Varicocele

Varicocele surgery: removal in men is done, the types of passes (turn), as last, testicular surgery (surgery), if the left is needed, preparation, if necessary

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Varicocele represents a pathological process, accompanied by expansion of the veins around the spermatic cord in 20% of men. Progressive disease violates the outflow of blood from the testes, leading to oxygen starvation and disorder trophicity genitals. Pathology negative impact on reproductive function, there is a decline in semen. In the absence of timely treatment possible infertility. Therefore, to eliminate varicocele surgery is the most effective treatment option.

Do I need a varicocele surgery

Do I need surgery for varicocele

Development of the disease are subject to men of any age group. But the risk of a pathological process increases during adolescence life. Varicocele in most cases are diagnosed in young men between 13 and 16 years. This is due to sharp changes in hormonal levels and puberty the body. These processes can exacerbate the pathology.

No effect on the initial stages of progressive disease on spermatogenesis and causes trophic disorders of the testicles. Therefore, surgery should be deferred until the age of 18, because the procedure can disrupt natural processes puberty, trigger the development of chronic diseases or appearance relapses.

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Prior to surgery the boy prescribe a comprehensive treatment of varicocele medication therapy and physiotherapy. left testicle pathology in some cases is a complication of varicose veins in the lower extremities. With vigorous development of the disease make an exception and carried out an operation to adulthood to prevent infertility.

Men's disease

For people over 18 years of surgical procedure are trying to carry out at an early stage after the confirmation of the diagnosis of varicocele. This is necessary for the prevention of infertility and testicular atrophy. Varicocele should do the operation as soon as possible to avoid not only reproductive disorders, but also the development of complications. Varicose veins on the left side of the egg can go to the right body, which can cause hormonal disruptions and erectile dysfunction.

It does not require immediate surgery in the elderly, when the reproductive function and testosterone levels are not important. The operation is performed only in the event of severe pain and local inflammation that interferes with the normal movement of the person.

The procedure is not carried out in the last stage of varicocele, when there was an irreversible atrophy of the testicles. In such cases varicose pampiniform vascular plexus results in complete infertility, so there is no need for surgery.

testimony

Surgical varicocele surgery in men is carried out in accordance with the following indications:

  • disruption of spermatogenesis in confirming the diagnosis;
  • severe pain of varicose;
  • re-occurrence of disease;
  • strong expansion of the veins around the spermatic cord, confirmed on Doppler and ultrasound.
disruption of spermatogenesis

Left varicocele When surgery is performed after failure of drug therapy. Surgery is required to carry out in case of disease in adolescence against the backdrop of severe pain or impaired mobility. The doctor begins to operate only in a hospital in the department of surgery and urology. Anesthesia is selected depending on the technology of the procedure.

For operation with decreasing egg affected side in size or in the development of pronounced inflammation.

Contraindications

By operation in varicocele, the following contraindications:

  • Bleeding disorders or taking drugs for its liquefaction. When operations are performed cuts, resulting in bleeding develops. If a person's blood does not clot, then holding cancel the procedure. There is a risk of severe blood loss or infection infection through an open wound directly into the bloodstream.
  • Pathological processes in the skin: suppurative bacterial diseases, inflammations, ulcers, psoriasis. If the structure is damaged epithelial tissue, it is strictly prohibited to perform surgical procedures. This ban is due to a disorder of tissue regeneration processes, the occurrence of systemic inflammation or infection possible hit. In purulent diseases of the operation is not carried out until the patient will take a course of antibiotic therapy.
  • Infectious and viral lesions of the urogenital tract, the presence of sexually transmitted diseases: bacterial prostatitis, an inflammation of the urethra, the prostate gland tuberculosis, cystitis, chlamydia, gonorrhea. The patient should be fully cured comorbidities before surgery to remove a varicocele.
  • Surgical intervention through the abdominal cavity is not carried out under severe abdominal pathologies such as sepsis, ascites, ileus, decompensated acidosis, motor neurosis of the gastrointestinal tract.
  • Lesion of the genitourinary system

    How to prepare

    Preparation for surgery of varicocele includes a set of remedial measures. The procedures are the same for any method of surgery. After passing through the preparatory phase treatment can be performed in a day. During these 24 hours, the patient must be under steady state conditions.

