Surgery to treat varicocele. Varicocele - causes, symptoms, diagnosis

On this moment This surgical intervention is considered one of the most worst options treatment, since it is almost 40%. And also possible various complications, up to infertility (with bilateral varicocele).

How is such an operation performed? A fairly large incision is made in iliac region, after which all damaged ovarian veins are ligated. This is the main drawback of the operation.

With such an incision and in such an area, the surgeon does not have full access to the venous ligament, so it is almost impossible to ligate absolutely all deformed and damaged veins (their branches).

Therefore, the tendency to relapse remains. The result directly depends on the stage of the disease at which the patient sought qualified medical help.

Operation Palomo It is carried out in a similar way, only the incision is made above the frontal region, under the peritoneum. In this case, there is no need to ligate each branch of the ovarian vein - the entire ligament is blocked with one tie.

The likelihood of relapse remains(since the clamps for blood vessels can stretch over time), but significantly lower than when operating using the Ivanissevich method. Today, Palomo surgery is performed quite rarely due to the complexity of its execution.

Still partially violated hormonal background, production decreases. All this adds up to reduce his attraction to women. And some men also develop complexes against the background of all this.

Who decides what operation will be performed on the patient? Of course, the decision is up to the patient himself, but it should be understood that public clinics Only the Ivanissevich operation is performed free of charge.

For more modern and optimal treatment methods you will have to pay a certain amount of money. Even better is to contact private clinics without wasting time. It will cost more, but the man’s reproductive function after the operation will not be impaired in any way.

Is it possible to perform an operation under the compulsory medical insurance policy?

The compulsory medical insurance policy includes wide range carried out free transactions, however, only using the Ivanissevich method and laparoscopy (punctures in the peritoneum).

That is, the compulsory health insurance policy covers only the most radical methods treatment of varicocele. This is only suitable in cases where the patient no longer plans to have children in the future or if varicose veins are one-sided.

Does the patient experience pain during the procedure?

Operations to eliminate varicocele are performed under local anesthesia, since there is no need for general anesthesia. And the doctor needs to monitor the patient’s condition during the procedure. Does he feel something during the process? surgical intervention?

The most painful part is making the initial incision or puncture. But the operation is carried out quickly enough, so no complications can arise after this. The main thing is to follow the rules for processing the seam in order to prevent infection, otherwise the incision will have to be opened again.

But the place where the operation was performed will hurt after the anesthesia stops working. And even then, the patient can be discharged from the hospital the very next day.

Longer rehabilitation and hospital stay will be required only if the surgical intervention was performed according to Ivanissevich, or the patient has the following complications:

increased body temperature;
signs infectious infection seam;
decreased hemoglobin;
recurrence of varicocele.

How to process a seam?

Treatment postoperative suture involves mandatory dressings 2 times a day.

First of all, it is treated with a solution of furatsilin for disinfection, then Levomekol ointment is applied to it. From above, everything is covered with cotton wool and wrapped with a bandage.

After 3-5 days, instead of Levomekol, any wound healing ointment, which also contributes to tissue scarring.

On average, suture treatment is carried out approximately 7-10 days after surgery, after which the sutures or staples are removed (depending on the treatment method used).

On days 5-6, a second examination is carried out by the attending physician (surgeon). If necessary, the doctor will prescribe additional procedures for seam processing.

Rehabilitation period

Complete rehabilitation takes 3 weeks (21 days) from the date of surgery. If a person is engaged by force sports, then you can restore your shape only after 30 days, starting with minimal loads.

If an operation was performed according to Ivanissevich or Palomo, then rehabilitation there lasts absolutely until the suture heals.

It should be noted that healing of blood vessels occurs much faster than that of the epithelium. That is, when the seam has already disappeared, the veins are guaranteed to restore nominal blood flow. After all this, it is recommended to take blood tests to determine the concentration of hormones - this way the functioning of the testicles and prostate gland is monitored.

The shortest rehabilitation period is introduced during endoscopy or microsurgery. There, there will be no need for suture treatment (after the operation, only an ice pack is applied in order to prevent swelling of the soft tissues and bleeding).

