What type of surgery is used for varicocele. What types of operations to remove varicocele exist? Indications for varicocele surgery

“I was going to get married. And my future husband warned that there might not be children. He has problems. We went to the urologist together. Yes, the diagnosis, the one that the husband said, was confirmed. Marmara. Advised not to delay the decision. We decided to read on the Internet where it is better to do a similar procedure. The Open Urology Center offered all the services. We contacted, consulted. We went and did not regret. The qualifications of the clinic staff, coherence in work, professionalism is simply at the highest level ! Many thanks to the surgeon Dmitry Alexandrovich and all the staff of the Open Urology. "

Margarita 28 years old

N-Novgorod

"We lived with my wife for 8 years already. But we still had no children. My wife was examined completely, she was tired of taking tests and going to doctors. I had to go to the doctor. After ultrasound and other tests, procedures, they found a problem. My illness did not allow my wife to become pregnant "The diagnosis is varicocele. The urologist warned that there is no medical treatment. We found the clinic Open Urology on the Internet. We made an appointment. After examining a specialist, they suggested doing a Marmar microsurgical operation. I confess, I was afraid. I thought, on the appointed date, I will gather my courage and go Boldly. But they offered to do it on the same day. I had to go. The surgeon is a master from God. Small incisions and a few stitches. Quickly and painlessly. A week later I forgot the feeling. At home, I underwent a course of restorative procedures. Our result is already 16 weeks according to ultrasound. Doctors, To all the staff, many thanks."

Oleg, 32 years old

Lipetsk

"At the Open Urology clinic, my husband was diagnosed with a bilateral varicocele. The urologist said that he needed an operation, otherwise the condition would worsen and he could develop testicular atrophy. The husband signed up for the operation immediately after hearing these words! We were lucky that Met a caring urologist doctor Same day surgery using microsurgical technique....Last week I got a positive pregnancy result!!I can't believe it!!!We are so excited,started planning many things for the new member family. Many thanks to the clinic and the urologist."

Vera 27 years old

Moscow

"I suffered from a bilateral varicocele. After surgery by the doctor, my sperm count more than doubled in just one month. His attention to detail is amazing and the instructions are easy to follow and very effective. I would advise anyone considering surgery, follow his regimen. Thank you doctor, you helped reduce the pain and increase the amount!"

Artur, 33

"Last year I had pain in my groin area. After a few weeks of anxiety and discomfort, I visited a doctor. He examined me and sent me for an ultrasound. They diagnosed me with a varicocele. The doctor said that the problem can be easily solved with Marmara microsurgery "I understood that I needed an operation and agreed. It took about an hour for the operation. I woke up and felt no pain, and after 2 hours I was sent home. Many thanks to the doctor!"

The only way that allows you to completely rid the patient of the disease is surgery. All other methods only prevent the further development of pathology and relieve symptoms. However, doctors do not prescribe surgical intervention in every case, since sometimes conservative therapy can be dispensed with.

There are 4 stages of development of varicocele:

The man does not notice the symptoms, the disease can only be diagnosed with the help of ultrasound.
During the examination, the urologist can palpate dilated veins while the patient is in a standing position, and the Valsalva maneuver can be additionally applied.
Pathology is palpable in any position, no sample is required.
Dilated veins are visible to the naked eye.

As a rule, to remove a varicocele, surgery is prescribed only at the last two stages of development, since it is during this period that pathological changes can occur that affect the fertility of a man. In the first two stages, surgery is usually not required, the doctor prescribes the patient medication, physiotherapy and regular examinations to keep the situation under control.

To remove a varicocele, the indications may be as follows:

There is a possibility of infertility. A spermogram is performed to study the quality of spermatozoa, and if it decreases, the doctor strongly recommends surgical treatment of the varicocele.
The patient constantly feels pain that is not stopped by conservative treatment methods.
The man is not satisfied with the appearance of the changed testicle.
There is a decrease in testicle size and other complications of the disease.

In any case, the decision on the need for an operation is made by the attending physician, however, the patient may insist on the desire to get rid of the disease if he fears possible complications. The opinions of urologists and surgeons are divided: some believe that the operation must be performed in any case in order to avoid infertility, others argue that this is an unjustified risk, and it is better to monitor the course of the disease.

There are also contraindications to the operation, it is not carried out until the limiting factors are completely eliminated. These include:

the presence of serious cardiovascular diseases, limiting the possibility of any operations;
chronic diseases in the acute stage;
infectious diseases accompanied by high fever;
acute inflammation;
diseases affecting blood clotting;
diabetes;
cirrhosis of the liver.

The patient will need to take tests and undergo an instrumental examination, which will be prescribed by the attending physician. This is done to identify all existing absolute and relative limitations to surgical intervention. Also, the specialist may postpone the procedure if the patient has concomitant diseases.

How to prepare for surgery

Preparation for varicocele surgery does not involve complex measures, but it is necessary to reduce the risk of complications and achieve an absolutely positive result. 10-14 days before the appointed date, the patient needs to be tested and undergo an instrumental examination.

