Varicocele surgery. What operations are performed to eliminate varicocele, review of options and methods

Testicular varicocele surgery is simply necessary if the disease causes inconvenience and the course of the disease has grown beyond stage 1. The above-mentioned disease affects 20% of the population (male) and the “healing” of most people from this number directly depends on surgical intervention.

How is the operation to remove varicocele performed?

The most progressive technique is microsurgical infrainguinal tightening of testicular veins. When using this method through a cut in the skin (up to 3 centimeters long) dilated veins are “taken out” spermatic cord(below the inguinal canal).

Everything happens under the supervision of a microscope and with the help of microsurgical instruments: the swollen veins of the testicle are isolated and cut out. The surgical process ends with a suture. If the intervention was successful and the patient feels satisfactory, then after 2 hours he can leave the intensive care unit. There are rarely complications after varicocele surgery. It all depends on the individuality of the human body, the experience of doctors, and medical equipment. Sometimes dropsy develops. Very often, patients complain that “veins remain visible.” The right choice doctor will reduce the chances of getting disastrous consequences after treatment.

Today, microsurgical resection is the most common surgical method for getting rid of dilated veins of the scrotum. Pros: injury lymphatic vessels- minimal, the testicular artery remains preserved. The success rate of this method is 95%. This surgical intervention can be performed either under local anesthesia or general anesthesia.

For clarity, getting rid of the micro problem surgically Watch varicocele removal in the video below.

If you dig deep into what the “root of the problem” called varicocele always comes from, you will find out that this is a genetic predisposition. Risk factors for the disease also include: scrotal injuries, constipation, heavy lifting. If a disease is easy to develop, then often you need to resort to surgery to get rid of it. Among the operational methods (besides what is mentioned above), there are a number of other methods.

Endoscopic intervention is a common operation for bilateral varicoceles. This method is similar to traditional surgical removal. But there is a slight difference - this operation uses an endoscope, which makes it minimally invasive. The rehabilitation period is two days. During surgery, the doctor may examine the entire vein in the scrotum. For bilateral testicular disease, only this method is used.

The photo always shows what a varicocele looks like before and after endoscopic surgery. Previously, surgical intervention was mandatory to treat the disease. Today, surgical treatment of the disease in all countries is carried out less frequently (if the disease is advanced).

Important timely diagnosis vein diseases The method of performing the operation is prescribed only after ultrasound examination.

Embolization of varicocele

Percutaneous testicular vein embolization is not a common method. The essence of the method: selection (selection) of family veins occurs. cord, then they are clogged with a special medical device or with the help of sclerosing agent B modern medicine Spirals are mainly used (material - stainless steel or platinum), and the scelerotizing substance, in turn, is sodium sulfate / tetradecyl.

Surgical treatment Varicocele using this method is a simple procedure that can be performed under local anesthesia. It is performed in a supine position (in the angiography room, the genitals are not in danger of exposure to radiation, since they will be protected). The purpose of the operation is to deliver a “medicinal” substance to the diseased veins of the scrotum. To do this, access is gained through the “large” vein (femoral). Under ultrasound control, a conductor is inserted, which will move “under the supervision” of fluoroscopy. Next, it is moved to the desired location, the varicocele is punctured and embolized.

At the end of everything, the conductor is removed and bleeding is prevented. After a couple of hours, the patient can go home. However, lifting heavy objects is not recommended. It is worth noting that embolization of the disease is not very effective method, since cases of relapse occur in 20-30%. The main advantage of the above method is that the risk of hydrocele is minimal, the risk of disruption of the blood supply to the scrotum is also eliminated and the testicular artery remains intact.

Movement of the coil, thrombophlebitis (veins around the scrotum) are possible troubles after embolization. The percentage of complications is 5-11.

Embolization of varicocele is characterized by the low cost of surgical “assistance” and rapid recovery after it, but it is performed quite rarely and only in specialized clinics.

Video of varicocele surgery (method described above).

The most common method of combating the above-mentioned disease is the Ivanissevich method. The essence: there is an “overlapping” of the branches of the veins of the testicle just above the opening of the (internal) inguinal canal.

Surgery for varicocele in men using this method, according to statistics, has almost 25% of cases of relapse. The percentage of complications (for example, hydrocele) is 15. Therefore this technique used quite rarely.

Removal of varicocele. Video (method described above).

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. Surgical treatment in this case is indicated in the presence of 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 on the right side, or bilateral lesions are 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. The incision is made on the left side 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 carried out under general anesthesia.

Laparoscopic surgery. This method is modern, minimally invasive, and most effective in the treatment of varicocele. The probability of recurrence 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 the later stage of the disease will take less time, because varicocele grade 2 or 3 is more pronounced. The advantages of this method include surgery. After laparoscopy, the patient is required to stay in the hospital for about two days.

Endovascular embalization. The femoral vein is punctured, and a sclerosing substance is delivered using a catheter into the testicular vein, which stops the blood circulation of the vein. 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 must protect yourself from physical activity and exercise 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. Men who have undergone this procedure experience discomfort at first, which quickly passes. 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 a good chance of conceiving children. Big percentage Male infertility is due to this disease. In addition, the sooner the operation is performed, the better the recovery process goes, and the faster reproductive function is restored.