Physical activity is allowed from day 12, but you should rely on the assurances of your doctor.

In summary, varicocele is best treated with surgery. Moreover, the operation should be performed in the early stages of detection of the disease. Optimal method– This is microsurgery followed by suturing of the vein. After such an operation, the functions of the testicle are completely restored, as is the reproductive function of the man (but only if there was no atrophy before). But the Ivanissevich operation should be abandoned. It has not been performed in most countries of the world for a long time due to its high morbidity and likelihood of relapse.

Varicocele can only be treated with one of the following existing techniques surgical intervention. The widespread belief that the disease can be cured at home is unfounded. Recommendations for wearing tight underwear, reducing physical activity and taking medicines may help relieve some symptoms, but not cure the disease itself. Irreversible varicose veins spermatic cord can only be cured surgically. Delaying surgery can lead to infertility and others.

Do all patients with varicocele need surgery?

Infertility with impaired spermatogenesis (according to spermatogram results)
Appearance of pain
In case of relapse of the disease
To prevent the development of testicular hypotrophy or atrophy
Cosmetic defect (in in rare cases with pronounced varicocele).

The most common indication for surgery is infertility (about 40% of men diagnosed with infertility suffer from varicocele). In this case, surgical intervention is prescribed regardless of the degree of development of venous vessel disease. To avoid the development of this problem, treatment is sometimes carried out in adolescence.

The operation to remove the dilated veins of the spermatic cord is classified as simple and safe. However, in Lately Many doctors are increasingly inclined to the prematureness of such prevention and believe that after making a diagnosis, it is quite enough to visit a urologist once every six months to monitor the progression of the disease. In case of rapid development of varicocele, deterioration of the spermatogram and the appearance pain symptoms, the doctor will prescribe surgical treatment.

Pain syndrome indicates the beginning of possible inflammatory processes and the appearance of microthrombi. The degree of development of varicoceles can influence their intensity and overall discomfort.

What types of surgical techniques are used in treatment?

The operation is performed to intersect the dilated venous vessels that are involved in the reverse outflow of blood. Recently, they have been mainly used the following techniques for the treatment of varicocele:

Traditional open access method (Ivanissevich and Palomo method)

The Ivanissevich operation is generally accepted effective method treatment at any stage of varicocele and involves ligation of the affected testicular veins at the level of the retroperitoneum. During the operation, the surgeon makes a small incision (4-5 centimeters) in the left iliac region and ligates the diseased vessels.

The Palomo method is essentially identical operative technique Ivanissevich. The difference between them lies in the choice of the location of the incision, which in Palomo is located higher.

Microsurgical method (Marmara)

The Marmara technique involves a small incision in the skin (about 2-3 centimeters) at the exit site of the spermatic cord. The intervention is carried out using special instruments and a microscope, which allows for more precise bandaging without touching the nearby artery, nerves and lymphatic vessels. Doctors give this technique the most positive reviews, since its injury rate and relapse rate are the lowest.

Endoscopic method (laparoscopic)

This method is applicable at any stage of the disease. The treatment is based on eliminating the problem by blocking the flow of blood through the veins of the testicle. Three punctures are made on the skin (in the navel and in the right and left iliac fossa) to insert a video camera and necessary tools. This allows you to examine the entire vein under magnification (6-10 times), highlight the affected areas, apply titanium brackets to its branches and intersect the vessels.

Embolization

A method such as embolization is based on the introduction of a substance or coil into the affected vein, which clogs its lumen. The procedure is performed through a puncture in the femoral vein on the right side, where a 1 mm thick catheter is placed, going to the left renal vein.

Sclerotherapy

The method involves injecting a sclerosant substance into the testicular vein, which blocks the lumen of the vessel and prevents the outflow of blood to the testicle. This treatment method is often prescribed to patients with somatic diseases or in cases where other methods are not applicable. A catheter is inserted through a small incision and the vessels are examined using a radiopaque contrast agent. Based on the obtained image, a sclerosant is injected into the affected areas, which seals the lumen of the vein.