On the eve of the procedure itself, it is necessary to cleanly shave the groin and lower abdomen. If a man takes any drugs, you need to coordinate their use before the operation with the doctor. On the day of the intervention, you can not eat or drink anything, you must take a shower in advance.

Operation types

There are different types of surgery for varicocele, this allows doctors to choose the most suitable method for the patient in each case.

All procedures can be conditionally divided into those after which the bridge between the testicular veins remains intact, and those that involve its excision. Most often, a varicocele occurs on the left, so only one testicle is affected during the operation. Rarely, there is a bilateral lesion.

Operation Ivanissevich

The technique of the operation resembles the removal of appendicitis, but the incision is made not on the right, but on the left. The surgeon makes an incision averaging 5 cm long in the groin, then locates the testicular vein and ligates it. Also, the specialist tries to find as many processes of this vessel as possible in order to bandage them too.

The operation to remove the varicocele ends with suturing and a sterile bandage. As a rule, the duration of the entire process varies from 30 to 60 minutes. The intervention is performed under local anesthesia, but in the case of children or adolescents, general anesthesia may be used.

Ivanissevich's method is quite simple for surgeons, but it does not fully guarantee the absence of relapses and complications, in addition, pain may be observed during the first month after removal of a testicular varicocele.

Operation Palomo

The Palomo operation for varicocele is in many ways similar to the Ivanissevich technique, however, during this procedure, the incision must be made above the inguinal canal. This allows you to ligate the vein in the area where it leaves the plexus, and capture more of its branches. In addition, the difference lies in the fact that the pathologically dilated vein is ligated along with the internal spermatic artery. All this reduces the risk of recurrence, however, the recurrence of the disease still occurs in every fourth case.

The danger of the Palomo technique also lies in the fact that there is a chance of damaging the lymph node passing in the inguinal region, which can subsequently lead to dropsy of the testicle.

The actions of surgeons after the formation of the incision are no different from Ivanissevich's technique: the vein is tied up through the extension, after which sutures are applied. This process may take 25-30 minutes. To date, the operation according to the Palomo method is considered quite outdated and is rarely performed.

Laparoscopic method

Laparoscopic surgery for varicocele is currently considered the most effective and safest, since the risks of complications and relapses are negligible. The surgeon operates with endoscopic instruments and controls the entire process on the monitor screen, so long incisions are avoided.

The procedure is performed under general anesthesia. At the beginning of the process, the doctor makes three punctures in the abdominal cavity - one near the navel and two in the iliac zone. The first one is intended for the insertion of the chamber with a light bulb, and through the other two the instruments are inserted directly.

Since the doctor controls the situation through the monitor screen, it is possible to track the pathological vein along its entire length and find all the branches. Staples made of medical titanium are applied to all elements of the affected vessel, after which the vein is stopped. How long the endoscopic varicocele surgery takes depends on the specific case, but in general it takes no more than half an hour.

Microsurgery for varicocele

The microsurgical method is the only varicocele removal procedure in which the affected vein is completely removed rather than ligated. After removing the dilated vessel, a healthy one, usually an epigastric one, is placed in its place. This allows you to restore normal blood circulation in the testicles immediately after the completion of the process.

Most often, microsurgical treatment of varicocele is performed under general anesthesia. The surgeon makes an incision with an average length of 5 cm in the inguinal region and removes the pathological vein from it, after which it is removed. At the same time, he removes the epigastric vein from the plexus and sutures it in place of the excised one. All manipulations are performed under a surgical microscope, so the likelihood of complications is reduced to zero. The whole procedure usually takes no more than half an hour.

Sclerotherapy for varicocele

Sclerotherapy is the most sparing procedure for varicocele, as the operation is performed on an outpatient basis. It lies in the fact that a sclerosing substance is injected into the testicular vein affected by varicose veins, which sticks it together, thereby narrowing it. Thus, no incisions are made, only a small puncture from a thin needle will remain on the body, which will not be noticeable after healing.

Among surgeons, sclerotherapy is considered to be less effective than traditional surgery, but the risk of recurrence is still slightly higher. Despite this, the procedure is still less common than other methods, it is usually recommended for the second or third stage of varicocele development.

Using a laser

This is a new direction in the treatment of varicocele. An intravascular endoscope and fiber optics determine the location of the dilated vessel, coagulate it with a laser beam, separating it from the blood flow. This modern method of treating varicocele eliminates anesthesia, greatly reduces recovery, and, importantly, eliminates complications or serious consequences.

Consequences and complications

After surgery for varicocele has been done, the man recovers completely, usually within 3-6 months. Gradually, analyzes and spermogram parameters are improving. When performing minimally invasive interventions, the risk of recurrence is 2%, and traditional methods in 9% of cases are not able to protect against the re-development of varicocele.

take a multivitamin complex;
treat the wound with an antiseptic;
if necessary, take painkillers;
in some cases, an enema may be prescribed if there are problems with digestion;
during the first two days, rest, wear compression underwear and keep the wound dry;
within 1-2 weeks, do not have sex, give up heavy physical exertion and visits to the bath or sauna.

