What is Varicocele Surgery or Varicocelectomy?
Varix (dilated vein), cele (a tumor) – Varicocele is a condition where the veins in the scrotum are abnormally enlarged. Similar to the varicose vein on the legs or hands, Varicocele is varicose on the testicles.
Bad news – Varicocele is one of the most identified causes of male infertility.
Good news – Varicocele can be corrected!
And the surgical technique that is performed to treat this condition and improve male fertility, is called Varicocelectomy.
How common is Varicocele?
Around 15% of all men have this Varicoceles, but not all are aware of their condition until they are evaluated for infertility. According to research, 35-40% primary infertility and 80% of secondary infertility cases are caused by Varicoceles. Varicocele is found to be prevalent in 25% of the cases of abnormal semen analysis.
So how does this enlarged vein on the testes influence fertility in men?
Varicocele and Infertility in men
The temperature in testicles is generally 2 degrees centigrade less than that of the rest of the body. The enlarged veins impair the testicular blood flow causing the increase in temperature which reduces the production of testosterone, thus reducing the number of spermatozoa in the semen. This increase in temperature also induces oxidative stress that damages the health of sperms, their motility, and morphology.
When the sperm production, as well as the health of the sperm, is compromised, the chances of conception severely takes a hit causing infertility.
Symptoms of Varicoceles
As said above, most of the men are not aware of this condition until the fertility evaluation is done. But in some cases, the enlargement of the vein is visible and so men even feel a mild to the sharp sensation of pain in their scrotum. A physical examination is done followed by an ultrasound to diagnose and evaluate the condition.
Treatment options to reverse the Varicocele
Being one of the most commonly identified conditions in men infertility cases, Varicocele can be reversed using Varicocele repair surgery where a one-inch incision is made to access the veins causing the Varicocele and they are ligated, thus alleviating the condition to improve the production and health of sperm. This surgery can be performed using a variety of techniques traditional (open), laparoscopic or using embolization.
How is the Varicocle surgery done?
A small incision is made in the groin region, to easily identify the structure of the spermatic cord, testicle arteries, lymphatics and small periarterial veins. The veins which are abnormally dialated (swollen) and then ligated. The wound is then closed.
How long does a Varicocele Surgery take?
It is generally a day care process, done under general or local anaesthesia and takes approximately 1-2 hours to complete.
Success rate of Varicocele Surgery
The Varicocelectomy shows a considerable improvement in the semen quality to about 60%-80%. This in its turn enhances the chance of pregnancy from 43% to 69% after controlling the female factors, within one to two years. The larger varicoceles, may incur more damage to the semen quality but are easier to repair compared to their smaller counterparts. However, the overall pregnancy rate is similar regardless to the size of the variococeles.
Varicocelectomy in younger men yields better result and faster recovery from the varicocele incurred injury to the testis.
Risks associated with Varicocele Surgery
There are minimal risks involved in the process apart from some swelling and pain that settles within a couple of days. In some cases formation of the Hydrocele (watery fluid around the testicles) or Testicular Atrophy (shrunk testicles) may happen. However, chances are very low, about 1%-15% for Hydrocele and only about 1%-2% for Testicular Atrophy.
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