Comparative analysis of treatment methods

Below is a summary of the details and details that most concern patients and help determine the strengths and side aspects proposed treatments:

Type and name of operation	Operation duration	Advantages of the method	Disadvantages and possible complications	Success of the method
Open access (according to Ivanissevich and Palomo)	20-40 minutes	Simple and fast operation, the most proven and inexpensive method treatment	Possibility of relapse (10-25%), hydrocele of the testicular membrane (7%), ligation of the testicular artery (50%), hospital (recovery 1-2 weeks)	50-75%
Microsurgical method (Marmara)	40 minutes	High level of safety, does not require hospitalization (2-3 days), lowest relapse rate (0.5-1%), no complications	Longer intervention and higher cost	95-98%
Endoscopic	40-60 minutes	Minimal trauma, preservation of the testicular artery, prevention of testicular atrophy, fast recovery(1-2 days)	Possibility of relapse (5-15%) due to the inaccessibility of some veins with this method, hydrocele of the testicles (10%) and other possible complications	85-90%
Embolization	60 minutes	No incision, preservation of the testicular artery, prevention of testicular atrophy, rapid recovery (1 day)	Possibility of recurrence (10-15% for unilateral and 30-49% for bilateral varicocele), possible damage to the testicular vein and the development of thrombosis	60-80%
Sclerotherapy	60 minutes	Does not require hospitalization	Possibility of relapse (10%), anatomical features vessels	80%

Possible complications after surgery

Consequences associated with surgical intervention, are directly related to the chosen treatment method. Modern methods Elimination of varicose veins makes it possible to reduce their manifestation to a minimum, but the patient is still not completely protected from them.

The most common post-operative problems include:

Lymphostasis

Bandaging and damage lymphatic vessels lead to swelling of the scrotum and painful sensations in this zone, which take place over two weeks. A special bandage allows you to quickly reduce swelling.

Postoperative pain

Pain after surgery usually goes away quickly. About 3-5% of patients may suffer from long-term pain in the testicular area, which appear over a long period of time (even several years).

Testicular hypotrophy or atrophy

This is one of the most complex and rare (about 1% of patients) complications, which can occur due to unintentional ligation of the spermatic artery and lead to a decrease in the volume of the testicle and even its atrophy. This problem eliminated by microsurgical intervention.

Hydrocele

Hydrocele of the testicle occurs in 0.5-9% of men who have undergone surgery, and most often manifests itself 6 months or 2 years after treatment. The main cause of the problem is the intersection lymph nodes. As a result, fluid begins to accumulate in the membranes of the testicle. A hydrocele usually goes away on its own over time.

Possibility of recurrence of varicocele

Recurrence of the disease is possible if outflow remains in the testicular vein venous blood, the outflow of blood was not completely stopped or additional venous vessels developed.

Percent secondary occurrence Varicocele directly depends on the treatment method and averages 10-40%. It is believed that the chance of relapse becomes higher if surgery to remove varicocele was performed in early childhood. Considering that the effectiveness of treatment decreases as the disease progresses, the patient should be regularly examined by a doctor. This approach will help you choose optimal time for surgical intervention.

Prevention of relapse is possible at the stage of examination before surgery and the choice of a treatment method that allows a detailed examination of the lumen of the vein.

Varicose veins of the spermatic cord and testicle today considered one of the most common male diseases . According to WHO statistics, this disease is diagnosed in more than 16% of the male population.

In 2% of cases, right- or bilateral varicocele occurs, in 98% - left-sided.

The degrees of varicocele vary depending on the intensity of the venous dilation.

Subclinical varicocele: testicular veins are not detected by palpation; varicocele can only be detected based on ultrasound results.

1st degree: dilated veins can be felt with your hands only in a standing position.
Grade 2: varicocele can be easily detected by palpation in any position of the body.
Grade 3: a visual examination is sufficient to identify dilated veins.

In most cases, varicocele rapidly progresses and, having reached any specific stage, stops developing.

Varicocele of subclinical and first stages does not require treatment. For elimination negative phenomena it is enough to eliminate stagnant processes localized in the pelvic organs.