In contact with

There is an opinion that using conservative methods(drug treatment or folk remedies), you can cure the disease at home. But research and practice prove that this opinion is wrong. A complete recovery from the disease is possible only after using the varicocele surgery method.

All famous conservative methods(reducing physical activity, wearing special underwear, using medications) only alleviate or eliminate some symptoms of the disease, and prepare the patient for varicocele surgery.

It should be recalled that the expansion of the veins of the spermatic cord is an irreversible process. If prompt measures are not taken, the man may have severe consequences for the body, up to infertility.

Which varicocele surgery is better?

Urologists are trying to find a non-surgical solution to male ailments. In their opinion, visiting a urological office at least once a month helps monitor the development of the disease and its early diagnosis.

If, as a result of research, a deterioration in the spermogram is detected, and sharp pain appears in the area of the spermatic cord and testicle, doctors make an immediate decision on surgical intervention. Doctors consider removal or ligation of the dilated veins of the spermatic cord to be the safest and simplest methods of varicocele surgery.

One of the types of surgical intervention to treat the disease is Ivanisevich varicocele. This is a traditional, generally accepted method of open access to the cavity of the lower abdomen. It can be used at any stage of the disease, even the most complex. This method is based on the detection and ligation of veins that are directed to the testicle (at the level of the retro-abdominal region).

Progress of the surgical procedure:

On preparatory stage carry out the necessary set of measures to collect information and materials for analysis current state patient (cardiogram, blood, urine).
Conducting anesthesia.
After this, an incision is made in the iliac region (muscles and aponeuroses are dissected).
Using special instruments and forceps, the vein is ligated and divided.
Stitching the incision.

The duration of the procedure is 20-40 minutes. The success rate of the method is 75%

A similar method is palomo surgery for varicocele. The difference is that the Palomo cut is made slightly higher.

The main advantage of the Ivanisevich-Palomo method is its accessibility to the general population.

The Marmara varicocele treatment method (microsurgical varicocelectomy) is very popular in Western countries. Microsurgery of Marmara varicocele is the most painless and effective method complete elimination of the disease. The rehabilitation period passes with the least amount of detection of relapses and complications.

Progress of the operation:

Preparatory stage. Carrying out activities to take blood tests, urine tests, and cardiac examinations.
General anesthesia is performed.
Microsurgical operation for varicocele begins with a small incision 1.5-2.5 cm long in the area where the spermatic cord exits (slightly below the area where underwear is worn).
A microscope and a special instrument are inserted into the hole. With their help, it is carried out precise definition veins and their ligation without touching the nerves, The lymph nodes, artery.
After a successful procedure, the instruments are removed and the hole is sutured.

The Marmara operation for varicocele has many advantages, the main of which are: invisibility of the presence of a suture, fast recovery, no need for hospitalization, low degree traumatism, 98% success rate of successful surgical intervention. The disadvantage of this method is the duration of the procedure (at least 40 minutes) and high cost. Videos of microsurgical operations using Marmar can be seen in many specialized publications and on the Internet.

There is another technique surgical treatment diseases - laparoscopy (endoscopic surgery for varicocele). For several years, this treatment method has been successfully used to eliminate the disease at the most complex stages (even with bilateral varicose veins). The method is based on complete blocking of the testicular vein, as a result of which blood flow through it is impossible.

Laparoscopy of varicocele is performed as follows:

A number of analyzes are being carried out.
The operation is performed under general anesthesia.
Direct laparoscopic varicocele surgery is performed using a special device with the introduction of three ports. To do this, three holes are pierced in the abdominal wall: a 10mm port. installed in the navel area (this is a video camera), the port is 5 mm. is entered into left side iliac region, another port 5 mm. or 10 mm. injected into right area belly.
A video of laparoscopic varicocele surgery is visible on the monitor screen. Thus, the surgeon has full information and access to the veins of both testicles.
Using special instruments, titanium staples are applied to the branches of the vein affected by the disease, and the vessels between the staples are cut.

Endovascular varicocele surgery (laparoscopy) is well tolerated by patients. Recovery of the body takes place from 3 days to 2 weeks, depending on the complexity of the surgical treatment of varicocele.

The advantages of this method: minimal trauma, integrity of the artery, prevention of testicular atrophy. Disadvantages include the possibility of relapse (up to 15% probability), as well as the appearance of dropsy (10% probability). The effectiveness of laparoscopy is 90%.

The modern method of treating the disease is laser surgery varicocele. Thanks to the effect of the laser on the tissue, the operation is almost bloodless and without the use of general anesthesia (only local). The laser not only performs precise manipulations, but also promotes coagulation of the blood circulation. The risk of damage to surrounding tissue is minimized. After 20 minutes after laser treatment of varicocele, you can go home. The patient's recovery proceeds without complications.

The male body is susceptible to many diseases, including varicocele. Otherwise, this is called varicose veins (dilation of the veins) of the testicles and is formed when there is insufficient or complete absence of blood flow in the scrotum due to enlarged veins in the pampiniform plexus of the spermatic cord.