Contrary to popular belief, a man's sexual function does not undergo any changes after surgery. The duration of the rehabilitation period is determined by the doctor, after the completion of the recovery, it will be possible to gradually return to the usual way of life.

Side effects from surgery include pain, swelling, and redness of the skin in the groin and testicles in particular. If the norms of the procedure were violated by the doctor or the patient himself, inflammation may occur against the background of an infection, testicular dropsy, a decrease in the size of the testicles and thrombosis. To avoid possible negative manifestations, it is better to choose a reliable clinic and strictly follow all the instructions of the attending physician.

Varicocele is a pathology of the male genitourinary system, which is a varicose expansion of the pampiniform plexus, as well as the internal testicular vein. This is a common disease, but data on frequency vary greatly: from 10 to 25%. Pathology occurs mainly in adolescent boys and young men.

The idiopathic, or primary, form can be associated with 3 factors:

with poorly developed or absent valves in the veins from birth;
with compression of the left renal vein, which includes the left internal testicular vein, between the aorta and the mesenteric artery;
with a large length of the left testicular vein.

The primary type is more common on the left side.

Secondary varicocele is a symptom of someone's disease. This type is less common.

It is with the idiopathic form that urologists often meet. This type of varicocele does not cause much discomfort. But impaired blood flow in the scrotum is dangerous and a common cause of male infertility. Approximately 40% of men who have problems with conception have varicose veins of the pampiniform plexus and the internal testicular vein.

The only effective treatment is surgery.

Surgical intervention for testicular varicose veins has a long history, during which more than 100 options have been proposed, but many methods have not been used. Basically, 4 types of surgical intervention are now used to eliminate varicocele.

Type of operation	a brief description of
Ivanissevich method	A traditional and very common technique that was developed among the first. It consists in pulling the internal testicular vein, which blocks the reverse flow of blood towards the testicles. Doctors have different opinions about this operation. According to statistics, Ivanissevich's technique gives a relapse in about 40% of cases. The advantage of this method is its simplicity and the possibility of application for men and boys over 13 years of age.
Marmar technique, or mini-access operation	It is considered more effective and less traumatic, since the incision located close to the base of the penis does not exceed 2-3 cm in length. The scar remains invisible, as it does not go beyond the border of the underwear, relapses occur much less frequently. Recovery after such an intervention is faster, hospitalization is not required.
Endoscopic method (laparoscopic)	It implies any of the techniques described above, but carried out by introducing instruments and a small video camera for monitoring into the abdominal cavity through small openings and advancing them to the area of operation. This method is less traumatic, associated with fewer complications, suitable for getting rid of a rare bilateral form of varicocele, allows you to better assess the degree of pathology and eliminate dilated vessels as much as possible.
	It is indicated for severe pain syndrome and a special effect of varicocele on the spermogram. The method provides instant restoration of normal blood flow. The operation is performed under a microscope and consists in replacing the dilated testicular vein with the epigastric one. A very effective, but quite traumatic operation, requires a longer recovery period.

The choice of method is determined by the doctor, and also depends on the patient's financial capabilities and the equipment of the clinic to which the person applied.

The course of operation for the main techniques will be described below.

Ivanissevich method

The operation according to the Ivanissevich method is carried out in an open way. It is performed under local anesthesia.

First, the surgeon makes an incision about 50 mm long in the region of the inguinal canal, or rather, slightly above it and parallel to its course. To roughly imagine the place of penetration, you need to remember what the scar looks like as a result of the removal of the appendix. Only with varicocele, the incision is made more often on the left. But this comparison is conditional.
Gradually cut all tissue structures, including the wall of the inguinal canal. It contains the spermatic cord (a soft, rounded cord with lymphatic and blood vessels, nerves, etc.). This is where enlarged veins are found.
A cord is pulled into the wound and an enlarged vessel is isolated.
Fix and clamp it in 2 places.
Cut and impose ligatures (special threads) on the cut ends.

This is done with all the vessels that have been removed. After that, the wound is sutured layer by layer, and a bandage of sterile material is applied on top.

For some time, the operated person will need to take pain-relieving and antibacterial medications and wear a supportive bandage that prevents stretching of the spermatic cord. The stitches are removed on the 9th day. Restriction to heavy physical activity is imposed for six months.

Surgical intervention according to the Marmar method

The essence of the operational technique is the same as that of Ivanissevich, that is, dilated veins are also cut off. However, the operation is somewhat different. It requires the use of microsurgical instruments and a microscope.

First, a small incision is made, the length of which is about 30 mm. It is localized in the region of the exit of the spermatic cord from the inguinal canal.
The fatty subcutaneous tissue and other structures are dissected to get to the spermatic cord.
Enlarged vessels of the spermatic cord and some other nearby veins are found, for example, the external spermatic
With the help of microsurgical instruments, enlarged areas are fixed, clamped, dissected and tightened with ligatures under a microscope.
The wound closes in layers.

Inspection through a microscope helps not only to reduce the size of the incision, but also to reduce the risk of damage to healthy blood and lymph vessels and nerves.

Endoscopic removal of varicocele

The principle of the surgical method, carried out with the help of an endoscope, does not differ much from the traditional intervention according to Ivanissevich. Another is the method of access to the enlarged vessel.