The list of such measures includes giving up alcohol, normalizing bowel movements, regular sex life, and balanced physical stress.

Such elementary actions can reduce dilated veins and prevent the disease from progressing.

Elderly people whose disease has frozen for early stage Wearing a jockstrap will be helpful.

During the second degree of varicocele, if the disease is characterized by pain, surgery is necessary.

An inevitable measure is surgery for third-degree varicocele. Now we have dealt with the question of whether surgery is necessary for varicocele and at what stages it should be done.

Varicocele may lead to other, more unpleasant problems such as infertility.

This is exactly the diagnosis in 40% of men suffering from. The fact is that dilated veins contribute to increased temperature in the scrotum, and this leads to disturbances in the morphology, motility of sperm and their number.

Surgery for varicocele: types, types, methods, methods (how is it done?)

The essence of all types of operations is the elimination of the affected areas of the veins. The operations differ in the method of execution, degree of injury, effectiveness and possible complications.

Traditional Operations

There are 3 types of traditional surgical intervention- By Ivanissevich, Marmar and Palomo.

Operation Ivanissevich

This operating technique is one of the very first developments to eliminate varicocele. Today she recognized as one of the most ineffective, because the relapse rate reached 40%.

Surgery in progress under local anesthesia. An incision up to 5 cm long is made in the left part of the iliac region. In depth, the incision reaches the walls of the inguinal canal, in which the veins and spermatic cord pass. The identified veins are crossed and the wound is sutured.

The purpose of the operation is to ligate absolutely all veins in one procedure. There is a high degree of risk that one or more blood vessels will be missed, which may lead to re-development diseases.

The likelihood that the testicular artery will be ligated by mistake depends on the level of skill of the operating doctor and the quality of his work, and this can lead to disruption of spermatogenesis.

The operation to remove testicular varicocele according to Ivanissevich is recognized as the most traumatic, The recovery period after it can be about 3 weeks.

Operation Marmara

Among surgical operations recognized as the most effective. During the operation, the veins of the spermatic cord are ligated through the inguinal approach.

The operation has a number of advantages:

minimal invasiveness, since the length of the incision is 2-3 cm, it can be compared with laparoscopic;
postoperative recovery in a short time;
minimal number of repeated manifestations of the disease and complications;
high cosmetic effect. The seam (scar) after such an operation is small and located lower than the level of wearing underwear.

During surgery The testicular artery is localized first, followed by sequential localization of all large and small veins of the spermatic cord.

After the operation, the patient will need to spend time in the clinic for day hospital about 4-7 hours. After this time, he can be sent home under the supervision of relatives.

Operation Palomo

This procedure is an improved version of the Ivanissevich operation. The difference is that the incision site is located higher than in the first case. The vein is ligated in the retroperitoneal tissue.

Laparoscopic surgery (endoscopic)

Minimally invasive and modern method treatment.

During surgery in the anterior abdominal wall punctures with a diameter of up to 5 mm are made, into which instruments and a laparoscope will subsequently be inserted.

During laparoscopic surgery for varicocele, the veins and artery of the testicle are isolated, and titanium staples are applied to the former or they are tied with a surgical thread.

Conduct this operation under general anesthesia . What’s remarkable is that she surgery to remove varicocele can last about 15-40 minutes. The duration of the operation may vary.

So, the later the stage of the disease, the less time will be spent on the operation due to the fact that the varicocele is already pronounced by this time.

During the operation, based on the image provided by the laparoscope, the doctor locates and crosses the testicular vein. After this operation, the patient must spend a maximum of two days in the clinic. For now laparoscopy is considered the most effective method of treating varicocele, since the devices allow you to examine the entire length of the testicular vein.

Laparoscopic surgery to remove varicocele is also good because it allows for simultaneous surgery on bilateral varicocele. The probability of relapse after endoscopic surgery does not exceed 2%.

Microsurgical revascularization

The result of this operation is normalization of blood flow in the testicular vein. Surgery is performed using general anesthesia.

An incision is made in the lower abdomen (5 cm), the testicular vein is brought into the wound along its entire length from the place where it enters the renal vein to the testicle. In parallel, a section of the epigastric vein is isolated. The testicular vein is completely removed and the epigastric vein is sutured in its place.