The disease was first described by Celsius in Art. BC. But the connection between testicular varicose veins and their dysfunction was proven only in the 19th century. The danger of the disease lies in the development of infertility.

When is surgery necessary?

Surgery for varicocele is prescribed for a man at any age in order to preserve the ability to fertilize. It is performed in the following cases:

bad spermogram;
testicular atrophy;
changes in testicle size;
pain in the groin.

With such symptoms, there is only one way out - surgical intervention, during which the patient ligates the veins passing near the spermatic cord and forces the blood to flow in a different direction. There are many types of operations for the treatment of varicocele and each of them has its own characteristics. The patient is pre-injected with anesthesia. The operation lasts about an hour.

Organizational aspects

10 days before surgery, the following studies are expected to begin:

general urine examination;
if necessary, it is recommended to do an ultrasound of the scrotum or a contrast ultrasound using the Doppler method, during which they obtain full picture situations;
blood tests, in particular for the Rh factor, sugar content, coagulability, and general indicators;
X-rays of light;
testing for AIDS, hepatitis C and B

On the day of the operation, you need to completely stop drinking and eating, take a shower and carefully shave the groin area. In case of admission medicines for chronic diseases (diabetes, hypertension, bronchitis, etc.), drug therapy is agreed with a doctor.

How is varicocele surgery performed?

There are many types of operations for treatment: laparoscopy, traditional surgery, according to Ivanissevich, carried out directly with direct contact, microsurgical methods and innovative developments.

Operation Palomo

performed by the Palomo method, involves incision of the testicular vein affected by varicose veins. It is performed above the inguinal canal. The surgeon immediately gains access to the testicular vein, ligates it and removes it. This approach will reduce the risk of injury to the neurovascular bundle. The operation can be performed under either local or general anesthesia. After the operation and suturing, the wound is fixed sterile bandage. The man can go home the very next day, and the stitches are removed within 8-9 days.

Varicocele: Ivanissevich operation

The most frequent method The treatment of varicocele in men is the Ivanissevich operation.

It consists of ligating the mouth of the testicular vein.
In this case, it is reached directly through the groin area, making a longitudinal oblique incision, behind which the venous inguinal plexus is located.
The mouth of the testicular vein is first ligated and then cut.
After the operation, the wound is sutured, connecting each layer, and then skin sutures are applied.

Before surgery, local anesthesia is administered. In some cases, general anesthesia is acceptable. However, it is worth remembering that Ivanissevich’s operation for varicocele can lead to consequences: damage to the femoral artery and other formations located in the neurovascular bundle of the inguinal canal.

Varicocele: endoscopic surgery

This method of getting rid of the problem is better than the previous one, since it is gentle (no incisions are made in the groin). In this case, all the principles of laparoscopy are used.

For varicocele, laparoscopic surgery involves making 3 small incisions (1 cm) in the abdominal cavity, through which an endoscope or laparoscope with a camera and miniature instruments is inserted. By moving the instrument during the operation, they enter the mouth of the testicular vein, where, using a titanium clip, clipping and subsequent cutting of the vein are performed.

According to reviews from doctors, this technology is good for its minimal tissue damage, fast healing scars and restoration of the body.

The disadvantage of laparoscopy is the inability to use local anesthesia, since the abdominal cavity is involved. In case of damage to both testicular veins (varicocele on the left and right), laparoscopic surgery for varicocele is the best option.

How does endovascular embolization surgery work?

This operation is performed under visual control.

To do this, an intravascular endoscope 2 mm thick is inserted through the femoral vein and advanced to the testicular vein.
Next, the course of the varicocele operation is as follows: the vein is examined using X-ray contrast agent.
Then, a sclerosant is injected into its expanded part - a substance through which “gluing” (embolization) of the lumens of blood vessels occurs.
This method of treating the disease is carried out without anesthesia, is minimally invasive, takes less time, has virtually no consequences or relapses, and is well tolerated by the patient.

Operation Marmara

Microsurgical operation of varicocele using the Marmara method is also based on ligation of the testicular vein. The incision is made along the outer edge of the inguinal canal in the area located below the level of wearing underwear. It is there that it is located under skin testicular vein. The length of the incision is maximum 2 cm. The advantage of the method is the almost complete absence of relapses and complications in the postoperative period.

Treatment with laser

Laser surgery for varicocele is a modern, less complicated technique that is performed without incisions in the groin.

The operation is performed using an intravascular endoscope.
The presence of a miniature camera allows you to quickly find the location of the affected vessel, which then coagulates under the influence of laser beam and no longer participates in the general blood flow.
When treating varicocele, surgery using this method can be performed without anesthesia.

When surgery is not possible

Despite the good tolerance of the operation, there are also contraindications that do not allow surgical treatment. Thus, sclerotization is not carried out when:

Increased pressure in the veins located near the disease area.
Anastomakh big size, which risks getting sclerosant into healthy arteries and veins.
Situations when it is impossible to insert a probe into the veins due to their structure

You cannot perform an open operation in the following cases:

Active inflammatory processes.
Diseases in the stage of decompensation, when elimination of organ dysfunction is impossible without treatment (for example, with cirrhosis of the liver, diabetes).