First, a small incision of 5 mm is made 10 mm above the navel, a special needle is inserted into it and gas is supplied through it to straighten the space.
The needle is removed, the incision is increased to approximately 10 mm, and a trocar is inserted into it, which is a triangular wide needle with a tube. It is an important tool required for endoscopy.
Through the trocar introduces the camera and continue to supply gas into the abdominal cavity using an insufflator. The latter device also regulates the gas pressure.
Two more holes are made under the control of the telescope. One is located to the side and about 30 mm below the navel, and the second is to the left and 20 mm below the navel. Trocars are also inserted into them for the introduction of the necessary instruments.
Gradually get to the place of operation.
Dilated veins are isolated and fixed, clamped, cut and applied with clips or ligature sutures.
The peritoneum is sutured, which had to be incised for the introduction of the instrument.
Bring out the tools.
Trocars are pulled out after removal of gas.
The holes are closed with sutures or a patch, depending on the size of the incision.

Important! Before excision of the veins, it is necessary to separate them from the lymphatic vessels in order to avoid the development of dropsy of the testicular membrane.

The whole procedure is carried out under general anesthesia, which is administered intravenously or by inhalation (endotracheal method).

In the hospital, the patient is left under observation for 1-2 days. After which he returns to normal life. In the postoperative period, painkillers may be prescribed.

There may be pain in the shoulders due to accumulated gas.

Microsurgical revascularization

This operation is fundamentally different from the previous ones. However, as with the Ivanissevich technique, the surgeon makes an incision 50 mm long parallel to the course of the genital canal. An enlarged internal testicular vein is also taken out and cut off from it.

At the same moment, a segment of the epigastric vein is separated, and it eventually replaces the removed vessel. The incision is then closed.

Such an operation is also carried out under a microscope and refers to microvascular.

Important! This is the most effective and preferred option, as it allows you to restore physiological blood circulation.

Surgery is the only way to eliminate varicose veins of the testicular vein and pampiniform plexus, as well as such unpleasant consequences associated with it as an aesthetic change in the scrotum, pain and, most importantly, infertility.

The recovery period in most cases passes quickly, and the prognosis after surgery is favorable.

Video - Postoperative period with varicocele

During puberty, boys may experience various problems that may not bother at a young age, but in the future lead to such an unpleasant diagnosis as infertility. Therefore, in order to prevent such diseases in a child, it is necessary to undergo an examination by a urologist. Most often in adolescents, a disease such as varicocele occurs. However, it is completely curable and does not pose a danger in case of timely diagnosis and taking the necessary measures.

What is a varicocele?

This disease is a varicose vein around the male ovaries. Most often, it manifests itself in adolescence, and its symptoms are pain in the scrotum and testicles of a young person. In most cases, one or both testicles hurt, and the pain itself is pulling in nature, a kind of heaviness is formed in the groin. Moreover, the pain can intensify during physical exertion or during sexual contact.

But it must be remembered that often a varicocele in a teenager or even in an adult man proceeds without symptoms and is discovered quite by accident during examinations related to other diseases. In this case, the consequences of varicocele in men can be very negative, up to infertility. It is this disease that causes the inability to have children in 10-15% of the male population.

The disease can be of four degrees. The first degree is characterized by a slight expansion of the vein, which can only be seen on ultrasound. In the second degree, the expansion of the vein can be felt if the patient is in a standing position. With the disease of the third stage, varicose veins can be easily detected in any position, which is a clear indication for surgery or other treatment. The most neglected is, of course, the fourth stage, when varicose veins can be detected even with a visual examination.

Causes of varicocele

The main cause of the disease is increased pressure in the veins that provide the outflow of blood from the ovaries. It may be the result of any anatomical disorders, intense physical activity, which lead to an increase in intra-abdominal pressure. In addition, you can get sick due to the presence of blood clots or a violation of the outflow of blood from the kidneys due to constant squeezing of the veins.

These disorders are often the result of malnutrition, unhealthy lifestyles. Therefore, for prevention purposes, it is recommended to be active, engage in moderate sports, do not drink alcohol in adolescence or smoke. After all, these actions lead to a violation in the cardiovascular system and can cause varicose veins not only in the scrotum, but also in other organs, which can be more dangerous to health.

Due to the peculiarities of the male body, varicocele is more often left-sided, since it is the vein near the left testicle that is more often susceptible to this disease. Violation of the outflow of blood from the spermatic cord leads to an increase in temperature in the testicles, which adversely affects their functions and the quality of spermatozoa, and in the future - lead to infertility.

Treatment Methods

Varicocele can be cured in two ways:

Operational way;
Folk means.

At the same time, the answer to the question: is an operation necessary for varicocele can only be given by a doctor after a detailed examination and passing all the tests.

In order not to operate on the patient, some doctors use sclerotherapy. Its technique lies in the fact that a special substance is introduced into the patient's body, which normalizes the outflow of blood in the ovaries of a man and varicose veins are eliminated.