Counts physiological operation , since blood circulation in the scrotum can be restored immediately after the operation, which reduces the risk of complications.

X-ray endovascular surgery

Surgery is performed under X-ray control.

By puncture in the femoral vein, a catheter is inserted into the body, delivering a sclerosing drug into the testicular vein, which occludes the testicular vein.

One of the least efficient operations- after it there is a big one huge probability manifestations of relapse.

For men who have undergone surgery to remove varicoceles, You will need to abstain from sexual intercourse for three weeks. For some time after varicocele surgery, during sex painful or discomfort .

Preferably within the next month after traditional surgery to remove varicocele avoid physical activity and sports. After endovascular or endoscopic surgery, you will be able to start physical activity much earlier.

In general, the first few postoperative days the patient must wear a suspensor, which is a special bandage for the scrotum, designed to reduce the tension of the tissues of the spermatic cord and scrotum.

Surgery for varicocele is performed with equal success at any age, both in children, especially in adolescence, and in adults, but the recommended age is at least 9 years.

If the operation is performed immediately after detection, the man’s reproductive function will be preserved. This suggests that a man who has undergone surgery to remove a varicocele remains fertile. The presence of this disease in many cases is precisely the temporary reason that a couple cannot have children.

In later stages, varicocele exists high probability development of infertility and erectile dysfunction.

As for nutrition, it is advisable for all the time rehabilitation period After surgery to remove varicocele, follow a gentle diet.

3 months after the operation it is necessary to do an analysis - a spermogram. If the test results are bad, treatment by an andrologist is prescribed for recovery. reproductive function after surgery to remove varicocele.

Postoperative period: how to rehabilitate and what may be the consequences (complications) after the operation?

The question is, what can and should be done after the operation? If a man has undergone surgery to remove varicocele, then after that Various complications may occur, and the most common is hydrocele. In this case, serous fluid accumulates between each of the testicular membranes.

The occurrence of dropsy is facilitated by impaired blood circulation in the testicle caused by surgery. After some time in the men's reproductive system A venous collateral drainage is formed, allowing blood to flow out through other veins of the scrotum.

Complications may arise if in the first weeks after surgery you show sexual activity . Until the rehabilitation process is completed after a varicocele cured by surgery, you should refrain from having sex with your partner and masturbation - these are the restrictions.

Also there is a possibility of relapse even if all rehabilitation rules are followed. The main cause of relapse is a pampiniform vein or branch missed by the surgeon. In addition, after unsuccessful operation possible damage iliac artery, infectious process in the wound, bleeding, hypertrophy, atrophy or azoospermia of the testicle.

In some cases, it is possible to repeat operations to remove varicoceles several times until the damaged veins are completely ligated.

After varicocele surgery Pain in the testicles may occur, but in 90% of cases it passes quickly. If the pain does not stop, you should consult your doctor.

Varicocele in men does not pose a threat to the patient's life, but it affects fertility and contributes to the development of infertility. If surgery is performed on time, testicular varicocele can be cured and dire consequences can be avoided. Moreover, surgery for varicocele is the only truly effective way get rid of the consequences of the disease.

The essence of all operations for varicocele is to exclude varicose veins of the pampiniform plexus from the bloodstream. Varicocele surgery can now be performed different ways. This and classic options Ivanissevich and Marmara, endoscopic operations, innovative intravascular methods, as well as microsurgical methods and mini-interventions.

Is surgery necessary for varicocele in a teenager?

If a varicocele is detected in a child before or during puberty, it is recommended that he postpone surgery until he is 18 years old.

This is due to the fact that early surgery The varicocele is removed, but after this, complications are possible in the form of dysfunction of the immature testicles. It should be remembered that the consequences of surgical treatment are irreversible, while varicocele itself in the first stages causes reversible changes in testicular function. Also, with early surgery, there is a high probability of relapse of the disease. For the period before surgery, the patient is prescribed maintenance drug therapy.

Is surgery necessary for varicocele?