Endoscopic surgery for varicocele is not prescribed for the above reasons, or if the client has undergone abdominal surgery in the past. In this case, the clinic is disrupted and the risk of doctor errors increases.

Recovery

Many men are interested in how long the recovery period lasts. It all depends on the characteristics of the body. It may take 2 weeks for complete recovery. To restore spermatogenesis, a man after surgery may be prescribed:

Dietary supplements based on zinc and selenium;
ointments containing antibiotics;
vitamin preparations;
hormonal medications;
Painkillers may also be needed.

After surgery, during the first two days you must follow the following recommendations:

move as little as possible and rest as much as possible;
do not wet the wound (if pain occurs, you can apply ice);
Be sure to wear a bandage (it helps hold the testicles in place).

In the first two weeks the following are strictly prohibited:

bath;
physical activity;
sex.

Complications

Surgery for varicocele may be accompanied by the following complications:

Neuralgic pain that occurs due to injury to nerve endings.
Relapse (reoccurring disease).
Hydrocele of the testicle as a result of injury to the lymphatic vessels.
Deep vein thrombosis due to hematoma in the puncture area or contrast injection.
Inflammatory processes.
Lymphatic edema is another consequence of surgery due to injury to the lymphatic vessels.
Reduction in testicular size. Caused by affecting the spermatic artery.
Damage to the ureter or intestines due to the inexperience of the doctor.

Varicocele – dangerous disease, leading to serious consequences, such as cancer, . Self-medication will only make the situation worse. Therefore, at the first symptoms of severity or pain in the testicles, sexual dysfunction, swollen veins, you should immediately consult a doctor for advice.

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Diagnosis of varicocele

Feeling the scrotum
A mandatory procedure that allows you to determine the severity of varicocele. Ultrasound(ultrasonography). Ultrasound is always combined with Dopplerography (a technique that determines the quality of blood supply) of the renal vessels (arteries and veins) and the testicular vein.
The study is carried out with the patient standing (orthostasis) and lying down (clinostasis) with the measurement of the blood flow gradient in these positions.
During an ultrasound, it is necessary to perform Valsalva maneuver:

Enlargement (varicose veins) of the testicular vein in size with vertical position bodies.
When the body is lying down, the vein collapses (reduces in size).

The testicular vein should not exceed 2 millimeters in diameter (normal). The speed of venous blood flow in the vein should not exceed 10 centimeters per second (normal). Absence of venous reflux (normal).

With varicocele of the first degree, the diameter of the testicular vein becomes 2 millimeters larger than normal and positive (up to 3 seconds) reflux is determined. Severe reflux indicates a more severe stage of the disease.

Ultrasound also allows you to determine the hemodynamic variant of varicocele, as well as identify renal venous hypertension (if any).

General urine analysis before and after physical activity ( marching test) . A positive march test - the appearance of a small amount of red blood cells in the urine (microhematuria) and the presence of protein in the urine (proteinuria) indicates renal venous hypertension.
X-ray methods. TO X-ray methods include:
Antegrade phlebotesticulography or retrograde renal phlebography - these research methods are performed after preliminary injection of a contrast agent into the veins of the scrotum.
Hormonal profile study – includes the concentration of testosterone, estradiol, prolactin, FSH (follicle-stimulating hormone), LH (luteinizing hormone).
Semiological research(semen examination) - in most patients pathospermia is detected (a decrease in the number of motile forms of sperm and an increase in the number of pathological forms) of varying degrees.

Treatment of varicocele

Non-drug treatment: Conservative treatment of varicocele is not effective.

Drug treatment: Drug treatment is prescribed only after surgery to stimulate spermatogenesis. Most often, a complex of vitamins is prescribed, biologically active additives to food (containing selenium and zinc). Sometimes prescribed hormonal drugs(androgens, human chorionic gonadotropin), they are used under strict laboratory control.

Preparation for surgical treatment: involves taking tests before surgery (to exclude decompensation of any organ or organ system). The following tests are required:

General blood test (to determine the state of hematopoiesis)
Blood type and Rh factor (for blood transfusion if necessary)
Urinalysis (to check kidney function)
Biochemical blood test (glucose, creatinine, urea)
ECG (electrocardiogram) – to determine the work of the heart
Radiography chest(to exclude lung pathology)

Surgical treatment
On this moment There are more than 120 types of surgical treatment for varicocele.
All operations can be divided into two groups:

Group I – operations in which the connection with the renal artery is preserved.
Group II – operations in which the communication with the renal artery is interrupted

Currently, microsurgical techniques are successfully and widely used in the treatment of varicocele. This made it possible to reduce the number of relapses (repeats) of the disease, as well as significantly reduce the risk of complications after surgery.

Classical operations on varicocele
One of the most common operations is according to Ivanissevich. It consists of ligation and further resection of the left testicular vein. This leads to the elimination of reflux from the renal vein into the pampiniform plexus. But with this operation there is a possible risk of developing renocaval anastomosis due to difficulty in the outflow of venous blood from the kidney.

Microsurgical methods for treating varicocele
Laparoscopic clipping of the testicular vein
Laparoscopic varicoetomy is endoscopic and minimally invasive method treatment of varicocele.