You can try to recover and folk remedies. The most popular are horse chestnut, blueberries and apricots. These products have a positive effect on the cardiovascular system and thus can normalize the blood flow in the male testicles.

The treatments described above are effective in the early stages of the disease. If the patient has a testicle that hurts, or it has decreased in size, and there are other sensations of discomfort, including a decrease in the amount of sperm during ejaculation, then preparation for varicocele surgery is necessary.

It consists in an external examination of the patient, an ultrasound examination. If necessary, dopplerography is performed to assess the condition of the veins in the testicles, and a spermogram may also be required to analyze the degree of the disease.

Operation and its consequences

There are the following types of operations for varicocele:

Ivanissevich's standard varicocele operation. It is performed in an open way, for which a skin incision is made, and then a vein is ligated to normalize blood circulation in the testicles. This operation requires local anesthesia and is not particularly difficult. The duration of Ivanissevich's operation does not exceed 15-20 minutes.
The Marmara operation for varicocele is microsurgical. Small incisions are made in the inguinal region and scrotum, through which the ovarian veins are dilated in a special way, which also results in the normalization of blood circulation in the male genitals. This operation also does not require anesthesia, local anesthesia is sufficient. The time of its holding is also not long and rarely takes more than half an hour.

Negative consequences after varicocele surgery are very rare. In the short term, dropsy sometimes occurs, but it disappears on its own, at the end of the recovery period after the operation and the normalization of the functioning of the body and genital organs. In the postoperative period, the testicles or tissues around the spermatic cord may hurt. However, this is also due to surgery, and the pain will pass.

During the period when recovery occurs after surgery on a varicocele, you should follow the doctor's recommendations in order to avoid complications after surgery and other negative consequences. Modern instruments allow you to fully control the course of the varicocele operation and carry it out with high efficiency and positive results.

What can not be done after the operation?

During the period when rehabilitation takes place after surgery, the following recommendations should be followed:

Do not carry out vigorous activity in the 48-hour postoperative period to avoid divergence of the sutures or the appearance of negative consequences.
Do not lift heavy, do not engage in active sports. However, during the recovery period after varicocele surgery, it is recommended to perform certain physical exercises under the supervision of a doctor.
It is forbidden to remove or wet dressings at the sites of operations to avoid infection.
Within three weeks, you should be observed by a doctor, and only after his permission to return to jogging, cycling, visiting the gym, and so on.
It is not recommended to take a bath for five days.

The main question, which, of course, worries men, is it possible to have sex or masturbate during the recovery period. Unfortunately no. It is necessary to be patient until it ends, until such permission is given by the doctor. Moreover, there is no single point of view on how long the recovery of a varicocele lasts. Each has individual scores. On average, you can resume sexual activity three weeks or a month after a varicocele.

Varicocele is a very unpleasant, but curable disease. The sooner it can be detected, the less consequences there will be. Therefore, experts recommend that men and adolescents during puberty visit a urologist periodically. After all, the most negative consequence of varicocele is infertility. It is this disease that causes the inability to have children in 10-15% of men. Its treatment is carried out mainly by surgery. However, modern technologies, like surgery on a varicocele, allow it to be performed with minimal tissue damage and a high therapeutic effect. Many are interested in whether it is possible to recover from this disease with folk remedies. It is possible, but only in the early stages.

Varicocele surgery is a treatment for the expansion of veins in the scrotum or seminiferous tubule in men, which can only be surgical. Surgery to remove a varicocele is easily tolerated and rarely causes complications. Before surgery, many patients are interested in how a varicocele looks in the photo before and after the operation.

The disease often occurs in adolescents and may not manifest itself in any way throughout life. In some cases, the patient has symptoms such as pain in the testicle, infertility, the appearance of tubercles on the scrotum, as a result of which the testicular vein is affected. A man feels discomfort and pain after stress. With the expansion of the vein of the spermatic cord, a testicular varicocele occurs.

The main treatment for varicocele is surgery. There are three types of surgical treatment - endovascular sclerotherapy, laparoscopy, open intervention. The stage of development of the varicocele and the method of the procedure affect its cost.

The operation performed for varicocele is easily tolerated and practically does not cause complications, but instrumental invasion into the body always raises many concerns not only about the surgical intervention and the patient's own feelings, but also about the future prospects - the rehabilitation period and the possibility of complete recovery.

Operation of varicocele: modern operations and treatment. Today there are about 120 different operations for varicocele. The main goal of surgery for varicocele is to prevent infertility due to venous congestion and subsequent sclerotic changes in the testis. Elimination of pain and cosmetic defect is considered as additional goals.

Interventions are carried out both in adults and in children older than 9 years. Operations for varicocele are performed in the conditions of the andrological department under anesthesia or local anesthesia. Both traditional open access and minimally invasive techniques can be used. The duration of hospitalization depends on the type of surgery for varicocele and the patient's condition.

The consequences of surgical intervention are irreversible, although at an early stage pathology provokes irreversible changes. With early manipulation, the likelihood of recurrence of the disease is high. Maintenance drug therapy is prescribed to the patient until puberty.