If a young man wants to preserve or restore his fertilizing function, then surgical treatment is indispensable. The operation may not be performed if the problem of paternity is not relevant for the man at the moment and in the future.

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Indications and preparation for varicocele surgery

Timely operation of testicular varicocele helps eliminate negative conditions for sperm maturation. It is carried out in a surgical clinic. Depending on the method of surgical intervention chosen by the doctor, it can be performed either under general anesthesia or local anesthesia.

With varicocele, the indications for surgery are reduced to the presence of varicocele, which is accompanied by impaired spermatogenesis function, nagging pain in the groin area and along the spermatic cord, either during sports and heavy lifting, or constant, as well as enlargement of the scrotum. These signs correspond to degrees 1 and 2 of the disease. The operation can also be performed up to 18 years of age, if there is initial signs testicular atrophy.

An indication for surgery is also a recurrence of varicocele after a previous operation.

For varicocele, which surgery is better?

The volume and tactics of surgical intervention are determined only by the doctor, taking into account general condition patient, condition venous system testicle and the severity of the lesion, as well as taking into account the capabilities of the clinic.

Contraindications to surgery may include: serious condition patient, accompanying pathologies, blood clotting disorder. There are restrictions if the patient has diabetes, since this sharply reduces the healing of the postoperative wound.

Also, surgery to remove varicocele should be advisable. If there are signs of testicular atrophy, when fertility is irreversibly impaired, surgery, unfortunately, will no longer be able to help restore the function of spermatogenesis.

Before the operation, the cause of congestion in the veins of the testicle must be clearly identified, and its primary nature must be proven.

Types of varicocele operations: Ivanisevich, Marmara, Paloma, laser and endoscopic surgery

For varicocele, the types of operations are currently quite widely represented. This traditional operations with direct access, laparoscopic interventions, microsurgical and innovative methods.

The most common Ivanissevich operation for varicocele involves ligation of the mouth of the testicular vein through direct access to the groin area. In this case, a longitudinal oblique incision is made in the groin area, the venous inguinal plexus is isolated.

The operation is performed under local anesthesia, but in case childhood or for other conditions, general anesthesia is possible. The mouth of the dilated testicular vein is ligated and then divided. After this, the wound is sutured in layers, followed by skin sutures.

There is a high risk of damage during Ivanissevich surgery femoral artery, as well as others anatomical formations, part of the neurovascular bundle passing in the inguinal canal.

Operation Palomo

The Palomo operation for varicocele also involves cutting the varicose testicular vein, but unlike the Ivanissevich operation, with this technique the incision is made above the inguinal canal, which significantly reduces the risk of damage to the neurovascular bundle. Just like the Ivanissevich operation, it can be performed under local or general anesthesia.

In both cases, a sterile dressing. The patient is discharged on the second day, and the sutures are removed on days 8-9.

Surgery using the Palomo method differs from surgery using the Ivanissevich method in that the incision is made above the inguinal canal. After cutting the tissue, the surgeon gains access to the testicular vein, after which it is ligated and removed. According to the Palomo method, one operates under both local and general anesthesia.

note

Varicocele surgery under local anesthesia is preferable to surgery under general anesthesia because it avoids the complications of general anesthesia, which is especially important for patients who have contraindications to intravenous or endotracheal anesthesia.

Operation Marmara

The Marmara microsurgical operation is also based on ligation of the testicular vein.

With this method, an incision is made along the outer edge of the inguinal canal, below the level of wearing underwear, where the testicular vein lies under the skin. The incision itself is less than 2 cm in length.

If Marmara surgery was performed for varicocele, reviews from doctors indicate a low number of postoperative complications.

Moreover, the relapse rate has been proven to be lower than in the case of the Ivanissevich and Palomo operation.

Endoscopic surgery

Endoscopic surgery for varicocele allows you to treat it without incisions in the area inguinal fold. This modern technique takes advantage of the laparoscopy technique.

It is carried out using a special long instrument - an endoscope, or laparoscope, which has an optical unit and mini-instruments at its free end.

Through a small incision it is inserted into the abdominal cavity, its intra-abdominal end is brought to the mouth of the testicular vein, then it is clipped using a titanium clip and crossed.