    Before surgical treatment of varicocele is necessary to pass a comprehensive examination:

    • If the operation will take place under general anesthesia, the patient should undergo chest X-rays, an electrocardiogram done, tell the surgeon blood group and Rh factor. You need to check on the human hypersensitivity and anaphylactic reactions to drugs for anesthesia.
    • To determine the severity of the disease and the affected area is required to take a blood and urine on a common analysis, undergo ultrasound of the scrotum and research on testosterone levels. To identify the impact of the disease on the reproductive function, the patient must make a semen analysis. Before the operation is necessary to avoid HIV, hepatitis, infectious disease and syphilis.
    • In the presence of chronic diseases need to consult your doctor and the resolution of a narrow profile. If there are no co-morbidities, it requires only the conclusion of a urologist or a therapist.
    eliminate HIV

    Before the procedure is recommended to prepare yourself: shave the hair in the pubic and groin area. If the operation is carried out in the morning, you can eat and drink liquids only until 22:00 the previous day. After that time forbidden to eat and drink beverages.

    How do different types of operations

    There are various kinds of operations with varicocele, via which removed or damaged vessels cropped bloodstream over extended veins. There are classic treatments, implying excision of tissue in order to open a direct access of varicose veins, laparoscopic intervention, intravascular or microsurgical technology. Best technique is selected based on the individual characteristics of the patient, laboratory parameters, and the severity of the pathological process.

    operation Marmara

    Surgical intervention refers to microsurgical treatments. During the procedure, you must not penetrate into the abdominal cavity, so the technology to remove the varicocele is considered the most effective. After the operation there is a low likelihood of relapse and complications. Minimally invasive treatment practically does not injure the tissue. Positive dynamics of tissue recovery without recurrence of the disease occurs in 90% of patients. Operation lasts about 40 minutes.

    Before the surgery required to pass general blood and urine, do an electrocardiogram.

    At the initial stage surgical incision is 3 cm in the place of exit of the spermatic cord. From the base of the penis soft tissue excision carried out at a distance of 1 cm. Thanks to surgical instrumentation doctor finds the spermatic cord and under the microscope begins to dress the surrounding venous vessels. Accuracy ligation caused a visual extension of the affected veins, so in the course of the procedure are not injured arteries, lymphatic vessels and nerves. After completion of the manipulation of the wound is sutured in layers.

    rehabilitation period is only 48 hours, so there is no need for a long-term hospitalization. After 2 days the patient is discharged from hospital. During the week, you can not do intense exercise, and raise different severity. Thanks to the technology of the seam is carried out below the level of the laundry, so a small scar will not stand out.

    operation Ivanissevicha

    Surgery for varicoceles in most cases carried out by Ivanissevicha technology. During surgery, the manipulation is performed through direct access in the groin area: thanks to the longitudinally-skew excision can be identified inguinal venous plexus. Incision of no more than 5 cm is made in the lower abdominal area parallel to the inguinal canal.

    During the operation doctors ligated mouth testicular vein, followed by dissection. Vessels closed by ligatures. Similar actions can be performed with testicular vein branches. In this case, an adult patient is conscious, is made a local anesthesia. In childhood, the procedure is performed under general anesthesia. After completing manipulation of the tissue layers are sewn and fixed superposition skin sutures. Superimposed over the sterile dressing.

    operation Ivanissevicha

    Despite the prevalence technique there is a high risk of damage to the lymph nodes, nerves, a large femoral artery and other blood vessels in the inguinal canal. Technology Ivanissevicha ineffective, so in 40-65% of patients undergoing a second procedure because of relapse. This is due to the fact that during the operation, the doctor can not detect all the affected veins. The vision of the surgeon is limited to a small incision. Duration of surgery is 15-40 minutes.

    After completion of the procedure may develop pain that cropped with ice or painkillers. For the prevention of infectious and inflammatory diseases take antibiotics. Within a week after the operation it is necessary to wear a supportive bandage. This bandage reduces the tension of the spermatic cord and reduces the risk of discomfort. The recovery period is about 3 weeks. Sutures are removed on day 9.

    The first 2-3 days is necessary to limit the motor activity. After this time, you can make brief walks. In the next 6 months is not recommended to expose the body to physical overexertion.

    Laparoscopic surgery

    Endoscopic surgery is performed in varicocele without excision of soft tissue in the inguinal folds. The technology implemented by laparoscopy method. The aim of surgical intervention is the same with other methods for treating varicose veins and assumes ligation and dissection testicular vein.

    During the operation using special tools - laparoscope or endoscope, which is introduced using a catheter. Phones equipped with fiber node, the transmitting the image on the monitor. At the end of the endoscope positioned instruments small size. Through the use of a laparoscope is possible to avoid severe bleeding, lower risk of complications and soft tissue trauma.