According to statistics, varicocele is a common pathology. Clinical and subclinical forms of this disease are detected in 16% of men. Pathology can occur both in adults and in patients of childhood.

The widespread prevalence of varicocele has led to the emergence of a large number of surgical techniques aimed at eliminating this pathology. Operations for varicocele are performed using retroperitoneal, inguinal and subinguinal access. In some cases, optical equipment and special instruments are used to reduce the number of relapses, early and late complications.

The list of the most common for varicocele using open access includes such operations as: Ivanissevich, Palomo and Marmara. Along with the listed interventions, laparoscopic excision of the testicular vein is widely used in modern andrology. In recent years, microsurgical testicular revascularization has become increasingly popular.

History and causes of varicocele

The pathology of veins (varicose veins) located in the scrotum and surrounding the testicles is called varicocele. Veins are the tubes that carry blood back to the heart from body tissues. To prevent the flow of blood in the opposite direction, the veins are equipped with one-way valves.

When for some reason they cease to perform their functions, a backflow occurs. Blood accumulates in a vein (especially when a person is standing) and bursts it. This is called varicose veins.

Varicocele in men surgery - when to start treatment

The testicles are surrounded by a whole system of small veins (pampiniform plexus). From them, blood enters the testicular vein (larger), and from there - into the renal (left testicle) or inferior vena cava (right testicle) vein. The pressure in the renal vein is much higher than in the inferior vena cava. This fact explains why the veins of the left testicle are mainly exposed to varicose veins.

Varicocele is a common cause of male infertility. This is due to the fact that blood accumulates in the dilated veins, which increases the temperature of the testicle. As a result, their function (spermatogenesis) is disrupted. Spermatozoa are produced less, and they are inactive.

The disease has several causes. Depending on the etiology, they are diagnosed: primary (idiopathic) and secondary (symptomatic) varicocele. Idiopathic varicocele most often occurs due to a genetic predisposition and manifests itself in adolescents during puberty.

At this time, there is an enhanced formation of the reproductive system, which requires increased blood supply. The increase in blood flow makes the veins work harder. If there are any pathologies in them, a failure occurs, which leads to varicose veins of the pampiniform plexus.

Stages of the disease and indications for surgery

There are 4 degrees of development of varicocele:

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

Decreased spermatogenic function, which can eventually lead to infertility, usually begins only in the last stages of the disease.

Surgery for varicocele: what types of operations exist and how they are done

Testicular varicocele (varicose veins) with dropsy has a specific configuration - the pampiniform plexus. Varicocele is the most common cause of male infertility. In 95% of cases, there is an expansion of the left testicular vein, since the outflow of blood from the system of the left renal artery into the testicular vein is carried out at a right angle, which creates high pressure on the venous valve system. Increased hydrostatic pressure overcomes the resistance of the valvular apparatus, so there is stagnation of the venous testicular system on the left.

Operation varicocele - Photo 1

Statistics say that varicocele is a common disease. About 16% of men on the planet suffer from it, but it is detected only in patients who turn to specialists due to infertility.

There are no pronounced symptoms in pathology, so you should carefully listen to health. The only manifestation of the pathology can be a pulling pain in the scrotum after exercise, walking, lifting weights.

Indications for surgery for varicocele:

Enlargement of the scrotum over 2 degrees;
Hypogonadism with an increase in one testicle in relation to the other by 20%;
Dropsy with impaired spermatogenesis;
Relapse after a previous operation;
Infertility.

The tactics and volume of surgical intervention is determined by the surgeon after a thorough examination of the patient. Before the intervention, the damaged vein must be identified and the nature of congestive changes proved.

Varicocele types of operations in men:

Laser coagulation is carried out by cauterizing the damaged area with a laser. The intervention is carried out with an intravascular endoscope. With the help of fiber optic technologies, coagulation of the injury site is carried out. With the help of laser beams, the damaged vein is switched off from the general blood flow. Manipulation is carried out without anesthesia;
Embolization endovascular - is carried out using a thin endoscope (about 2 mm thick), when varicose veins are contrasted through the femoral vein. Then, a sclerosing drug is injected into the injury site, gluing the lumen of the vessels.

The above operations belong to a number of intravascular. They are less traumatic, but are performed only if it is impossible to surgically remove the varicose vein, as they are accompanied by a large number of complications.

Varicocele surgery can be performed in the following cases:

The patient is in pain. They begin to appear at stages 2-3 of the disease, at first they are insignificant. Unpleasant sensations are aggravated by walking, after physical exertion. Note. In the vast majority of cases, a varicocele of the left testicle develops, so the pain most often has the same localization;
The testicle begins to decrease in size;
Irregularities in sperm formation were revealed. During the study, it was found that in the seminal fluid the number of spermatozoa is reduced, their mobility is reduced, there is blood or pus;
The patient is not satisfied with the appearance of the scrotum.

In the absence of symptoms, surgery for varicocele may also be recommended. Some doctors believe that surgical intervention, carried out in a timely manner, avoids infertility. Others believe that this is an unjustified risk, and advise limiting observation through periodic examinations and ultrasound.

