According to statistical data, the most common explanation of male infertility is varicocele. This pathology is observed in 1/6 of the male population, and in a third of men under 30 years of age who have infertility, its cause is varicocele. If we talk about infertility of older men, varicocele is the main culprit in 85% of infertile men. According to this statistic, the conclusion suggests - violations of spermatogenesis and testicular dysfunction progress with age. This explains the fact that as a young man, a man was able to conceive a child, and at maturity this is no longer possible( for example, in a second marriage).The picture is formed in such a way that varicocele and infertility often coexist with each other.
Causes of pathological abnormalities
Pathology consists in the expansion of veins, entangling the testicles and the spermatic cord. When probing in patients with varicocele, it is felt that the spermatic cord is somewhat thickened, and the veins around the testicle are tense and look like a "tangle of worms."
If the patient strains the abdominal press and simultaneously delays breathing on the inspiration, the veins affected by the varicocele become even more tense. This method of diagnosis is called the Valsalva trial.
Varicocele can develop in any man, regardless of social and professional affiliation, but still more likely to be affected by persons whose activity is in hard physical labor and sport. Most varicocele is left-sided, which is due to certain features of the circulatory system of male genital organs.
Infertility in patients with varicocele develops due to increased testicular temperature. Blood from the testicle and nearby organs flows through the vessels of the scrotum towards the heart from the bottom up. In a healthy man, the reverse blood flow is prevented by special venous valves. If the veins are exposed to varicose veins, the valves can no longer function properly, causing the blood to move along the veins in a pendulum, which disrupts the ovarian blood supply.
As a result of these disorders, the network of veins located around the testicle increases, and the testicle itself is immersed in the venous-vascular sponge. As a result, the testicle no longer cools. For spermatozoids, the temperature is slightly lower than in the whole body, and when the varicocele is higher, the spermatozoa cease to develop at all. The result of such pathological changes is male infertility. It is this circumstance that closely links varicocele and infertility.
Due to the peculiarities of the ovarian tissues against the background of the developing varicocele, an aseptic autoimmune inflammatory process may occur, which may exert a depressing effect on spermatogenesis.
How to treat varicocele
If a varicocele is found in relatively young men who are planning paternity in the future, a mandatory surgical procedure is indicated. Even at school, adolescents undergo a planned urological examination, and if a varicocele is found, an operation is prescribed. If the pathology is found in a fully mature man who does not plan paternity in the future, then surgical treatment can not be carried out, since varicocele absolutely does not threaten health, affecting only the ability to conceive.
Treatment of pathology with medicinal products does not give positive changes, therefore it is not applied. But surgical intervention can not always help, only in cases where the duration of the pathology does not exceed a 5-year period.
Usually varicocele is bilateral, therefore the operation is carried out on both sides. In general, indications for surgery are:
- Infertility;
- Painful syndrome in the scrotum, interfering with the normal functioning of men( for example, with sexual contact, physical exertion);
- Extended veins lead to changes in the consistency of the testicle or a decrease in its size;
- Pathologically progressive changes in spermogram.
There are several varieties of surgical treatment varicocele. These can be traditional operative measures, x-ray endovascular or endoscopic surgery. The essence of operations as a whole is reduced to the removal of dilated veins, but the techniques are different. In the case of traditional surgical interventions( operation Marmara, Ivanissevicha, Palomo), the Marmara operation, involving the doping of the enlarged veins by a microsurgical method through the groin, is the most effective and minimally traumatic.
This method from such standard open operations is characterized by maximum efficiency and minimal complications, low invasiveness( seam length is not more than 3 cm) and excellent cosmetic effect. Operation Marmara assumes a dressing of all veins in the spermatic cord, thereby eliminating complications and relapses. A few hours after the procedure, the patient can return home.
The method of surgical treatment popular in patients is laparoscopic surgery. This is a sufficiently minimally invasive and effective method for treating varicocele, in which the operation is performed through small punctures in the peritoneum: the ovarian veins are bandaged and pinched by titanium braces. The laparoscopy takes about half an hour, or even less - depends on the severity of the disease.
