Varicocele is a urological health problem that means the expansion of blood vessels (veins) that provide venous deposition of the testicles. It can be detected in approximately 15% of the general male population. The internal structure and valves of the veins that develop varicocele deteriorate over time, and the dirty blood cannot be drawn back enough. Therefore, the testis is under the long-term effect of both toxic substances in the dirty blood and increased temperature. This may cause deterioration in the internal structure of the testis and sperm production. Varicocele is one of the most common causes of male infertility. The presence of varicocele is reported in one third of men who cannot have children and whose spouses have not been found to have a medical problem. Varicocele is much more common on the left because the spermatic vein (vein of the testis) is poured out, but the vein is different. The presence of right varicocele alone is a much rarer medical condition.
If a man has a varicocele and the more severe this varicocele is, the more likely it is that the sperm production system, which we call spermatogenesis, will be negatively affected. The increased heat in the testis and the pooling of toxic substances in the testis cause oxidative stress on the cells, which causes them to degrade the sperm DNA. Over time, the number of sperm in the semen decreases, its mobility decreases and its quality deteriorates. This process can result in infertility in men, which we call infertility. However, the following issue is particularly important; The presence of varicocele does not necessarily mean that it is a condition that needs to be treated. If varicocele has disrupted sperm parameters and is a cause of infertility, then treatment is of course necessary. But if it does not cause a problem in the person, follow-up without treatment will be a much more accurate approach. Varicocele can cause decreased testicular volume and impaired testosterone production. Undoubtedly, this situation may have negative reflections on sexual functions.
Manual examination alone is often sufficient for the diagnosis of varicocele. In this way, both the presence and degree of varicocele can be detected easily. However, we frequently use the radiological examination, which we call scrotal Doppler ultrasonography, in our medical practice in order to confirm the diagnosis, document it and follow the treatment process. Here, the diameter of the spermatic vein, that is, the vein, and whether there is a reverse flow can be easily detected. However, it is not an absolute requirement for diagnosis.
We urologists classify varicocele in 3 degrees according to the findings of the examination.
1st Degree Varicocele; On examination, the vascular structures are normal, but it is felt to be fuller with straining.
2nd Degree Varicocele; Swollen veins are palpable without straining, and they become more obvious when straining.
3rd Degree Varicocele; Even without examination, clearly swollen and convoluted veins are observed with the naked eye.
If varicocele is detected, at least 2 sperm tests should be performed and it should be checked whether spermatogenesis is affected or not. Because the result of the sperm analysis is the most important issue in deciding the treatment. After that, a decision is made with the patient, taking into account the person's marital status, whether they have children, the health status of their spouse in terms of pregnancy, and their future child plans. It is necessary to know that the longer the process until the treatment and the more severe the varicocele, the more the damage will be. In this case, it would of course be more logical to perform the treatment at the most appropriate time without neglecting it too much. If there are the following condition or conditions, varicocele must be treated absolutely.
1- If sperm values are impaired
2- If the testicular volume has decreased by more than 10%
3- Even if sperm parameters are normal, if sperm DNA damage has developed
Apart from this, severe varicocele may be cosmetically disturbing to the person. Or, in the slightest activity, varicocele can also manifest itself in the form of testicular, groin and inner leg pain. Pain is an important complaint that disrupts the comfort of life in some men. In these cases, varicocele treatment may be required.
TREATMENT OF VARICOCELE:
The treatment of varicocele is only surgical, that is, surgical methods. In other words, varicocele is not a problem that can be treated with drugs. These surgeries can be performed in roughly 4 different ways.
1- Open conventional classical method; It is a type of surgery performed with a low-level incision in the groin area and with the naked eye (or loop glasses). The spermatic veins are ligated individually in this way.
2- Laparoscopic method; It is the method of connecting the spermatic veins from the inside and at a high level with the help of a camera that is placed inside the abdomen.
3- Microsurgery microscopic method; It is a very popular treatment method in recent years. As in the classical method, a small incision is made in the inguinal region and the spermatic cord is suspended. Afterwards, with the help of an advanced surgical microscope, the veins are examined one by one.