Important! Operations for varicocele under 18 years of age are usually not performed. According to statistics, in adulthood after surgery, relapses are much less common - the re-development of varicocele. Therefore, it is better to exercise it after puberty.

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

Cost of varicocele surgery

Varicocele surgery is not included in the list of "high-tech care" services for which funds are allocated. The website of some clinics indicates that they work with CHI and VHI, but in the first case, it is only about a discount that a client who has contacted them can receive, or a refund of part of the money spent.

Operation varicocele - Photo 2

The cost of the operation depends on the chosen technique and region. In the provincial cities of central Russia, the price for open surgery starts from 5,000 rubles, in Moscow - from 8,000 - 10,000 rubles. Approximately the same will cost sclerotherapy.

Microsurgical intervention (according to Marmar) will cost at least 20,000 - 30,000 rubles. A laparoscopic operation will cost somewhat cheaper - 15,000 - 25,000 rubles. Prices are based on local anesthesia, if the patient prefers general anesthesia, he will have to pay separately - 7,000 - 10,000 rubles.

Operation Ivanissevich - from 4,000 to 115,000 rubles;
Laparoscopic excision of the testicular vein - from 5,000 to 188,500 rubles;
Operation Marmara - from 11,100 to 246,600 rubles;
Embolization of varicocele - from 12,850 to 46,000 rubles;
Operation Palomo - from 16,800 to 108,100 rubles.

Is varicocele surgery necessary? If a young man wants to preserve or restore his fertilizing function, then surgical treatment is indispensable. The operation can be omitted if the problem of paternity for a man today and in the future is irrelevant.

Indications for varicocele surgery

Timely operations with varicocele on the testicle contribute to the elimination of negative conditions for the maturation of spermatozoa. They are performed in a surgical clinic. Depending on the method of surgical intervention chosen by the doctor, they can be performed both under general anesthesia and under local anesthesia.

In case of varicocele, the indications for surgery are reduced to the presence of varicocele, which is accompanied by a dysfunction of spermatogenesis, pulling pain in the groin area and along the spermatic cord, either when playing sports and lifting weights, or permanently, as well as an increase in the scrotum. These signs correspond to 1 and 2 degrees of the disease. The operation can also be performed before the age of 18, if there are initial signs of testicular atrophy.

Preparing for the operation

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

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

In addition, the doctor will usually prescribe an ultrasound of the scrotum or 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 the operation, you need to refuse food and water, take a hygienic shower. The pubis and belly must be clean-shaven. Taking drugs for chronic diseases (diabetes, hypertension, bronchitis, etc.) must be agreed with the doctor.

Operations for varicocele - types

How is varicocele surgery done? To perform an operation on a varicocele, there are several types of surgical interventions - classical and modern. These include:

Operation Ivanissevich;
Operation Marmara;
Laparoscopic surgery;
Operation Palomo;
microsurgical method.

Each of these types has its own indications and contraindications, its pros and cons.

Operation Ivanissevich

Video of Ivanissevich's operation with varicocele

The Ivanissevich operation is a long-established standard technique for varicocele surgery, which future surgeons study as students, so it is a must-have in the set of professional skills of any urologist-surgeon. How is varicocele surgery performed? Its essence lies in the ligation of the testicular vein in the retroperitoneal space, resulting in a complete blockage of the blood supply in it.

What are its benefits? Operations on varicocele according to Ivanissevich are carried out for both adults and children who need them. The intervention is carried out under local anesthesia, which protects the cardiovascular system of patients from excessive stress. The operation does not require the use of special equipment, so it is available to patients in ordinary hospitals, and not just expensive private clinics.

This type of surgical treatment of varicocele is simple to perform and quite effective, and therefore has been successfully used for more than half a century. However, there are also disadvantages here - and very significant ones: they relate to the postoperative period, in which many patients develop a hydrocele (hydrocele), as well as re-expansion of the veins (recurrent varicocele). In addition, although rare, testicular atrophy is possible, which is one of the most unpleasant consequences of this surgical technique.

Relapses are especially frequent in children: they develop in slightly less than half of the cases. This is due to the fact that after ligation of the testicular vein, small vessels remain that extend from it, as well as collaterals - additional blood-supplying branches, which are almost impossible to manually tie, because they are often not visible to the surgeon. They subsequently undergo repeated varicose veins, which again turns into the development of varicocele.

Operation Marmara

Video operation Marmar with varicocele

This type of intervention involves micro-access and a low degree of invasiveness. It is carried out under the control of a microscope. The choice of anesthesia largely depends on the desire of the patient, in most cases local anesthesia is sufficient, in which there may be slight pain or a feeling of tingling, warmth.

The surgeon makes an incision in the pubic area, as close as possible to the ilium, which makes the suture invisible after the operation (it will be located below the top edge of the underwear). The doctor excised the integument and subcutaneous tissue, allocates the seminal canal and bandages the vein. The fabrics are sutured. The sutures are removed on the 7th day. How is the Marmara operation going? It is highly accurate, which reduces the risk of damage to arteries or lymphatic vessels.