    Surgical intervention is performed under general anesthesia. For blocking testicular vein blood flow to make the stomach 3 small puncture is no longer than 0.5 cm. The incision in the navel catheter through which penetrates into the abdominal cavity of a small video camera. In other protocols 2 perform surgical procedures. They introduce scissors, clamps and ligatures. The operation of varicocele laparoscopy technologies is 30-40 minutes.

    At the initial stage of the procedure introduced in one puncture insufflyatornuyu tube for insertion into the preperitoneal space and retroperitoneal gas. At this time, the camera transmits an enlarged image on a special monitor. Due to the resulting picture surgeon may navigate freely in the treated area. Broad overview allows the physician to rapidly withdraw arterial and venous testicular vessels from under the peritoneum. Thereafter vein superimposed titanium staples and ligatures tied off blood flow. Upon completion of the removal or manipulation produce vascular intersection.

    On the 3rd day the patient is discharged from hospital. Puncture impose a sterile bandage, so tissue recovered in a short period. Due laparoscopic operations can be parallel to the bandage receptacles bilateral varicocele. Other technologies require treatment of the two separate sections. Endoscopic procedure may be carried out under expressed pain syndrome or asymptomatic disease.

    This technique varicocele treatment is performed under general anesthesia due to involvement in the course of surgery of the abdominal cavity and fill the void space gas from the bodies. If the patient was conscious, he must feel a strong pain shock.

    Laser surgery

    Against the background of a varicocele forms of operation in almost any technique require excision of tissue in the affected location. Laser therapy is performed without an incision in the abdomen or groin. Operative intervention is carried out via intravascular endoscope. Built-in video camera helps you quickly find the inflamed vessel. Struck endothelium from inside is coagulated under the influence of the laser. varicose veins are removed from the local blood flow in the blood clotting process and burn tissue. Through this procedure does not require general anesthesia.

    The procedure is in accordance with the following sequence of actions:

    1. Place of anesthetize surgical procedures.
    2. The groin make a small incision and injected into the femoral vein catheter is approximately 2 mm thick. According to it, in large vessels penetrate the endoscope.
    3. Thanks to the camera control unit and the X-ray is performed to the affected blood flow, where doctors coagulated blood circulation.
    4. Duration of the procedure is 20 minutes. After this time, surgical instruments are removed and a pressure bandage is applied.

    The patient can leave the hospital within 30 minutes after completion of the operation.

    The postoperative period

    When carrying out operations on the testicular varicocele on Marmara Ivanissevicha technology or the patient must be in the hospital about 48 hours. Sutures are removed on day 8-9. Within a month, you need to visit a urologist for the prevention of complications.

    recovery

    The duration of the rehabilitation period after surgical treatment of varicocele depends on the technology and the patient's age: the older the man, the longer the fabric will be restored. On average, the regeneration is completed in 1-2 weeks. In laparoscopic surgery the body is restored in 24-48 hours at microsurgical varicocelectomy - 2-3 days.

    To prevent relapses and complications is necessary to comply with the doctor's recommendation, move more, and a balanced diet. At the same time during the rehabilitation period is strictly forbidden to expose the body strong physical stress, lift heavy things and run. Foot movement is allowed for 10-15 minutes. Activity is needed to avoid the development of adhesive processes.

    balanced diet

    To avoid the occurrence of infectious diseases, it is necessary to pass a course of antibiotics. it is recommended to purchase a special bandage that needs to wear during the week to reduce the load on the spermatic cord. Excessive use of painkillers in the recovery period should not be, because it may be addictive. As a result, anesthetics cease to operate. For pain relief, you can apply ice.

    After the operation is necessary to periodically consult the urologist and to be tested for semen analysis and for determination of the activity of sex hormones.

    possible complications

    Surgery to remove a varicocele on the testis can cause complications:

    • Lymphatic stasis. The pathological process develops in damaged lymph node during surgery. A similar situation occurs in violation of the innervation and blood supply to the tissues.
    • Recurrence of disease process.
    • Pain syndrome in the scrotum. The pain is caused by the development of adhesive processes or impaired production of prostaglandins.
    • Dystrophy or tissue degenerative processes in the male testis. Complication characterized by atrophy of the organ after careless ligation of the arteries with the veins damaged. Egg is not receiving power as a result of violations of microcirculation.
    • Hydrocele or hydrocele. Disorder of venous outflow can lead to fluid accumulation in the scrotum.

    The risk of complications depends on the experience of the operating surgeon, the severity of pathology and anatomical structure of individual organs.

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