Indications for laparoscopic testicular vein clipping surgery	Advantages of the laparoscopic method over classical operations	Contraindications for laparoscopic testicular vein clipping
Varicocele 1, 2, 3 degrees	Possibility of vein clipping for bilateral lesions	Abdominal surgeries in the past.
Reno-testicular type of varicocele	Reduced risk of postoperative complications
Ileo-testicular type of varicocele	The length of hospital stay is reduced to 2-3 days
Mixed type varicocele	Almost complete absence of pain in the wound
	No pain when walking on the first day
	Good cosmetic effect
	Good sperm count after surgery

The operation is performed under general anesthesia (the patient is put under anesthesia). A trocar is inserted near the navel and the abdominal cavity is examined. Then the veins of the testicle are found, and the artery and lymphatic vessels are carefully separated from the veins. Then the veins are clipped (applying special clips) and the operation is completed.

Endovascular phlebosclerosis
The method involves blocking the testicular vein various substances or special devices.

Indications for the use of endovascular phlebosclerosis	Advantages of endovascular phleboskerosis	Contraindications for endovascular phlebosclerosis
Reno-testicular type varicocele	The operation is performed under local anesthesia (the patient is conscious)	Large reno-testicular collaterals, which can lead to drug entry into the systemic circulation
No renal vein stenosis	Hospital stay is reduced to 2 days	Renal venous hypertension
Absence of venous hypertension	Absence of surgical intervention as such (with this method no cuts)	Loose vein type
	This method allows you to avoid complications such as hydrocele.
	Possibility of re-occlusion of the vein in case of relapse of the disease

Endovascular obliteration (occlusion) of the testicular vein is performed in both adults and children. Various substances are used for occlusion:

Spiral emboli
Fabric glue
Wire umbrella devices
Various cylinders
Drugs that cause vein sclerosis

This method consists of catheterization femoral vein, then the probe is passed to the testicular vein and a thrombotic drug is injected, the blockage of the vein is checked and the operation ends.

Possible complications after surgery

Complications developing after classical operations.

Hydrocele (hydroxycele) – a complication in which fluid accumulates in the lining of the scrotum. In this case, hydrocele appears due to a violation of the outflow of lymphatic fluid. Disruption of lymph outflow occurs due to ligation of the lymphatic vessels along with the testicular vein during surgery.

This complication is treated, as a rule, either by puncture of the affected part with pumping out fluid or by surgery to restore lymph outflow.

Testicular atrophy. A very rare but serious complication is testicular atrophy. Testicular atrophy is characterized by a decrease in testicular size and a significant decrease in its function. According to statistics, this complication develops in 1:1000 patients operated on for varicocele.

Postoperative pain occurs due to blood overflow of the epididymis and, as a result, stretching of its capsule. But most often, patients after surgery experience a decrease in pain sensitivity.
Complications developing after laparoscopic clipping of the testicular vein.

Complications develop extremely rarely. The most a common complication is mild discomfort in the abdominal cavity after surgery, which is explained by pneumoperitoneum (filling of the abdominal cavity with air). Performed during endoscopic surgery for better visualization of organs. Over time, the air is absorbed and the discomfort goes away.
Complications that develop during testicular vein embolization:

Allergic reactions to contrast agent. Can be avoided by administering desensitizing drugs before surgery
Thrombophlebitis of the veins of the pampiniform plexus. Can be avoided by preventing thrombosis.
Perforation of vessel walls.

Surgery to remove varicocele is indicated for varicose veins of the spermatic cord, as this is the main cause of infertility in men. Therefore, surgical treatment must be carried out at the very beginning of the formation of a testicular tumor.

Indications for surgical treatment

Due to the expansion of the veins, the normal blood supply to the testicular tissues and the process of thermoregulation are disrupted. The number of sperm decreases and they become less mobile. In most cases, the left side is affected, although bilateral pathology sometimes occurs.

Varicocele can be congenital and usually begins very early, but in childhood doesn't show up at all. First Clinical signs begin to occur as the child grows older (in adolescence).

Surgery to remove varicocele is necessary if there is the following signs in a teenager or adult man: The course of the disease in a teenager may be asymptomatic, so the indication for surgery is surgical removal varicocele can be indicated by data obtained as a result of the Valsalva maneuver, ultrasound examination or palpation of the pampiniform plexus. The effectiveness of treatment depends entirely on the degree of the disease and the chosen technique. If necessary, the patient is prescribed a testicular biopsy.

pain in the groin;
feeling of discomfort;
swelling;
testicular swelling.

The technique of surgical manipulation depends on the size of the testicle and the age of the patient. Before starting treatment, it is necessary to prepare for testicular surgery for varicocele in order to avoid serious complications and consequences.

Advice: The earlier the disease is detected, the sooner treatment will begin and the risk of developing serious complications will decrease. Therefore, when the slightest sign or concerns, you should consult a doctor.

Preparing for surgery

Preparation for surgery begins with laboratory examination patient. It is needed to exclude certain diseases: chronic diseases, lung pathologies, problems with gastrointestinal tract. All this can affect the course of the operation and the patient’s condition.