It is worth noting

Its peculiarity is the presence of three postoperative scars in the navel area, since endoscopic surgery requires three small incisions, but they are no more than 1 cm.

Endoscopic operations are associated with less tissue trauma; postoperative scars after them heal quite quickly due to their small size.

This type of operation is not performed under local anesthesia, since the abdominal cavity is involved, and is only possible under general anesthesia, intravenous or endotracheal. Laparoscopic surgery is excellent for treating bilateral lesions because it allows both testicular veins to be divided without additional incisions.

Laser surgery

With varicocele laser surgery, or laser ablation, is performed using modern technologies without an incision in the groin area.

The intervention is performed using an intravascular endoscope. With help fiber optics there is a place where the vessel dilates, which is then coagulated from the inside using laser beam and are removed from the bloodstream. This efficient look interventions can be performed without anesthesia.

Endovascular embolization

There is also endovascular embolization of the testicular vein, when, under X-ray control, a thin intravascular endoscope up to 2 mm thick is inserted and passed through the femoral vein into the testicular vein. Next, the veins are examined using an X-ray contrast agent, and then a sclerosant drug is injected into the lumen of the varicose veins, which embolizes and glues the lumens of the vessels. The operation is performed without anesthesia.

The advantages of intravascular operations are significant; they are minimally invasive, do not require anesthesia, and are also easier to tolerate by the patient. The number of complications and relapses after their implementation is significantly less.

During varicocele surgery, how long do you have to stay in the hospital?

If this is a Palomo, Ivanissevich or Marmara operation, then the hospital stay may take two days in the absence of complications. On day 8-9 you will need to see a surgeon to remove the stitches, and within a month after the operation, see a urologist. With intravascular intervention, the operation can be performed on an outpatient basis.

How long does varicocele surgery take?

Depending on the method and method of surgical intervention, it can last from several tens of minutes to several hours.

How to perform varicocele surgery: stages

When surgery is performed for varicocele, its progress greatly depends on the method of surgical intervention.

If this normal operation with an incision in the area of the inguinal fold, above or below, then the first stage of the operation is anesthesia.

Next, the surgeon dissects the tissue layer by layer and widens the incision in order to isolate the testicular vein, which he then ligates and crosses. Also, as part of the operation, if necessary, excision of varicose veins is performed through mini-incisions in the skin of the scrotum.
After the manipulations, the wound is sutured in layers, with sutures placed on the skin. A sterile bandage is applied to the surface of the wound.

In the case of endoscopic surgery, anesthesia is first performed.

After this, three small incisions, up to 1 cm, are made in the abdomen in the navel area, through one of them a special device is inserted, which pumps the abdominal cavity with a gas mixture.
Next, endoscopic instruments are inserted into the resulting cavity, they reach the mouth of the renal vein and clamp it with a special titanium clip. How varicocele surgery is performed is broadcast in real time on a special video screen.
Next, the instruments are removed, the gas mixture is removed through the incisions, and the incisions themselves are sutured.

In the case of intravascular surgery, anesthesia is not performed.

A puncture is made in the groin area, and a thin endoscope or catheter no more than 2 mm thick is inserted into the femoral vein.
Under visual or radiological control, it is carried out to the affected vessels, where the necessary manipulations of sclerosis, embolization or laser ablation are performed.
After performing the manipulations, the endoscope is removed and a pressure bandage is applied to the wound canal.

Is varicocele surgery dangerous?

There are several methods of performing operations on varicocele - from abdominal to microinvasive. The danger of each such operation depends on the professionalism of the doctors and the correctness of its implementation. If all proper manipulations are carried out clearly and harmoniously, such an operation is not more dangerous than any other surgical intervention.

The effectiveness of varicocele surgery and reviews

The effectiveness of varicocele surgery is quite high. Due to the exclusion of varicose veins from the bloodstream, their lumens collapse, and the local temperature normalizes. The outflow of blood occurs through venous collaterals, as a result of which it decreases toxic effects stagnation of blood, carbon dioxide is excreted. After some time, testicular function begins to recover, and conditions for spermatogenesis improve, as a result of which fertility is restored.