Laparoscopic surgery

Video Laparoscopic varicocele surgery

General or local (more often) anesthesia is used. Epidural anesthesia (pain medication is injected into the spine) is also sometimes used. After the onset of anesthesia, the surgeon makes a puncture in the navel with a diameter of about 5 mm. A trocar is inserted into it - a triangular needle connected to a tube. Gas is injected into the abdominal cavity to free up space for surgical procedures.

How is varicocele surgery performed? A laparoscope is inserted into the hole - a tube connected to a lighting device and a camera. It allows the doctor to monitor the progress of the operation. Under the control of a laparoscope, two more five-millimeter punctures are carried out - in the iliac region and above the womb, and the introduction of trocars into them. The patient is tilted to the right by 15-20° for better visualization. The doctor, using scissors inserted into the puncture, cuts the peritoneum.

Next is the allocation of arteries and lymphatic vessels. This is necessary so that they do not suffer during the operation. The dilated veins are ligated. The peritoneum is sutured. An aseptic dressing is applied to the punctures. The duration of hospitalization depends on the chosen anesthesia.

After local anesthesia, you can go home on the day of surgery or the next. After general anesthesia, discharge occurs 3-7 days after the intervention. The effectiveness of the operation is assessed using ultrasound or dopplerography.

Operation Palomo

This type of intervention is similar to the previous one. However, the incision is made higher, which gives a better view for the surgeon. This approach lowers the risk of recurrence, but increases the chance of cutting the artery that supplies blood to the seminiferous canal.

Operation varicocele - Photo 3

This is a small vessel that comes close to the pampiniform plexus and is therefore often damaged during surgery. There is also a risk of grazing the lymphatic channels, especially in childhood. This can lead to serious complications.

Microsurgical technique

Video Microsurgical operation of varicocele

The microsurgical technique of varicocele surgery is recognized as the best among all existing methods for the treatment of varicose veins of the spermatic cord. Its purpose is to replace the diseased testicular vein with a healthy one - for this, an epigastric vessel is used, which is sutured to the site of the removed section of the vein of the spermatic cord with the creation of a vascular anastomosis - anastomosis.

The advantages of the method are its physiology, a small number of cases of re-development of varicose veins, a short period of stay in the surgical department and the same short rehabilitation. This is due not only to the fact that the restoration of blood circulation in the operated testicle occurs immediately, and not after a few days, as with other types of operations on a varicocele.

The very meaning of such an intervention lies in the complete normalization of blood flow in the testicle, and not in the simple ligation of the affected vein and its branches, and therefore the number of negative consequences here is negligible.

Operation varicocele - Photo 4

Complications of microsurgical intervention include accidental damage to the nerve endings in the inguinal canal, bleeding and infectious inflammation of the operated areas, but these consequences are very rare. Do not perform microsurgical operations on varicocele in patients with oncology and severe cardiovascular diseases, diabetes mellitus.

The recovery period passes quickly enough: already on the second or third day, patients are discharged from the hospital, and the stitches are removed after 8-10 days. The main disadvantage of microsurgical intervention for varicocele is its high cost: the cost of the operation varies from 40 to 90 thousand rubles. This is due not only to the need to use expensive optics and special instruments, but also to the fact that only specially trained surgeons of the appropriate qualification can perform such operations.

What type of surgical treatment to choose is a question that is decided by both the patient himself and the attending physician: the patient wants the operations for varicocele to be inexpensive and effective, while the specialist is forced to think not so much about the patient's solvency, but about purely medical things - age, comorbidities , the likelihood of complications. Therefore, it makes sense to listen to the doctor's opinion if he recommends not a simple Ivanissevich operation, but laparoscopy or microsurgical treatment: most likely, the specialist has serious reasons for such a choice.

Treatment of varicocele without surgery

Treatment of varicocele without surgery is possible, but only with the aim of normalizing the functioning of the ovaries, correcting the disturbed hormonal background. Dropsy of the ovary is accompanied by impaired spermatogenesis and infertility. In older men without severe symptoms, it is irrational to remove the dilated testicular veins, since the return of reproductive function by surgery is not a rational step. At home, such patients take antioxidants and venotonics (phlebodia) to prevent the destruction of testicular tissue and maintain the tone of the venous wall.

Conservative treatment of varicocele without surgery is performed for young people up to the age of 18. Only after the formation of the reproductive sphere is dropsy therapy carried out. Until the maturation of the reproductive organs, surgical intervention on the genitals is not performed, since after the procedure there is often a violation of the formation of the testicles, a slowdown in their growth. The task of conservative treatment in this case is to prevent the progression of the disease.

Treatment of varicocele in men without surgery can be carried out at home with folk remedies only if the person has refused manipulation. This approach is not rational, since conservative methods cannot restore the tone of a varicose vein. There are cases of religious beliefs regarding the manipulation of the genitals, so some patients refuse the procedure.

How long does varicocele surgery take? This may depend on what procedure you need to perform. But as usual, any simple operation lasts about 30-50 minutes, in some cases it takes from 1 hour to 3 hours.

What type of surgery is used for varicocele. What types of operations to remove varicocele exist? Indications for varicocele surgery

How to prepare for surgery