Varicocele , Micro Surgical Varicocelectomy .

WHAT IS Varicocele?

A varicocele is an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum). A varicocele is similar to a varicose vein you might see in your leg.

Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to fail to develop normally or shrink.

Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose and many don't need treatment. If a varicocele causes symptoms, it often can be repaired surgically.

How is varicocele treated?

The decision to treat a varicocele depends on whether you are having symptoms and on whether you are trying to have children. Men who are not having symptoms usually do not need to be treated. For men who are having mild or occasional symptoms, the following steps may be enough to control the discomfort:

Wearing a jockstrap during exercise or prolonged standing.
Avoiding activity that causes the discomfort.
Applying ice to the scrotum and groin, and/or.
Taking the occasional over-the-counter pain reliever such as ibuprofen or acetaminophen.

Clear indications to repair a varicocele

in adolescence include

1.Progressive testicular atrophy

2.Pain or

3.Abnormal semen analysis results.

Although treatment of a varicocele generally improves sperm characteristics, it's not clear if an untreated varicocele leads to progressive worsening of sperm quality over time.

TREATMENT OPTIONS

microsurgical varicocelectomy

This treatment usually is done on an outpatient basis, during general or local anesthetic. Commonly, your surgeon will approach the vein through your groin (inguinal or subinguinal), but it's also possible to make an incision in your abdomen or below your groin.

Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.

You might be able to return to normal, nonstrenuous activities after two days. As long as you're not uncomfortable, you might return to more strenuous activity, such as exercising, after two weeks.

Pain from this surgery generally is mild but might continue for several days or weeks. Your doctor might prescribe pain medication for a limited period after surgery. After that, your doctor might advise you to take over-the-counter painkillers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve discomfort.

Your doctor might advise you not to have sex for a period of time. Most often, it will take several months after surgery before improvements in sperm quality can be seen with a semen analysis. This is because it takes approximately three months for new sperm to develop.

Open surgery using a microscope and subinguinal approach (microsurgical subinguinal varicocelectomy) has the highest success rates when compared with other surgical methods.

Laparoscopic surgery.

Your surgeon makes a small incision in your abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. This procedure requires general anesthesia.

Percutaneous embolization

A radiologist inserts a tube into a vein in your groin or neck through which instruments can be passed. Viewing your enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure isn't as widely used as surgery.

After embolization, you can often return to work after two days, and begin exercising after seven to 10 days.

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