Before performing surgery to remove varicocele, you need to establish main reason, which causes stagnation of blood in the testicle.
Also, depending on this, the type of operation is selected that will help preserve the man’s ability to fertilize.
Immediately before surgery, the hair growing in the area of the surgical field is shaved.
First of all, you need to pass general analysis urine and blood, blood for creatinine, Rh factor and group.
An analysis is also prescribed for prothrombin index and electrocardiogram.
The doctor is obliged to familiarize the patient with information about how long the operation will take and the methodology for carrying it out.

Types of operations

Today there are different types Testicular surgery to remove varicocele. Among them are the most important:

Marmara operation for varicocele;
laparoscopic varicocelectomy;
laser surgery;
Ivanissevich operation.

Microsurgical operation Marmara is the most best technique replacing a diseased testicular vein with a healthy vein. To do this, doctors provide themselves with mini-access to the required area of the body, without penetrating the abdominal cavity. The microsurgical technique is considered the least traumatic among all other techniques, since it almost never causes the appearance of cosmetic skin defects.

Also, microsurgery has the lowest risk of relapse and serious complications. Its advantages include a quick recovery period and low invasiveness.

Microsurgical manipulation does not require mandatory hospitalization of the patient in a hospital and can even be performed on an outpatient basis. The preparatory period is standard, as for all other surgical interventions.

Progress of Operation Marmara

The patient is given an anesthetic injection, which has an anesthetic effect. The anesthesiologist decides how much anesthetic to administer based on the patient’s total weight and age. Next, the surgeon makes a small incision in groin area no more than 2-3 cm. After the swollen vein is found, it is bandaged, stitched and crossed. This helps normalize blood flow and relieve the negative symptoms of varicocele.

During Marmara microsurgery in rare cases accidental damage may occur nerve ending in the groin or bleeding.
The recovery period is only 3 days, and the stitches are removed already 8-10 days after they are applied.
The only disadvantages of this technique include the high cost, because special tools and expensive optics are used.

During the postoperative period, it is recommended to avoid severe physical activity and sudden movements. You cannot have sex for one month and you must protect the incision area from friction. Underwear should be natural and not tight.

After three months, you should take a spermogram in order to assess the ability of sperm to fertilize. Six months after treatment you can return to to the usual way life.

Advice: The doctor must decide which types of surgical interventions to prefer from all available ones, taking into account the patient’s age and individual problem.

Progress of Ivanissevich's operation

During the Ivanissevich operation, the lumen of the varicose vein is completely closed under local anesthesia for adults. For children, surgery is usually performed under general anesthesia. It takes about 30 minutes. This type of treatment for testicular varicocele is considered cheaper. The essence of the method is to cut and ligate the left vein in the testicle. This helps eliminate the main negative factor, which causes blood to flow back into the testicular plexus.

Postoperative period in this case, it is longer, and the risk of complications is quite high.
During all manipulations, damage may occur. femoral artery and other anatomical formations in the inguinal canal.
In addition, the disadvantages include complete dissection abdominal wall and penetration into the abdominal cavity.
The patient will be unable to work for several months.
There remains a chance of relapse, which is about 40%.
The advantages of Ivanissevich’s operation include the absence of the need to use special equipment and the ability to perform it for everyone.

Laparoscopic surgery

Endoscopic varicocelectomy is performed in cases where the patient has bilateral dilatation of the veins of the spermatic cord. Incisions are made in the navel, left and right iliac region. Their size very often does not exceed 1 cm. Endoscopic devices, instruments and an endoscopic television camera pass through them. Therefore, the doctor can monitor the progress of the operation and, if necessary, adjust his actions.

The most non-invasive operation is considered to be laparoscopic, which occurs with minimal trauma to the patient.
In this regard, it carries a lower risk of complications than other types of surgical interventions, which often cause bleeding or the formation of infiltrates.
After using the laparoscopic technique, the patient does not receive cosmetic defect, since the seam remains almost invisible.

Disadvantages include the high cost of the operation and the need for general anesthesia. The postoperative period usually takes about 3 days, after which the patient is discharged. The doctor tells him when he needs to come to have the stitches removed, how many days it will take full recovery after varicocele surgery, etc.

Laser surgery for varicocele

The advantages of this type of intervention include the absence of the need for anesthesia and a quick rehabilitation period.

You can also highlight the minimal risk of complications or serious consequences.
Surgeries for varicocele have significant differences from circumcision of the foreskin, surgery to remove a testicle in men, or amputation of the penis.
Only a doctor can answer the question of how long the rehabilitation period will take and what the cost of surgery to restore the testicle will be.
Laser treatment of varicocele is one of the most modern methods solutions to this problem.
To do this, there is no need to make an incision in the groin area, and all manipulations are performed using an intravascular endoscope.
Fiber optics helps to find the exact area of vessel dilation and coagulate it under the action of a laser beam.
After this, it is switched off from the general bloodstream.

Contraindications

Not all patients can undergo surgical treatment of the testicle, as there are certain contraindications. Laparoscopic surgery cannot be performed if the patient has already undergone such an intervention earlier or if he has malignancy. Microsurgical operation is prohibited if the patient has diabetes mellitus or severe cardiovascular pathologies.