The operation performed for varicocele has different reviews, depending on the technique and the presence of complications. During operations with access to the inguinal canal, symptoms of lymphostasis, the development of hematoma, and testicular hydrocele are possible. As a rule, everything goes away within a month. The patient may complain of pain at the incision site, along the spermatic cord.

note

In most cases postoperative period runs smoothly total number Complications after surgery for varicocele do not exceed 10%. Postoperative scar if all rules of asepsis and antisepsis are observed, it heals primary intention within 2 weeks.

Intravascular operations have the least number of complications and do not leave a postoperative scar.

The varicocele scar in the area of the inguinal fold is a small light cord, from 5 to 2 cm, depending on what operation was performed. After laparoscopy, three pinpoint scars remain just below the navel.

Review of prices for varicocele operations in different cities

The cost of surgery to eliminate varicocele varies depending on the city, the level of the clinic, and the surgical method.

Prices for Ivanissevich's surgery in Moscow are on average at the level of 18,000 rubles. The Marmara operation will cost more, from 28 to 48,000 rubles for a unilateral lesion. An endoscopic surgical aid in Moscow costs an average of 44,000 rubles.

IN Novosibirsk Ivanissevich's operation costs 10,000 rubles, and Marmara's operation costs 18,000 rubles.

Prices in St. Petersburg for an Ivanissevich operation are in the range from 5 to 20 thousand rubles, and for an endoscopic operation at the level of 16-25,000 rubles, excluding anesthesia and hospital stay.

Is it painful to remove stitches after varicocele?

Hardly ever. Removal of sutures occurs quite quickly. There may be slight pain when hypersensitivity skin in the area of the inguinal fold.

Prices for Ivanissevich’s operation are distributed across Russian cities in the following way: Nizhny Novgorod - 6300 rubles, Saratov- 8000 rubles, Permian 6600 rubles, Tula,Odessa,Chelyabinsk,Ufa,Voronezh- from 5 to 8000 rubles. Endoscopic surgery in Thule costs 12,000 rubles.

Ivanissevich's operation Kyiv And Kharkov costs from 1,400 to 3,000 hryvnia, and embolization surgery costs from 3,000 to 5,000 hryvnia. Laser surgery in Dnepropetrovsk will cost 4500 hryvnia.

IN Novosibirsk Ivanissevich’s operation costs 10,000, and Marmara’s 18,000 rubles. Krasnodar provides these services at a price of 13,500 rubles.

IN Yekaterinburg the price of the Marmara operation is 18,500 rubles, and endoscopic surgery 20,000 rubles.

Marmara surgery cost in Odessa is 55,000 rubles including anesthesia.

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 a conservative method of getting rid of it, 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 this way only restores hormonal levels 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. Surgery in this case shown if available 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 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 of varicocele in men is carried out 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. An incision is made in the left side of the iliac region, its length reaches 5 cm. Next, all veins are crossed, and the wound is sutured. The disadvantage of this method is that there is a risk of missing blood vessels, because of which the disease will 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. On a positive note way 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 on the lower abdomen, then deletion in progress testicular vein, running 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. Probability repeated illness 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. To the benefits this method can be attributed to 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:

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 surgery.
The first 2-3 days require careful care of the wound, avoiding any moisture - it is important that it remains dry.
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.
After elimination, you need to protect yourself from physical activity and sports for about a month. After endoscopy, loads are resolved a little earlier.
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 increase fertility after removal of the varicocele.
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 of serous fluid in the testicles. This is facilitated by poor circulation which can be caused by varicocele surgery. There are cases when a series of operations are performed until all dilated veins are ligated. In men who have undergone this procedure, at first there are unpleasant sensations that quickly pass. 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, other associated factors, and is decided by the patient together with the attending physician. However, it has been proven that approximately half of the cases of varicocele, the treatment of which was carried out operationally gives good chances for conceiving children. Big percentage male infertility falls specifically on this disease. In addition, the sooner the operation is performed, the better the recovery process goes, and the faster reproductive function is restored.

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