inflammatory processes or malignant tumors of the abdominal cavity.
Laser treatment
Laser surgery is a modern, less complicated technique that is performed without additional incisions in the groin area. It is performed using an intravascular endoscope. Thanks to a miniature camera, it is possible to quickly detect the area of localization of the affected vessel, which is then cauterized under the influence of a laser beam and no longer participates in the general blood flow. When conducting treatment with this method, you can not use anesthesia.
One of the advantages of laser therapy is a quick recovery period. In addition, the risk of complications or serious consequences can be minimized.
Endovascular embolization
Such an operation is carried out under visual control. To do this, a 2 mm thick intravascular endoscope is inserted through the femoral vein, which then advances to the testicular vein. She is then examined with a radiopaque agent.
Sclerosant is injected into the dilated part of the vein. This is a substance that embolizes the lumen of blood vessels. This method of treatment is performed without the use of anesthesia, refers to minimally invasive techniques, takes much less time, and also has virtually no relapses and consequences.
Contraindications for surgery
It is important to know how the operation is done for varicocele, as well as what are the contraindications for its implementation. In addition, a mandatory consultation with the attending doctor is required.
Different methods of the operation may have a variety of contraindications. Open interventions are not performed in the presence of diseases in the stage of decompensation, as well as in the presence of inflammation in the active stage.
Sclerotherapy is not performed if there are such contraindications as:
- large anastomoses between vessels;
- increased pressure in adjacent veins;
- the structure of the vessels makes it impossible to insert the probe.
Endoscopic operations, in addition, are also not carried out with previous interventions in the abdominal cavity. This is due to the likelihood of a violation of the clinical picture and medical errors.
Rehab
After the operation, sexual relations are possible only at the end of the rehabilitation period, taking into account the characteristics of each person and the type of operation. In terms of time, this time is approximately 3 weeks. After the operation, the libido remains at the same level.
To restore spermatogenesis in a man after surgery, the following can be prescribed:
- zinc-based supplements;
- antibacterial ointments;
- vitamin complexes;
- hormonal drugs;
- painkillers.
After the operation, you need as little as possiblemove and rest more, do not wet the wound, so it is forbidden to take a bath for two weeks. For severe pain, ice can be applied. For the first few days, a bandage is required to help hold the testicles.
Possible Complications
The operation can cause a variety of complications, which should include such as:
- drawing pain in the testicles in men due to injury to the nerve endings;
- disease recurrence;
- vein thrombosis;
- inflammation;
- testicular size reduction.
Due to the inexperience of the doctor, there may be damage to the intestines and ureter. If the lymphatic vessels are injured, there may be swelling of the scrotum.
How does it affect military service
Many believe that varicocele and the army are incompatible concepts, but this is absolutely not the case. A conscript with such a pathology may well be admitted to military service by decision of the doctor. You need to come to the military registration and enlistment office with documents confirming the presence of the disease. In addition, a full medical examination is prescribed to determine the course of the disease and correctly diagnose.
Varicocele and the army are quite compatible concepts, however, it all depends on the stage of the disease. At the first stage, the conscript is allowed to military service, and at the 2nd stage, an operation is required and a delay of at least 6 months is given.
In the case of stage 3-4, everything depends on the characteristics of the course of the disease, as well as the success of the intervention. With a positive outcome and after full recovery, the conscript can be re-call for service. The duration of the delay depends on many different factors, which is why the doctor decides.
Varicocele is a dangerous disease that can lead to dangerous consequences, in particular, such as infertility, cancer, impotence. It is not recommended to self-medicate. That is why, at the first signs of illness, you need to consult a doctor.