Before undergoing surgery to remove testicular varicocele, the patient must undergo thorough examination for the doctor to identify exact reason diseases.
After this, it will be possible to select the optimal type of surgical intervention, taking into account the individual pathology, the patient’s age and his financial capabilities.

vseoperacii.com/mps/mpo/udalenie-varikocele.html

Varicocele - general information

Varicocele is a very common disease that develops from insufficient functioning of the valves of the internal testicular vein or their complete absence, and is characterized by dilation of the veins of the spermatic cord of the testicle.

In my own way anatomical structure the sexual organ consists of a tubular muscular wall, with a passing testicular artery that supplies blood to this body and venous vessels through which blood flows in the opposite direction.
The spermatic cord contains the vas deferens, which exists to transport sperm to urethra and lymphatic vascular collectors.

This disease affects up to 20 percent of the male population. Anatomical features the structures of this organ provoke the occurrence of this disease From the left side. Right-sided varicose veins may indicate a tumor in the right kidney. The internal testicular vein drains blood from the testicle.

WITH right side the outflow of blood is directed to the inferior vena cava while on the left side all the blood is directed to the left renal vein.
The testicular vein has a much lower hydrostatic pressure than the renal vein into which it flows.
During normal activity of the testicular vein valves, blood from the renal vein does not enter the testicular vein.
If these valves do not exist or their operation is ineffective, blood from the system, where the pressure is much higher, will be thrown to where the pressure is lower.

In this case, blood from the left renal vein will flow into the left testicular vein. As a result, blood circulation in the testicle is disrupted - blood stagnates in the veins of the spermatic cord. From the cluster large quantity blood, its temperature rises, which has an extremely negative effect on its function, and subsequently will lead to its complete loss. Normal spermatogenesis is possible under the condition of a stable temperature, which is also lower than body temperature.

Elevated temperature negatively affects the process of formation and maturation of sperm.

Manifestations of the disease

Clinically, the manifestation of varicose veins of the spermatic cord is manifested by pain in the scrotum and its significant enlargement. Sometimes the clinical picture is completely absent.

Most often, varicocele is discovered in adolescence.
Having reached a certain stage, it has no tendency to develop further.
Often they learn about the existing diagnosis during the next medical examination.

Patients rarely complain about this disease. This is due to the fact that the symptoms of such a disease are more likely to be visual than to cause any concern. Possible presence of small nagging pain on the affected side, which tend to intensify with walking, physical activity and sexual arousal. Often, an enlarged left side of the scrotum can be detected when a man is standing. In a supine position, it is not possible to see any sign of the disease due to its absence.

When the disease is in an advanced state, then the feeling of pain is constant. This disease characterized by a significant enlargement of the scrotum, a decrease in the left testicle, and varicose veins of the scrotum.

Is surgery necessary?

If a varicocele is diagnosed, men are interested in: is surgery necessary in this case?
During treatment varicose veins veins there is no other method than surgery.
However, not all cases of varicocele are an indication for surgery.

The operation must be carried out when male infertility, when, due to existing disorders, the quality, motility and quantity of sperm deteriorate, with constantly present pain in the testicular area, for an aesthetic effect and for the reason that the affected testicle stops growing at puberty.

What types of varicocele removal operations are there?

To have an idea of how surgery is performed for varicocele, it is necessary to consider all the main surgical techniques used today.

Laparoscopic intervention technique– characterized high efficiency and is low-traumatic. During the intervention, it is possible to intraoperatively determine the number of branches of the internal testicular vein, perform their resection, without touching the artery, which makes relapse impossible. During the operation, the patient is under general anesthesia. Patients are discharged after surgery the very next day.
Microsurgery– this technique is carried out using local anesthesia, taking several hours in duration, is highly effective, but some complications and relapses are possible. For such an intervention, a specialized microscope is required.
X-ray endovascular surgery– to perform it, X-ray control is used, under which the testicular veins are blocked. Being minimally invasive, the operation is not highly effective.
Open surgeries that are traditional– such methods include Ivanisevich and Palomo operations. A somewhat outdated version of surgical intervention. It is traumatic and has a high rate of complications and relapses. The recovery process is long. It is performed under local anesthesia.

The main reason for treating varicocele is the prevention and treatment of male infertility.

Postoperative period

After surgery for varicocele, sex is possible after rehabilitation period, taking into account the characteristics of each organism and the type of operation, the time period is approximately three weeks. After surgery, sex usually remains at the same level.

The most unpleasant complication After the operation, there may be damage to the nerve located in the inguinal canal.

In addition, there may be cases when, after varicocele surgery, bleeding occurs, the postoperative wound becomes infected, and testicular hydrocele occurs. In almost all cases, patients recover quickly and the pain goes away. If pain still occurs, you should consult your doctor.

Varicocele is a disease that is common in young people.
It is necessary to follow the rules of prevention so that, if necessary, you do not miss early diagnosis varicocele.
This includes proper distribution of physical activity, avoiding constipation, and periodic visits to a urologist.

Stages of the disease and indications for surgery

There are 4 degrees of development of varicocele:

Varicose veins are determined only by ultrasound.
The veins of the pampiniform plexus are palpated in a standing position.
By palpation in any position, the doctor can diagnose the disease.
Veins are visible to the naked eye.

A decrease in spermatogenic function, which can eventually lead to infertility, usually begins only at late stages diseases.

The operation can be performed in the following cases:

Disturbances in sperm formation were revealed. During the study, it was found that the number of spermatozoa in the seminal fluid is reduced, their motility is reduced, and blood or pus is present.
The patient is experiencing pain. They begin to appear at stages 2-3 of the disease, at first they are minor. Unpleasant sensations worse when walking, after physical activity. Note. In the vast majority of cases, varicocele of the left testicle develops, so the pain most often has the same localization.
The patient is not satisfied appearance scrotum
The testicle begins to decrease in size.

In the absence of symptoms, surgery may also be recommended. Some doctors believe that surgery, done in a timely manner, can prevent infertility. Others believe that this is an unjustified risk and advise limiting monitoring through periodic examinations and ultrasound.

Important! The operation is usually not performed before the age of 18. According to statistics, in adulthood, relapses occur much less often after surgery - re-development varicocele. Therefore, it is better to carry it out after puberty.

Compression of the veins can lead to the development of so-called “secondary varicocele”. It occurs as a result of a tumor, cyst or other formation. In this case, the patient is worried about fever, blood in the urine, dull or stabbing pain in the lumbar region. With secondary varicocele, it is necessary to eliminate the cause of the disease, vein truncation surgery is not required until the results of therapy for the underlying pathology appear.

Contraindications

Different surgical techniques may have different contraindications. Open surgical interventions are not performed for:

The presence of diseases in the stage of decompensation (impaired organ functions that cannot be restored without treatment) - diabetes mellitus, cirrhosis of the liver, etc.

Inflammation in the active stage.

In addition to the described contraindications, endoscopic operations are not performed in cases of previous surgical interventions in the abdominal cavity. This is due to a violation clinical picture and an increased likelihood of physician errors.

Sclerosis is not carried out with the following contraindications:

Large anastomoses (bridges) between vessels, which can lead to the entry of the drug used for gluing into healthy veins or arteries;
Increased pressure in nearby veins (eg, renal veins);
The structure of the vessels does not allow the insertion of a probe (the crumbly nature of the veins).

Preparing for surgery

10 days before the proposed procedure, patients need to undergo some tests:

Blood test (general, group and Rh factor, coagulability, sugar content).
General urine analysis.
X-rays of light.
Electrocardiogram (can be prescribed to all patients or only to men over 30 years of age).
Analysis for hepatitis B and C viruses, HIV.

In addition, the doctor usually prescribes an ultrasound of the scrotum or an ultrasound using the Doppler method (using a contrast agent) to obtain a more complete clinical picture. Additional studies are possible depending on the patient's condition.

In the morning before surgery you need refuse food and water, take a hygienic shower. The pubis and abdomen must be clean shaved. Taking medications for chronic diseases(diabetes, hypertension, bronchitis, etc.) must be agreed with your doctor.

Methods of performing the operation

The classification of surgical treatment methods can be based on the method of access and technology. Based on the second characteristic, two large groups of operations are distinguished:

With preservation of the recocaval anastomosis;
With its excision.

Note. A renocaval shunt (anastamosis) is a communication bridge between two testicular veins. It occurs as a pathology due to varicocele and contributes to blood stagnation.

The second method is currently recognized as the most effective and is used most often.

According to technology, it is customary to distinguish three main types of operations:

Laparoscopy (minimally invasive method);
Endovascular sclerotherapy;
Open surgery (can be performed in various modifications - according to Marmar, Ivanissevich, Palomo).

Important! Removal operations for varicocele are not performed. All vessels remain inside the body; they are either glued together (sclerotic) or ligated.

operaciya.info/urologia/varikocele/

Varicocele is a pathology of the testicle, which is accompanied by dilation of the spermatic cord vein. Usually, urological disease occurs in young men. The physiological abnormality affects reproductive function and male potency, may also be accompanied by pain during sexual intercourse.

Therapy for varicocele

Only possible way The treatment for varicocele disease is surgery. The main goal of surgical intervention is to normalize the inflow and outflow of blood in the genitals and compensate for the valves of the veins in the testicles.
When diagnosed with varicocele in medical centers Moscow perform microsurgical correction using high-precision microscopes (testicular revascularization). The principle of therapy is to excise the varicose vein and replace it with an epigastric one. The great advantage of microvascular surgery for varicocele is complete recovery. reproductive function and no relapses.

How is surgery for varicocele performed?

Surgery for varicocele is performed under general anesthesia. After the correction, the patient must remain in the hospital for 4-6 days. To restore the body and reduce the risk of inflammation before discharge, the microsurgeon prescribes a course drug therapy. After 1-2 months and six months later, a control ultrasound examination is performed.

Where in Moscow is testicular revascularization performed?

The Zoon information portal offers coordinates of reproductive medicine centers, surgical departments public hospitals and private urology clinics. We also present profiles of vascular surgeons, microsurgery specialists and leading urologists in the capital. On the Zoon website you can read the ratings of specialists, patient reviews and find out the cost of testicular revascularization surgery.