Varicocele

How is surgery done?

Varicocele surgery is performed by microsurgical method. The testis vessels are reached by entering a 2 cm incision in the groin area. Under a microscope, enlarged veins are separated from other vessels and tied up.

How long does a varicocele operation take?

Since varicocele surgery is performed by microsurgical methods, all the vessels in that area must be connected. The duration of the operation may vary from 1 to 2.5 hours, depending on whether the operation is unilateral or bilateral and the number of tied up vessels.

Is varicocele surgery risky?

Since varicocele surgery is performed by microsurgical method, the complication rate is extremely low. The most important risk is the connection of the testicular artery and its related complication of testisical shrinkage and blood supply deterioration. However, since the operation is performed by microsurgical method, artery and vein separation can be distinguished very clearly. The likelihood of such a complication is extremely low nowadays. The likelihood of liquid accumulation around the testicle is also very low. In addition, risks such as the development of postoperative infection and bleeding should not be ignored. By paying attention to sterilization and checking bleeding regularly minimize the possible problems.

Are varicocele different treatment methods?

Varicocele is treated with different surgical and radiological methods.

Embolization of varicocele; Injection of the obstructive material into the enlarged vessels can be performed by entering the groin through the interventional radiological methods. However, in this method, mobilization of the obstructive methods may cause side effects such as pain and allergic reaction. This treatment approach is not highly recommended in international guidelines.

There are other surgical methods except microsurgery. There are approaches from the groin area, the high inguinal area, or laparoscopically. However, the operation of the lower inguinal region under the microscope is considered to be the gold standard.

Does Varicocele reoccur?

The possibility of reoccurance in operations performed by microsurgery is almost zero.

How long does it take to recover?

After the operation by microsurgical method, the patient can return to daily activities in 2-3 days and  work life within 1 week and 10 days. It may take 4-6 weeks to perform activities such as exercise which require heavy effort

When do the sperm recover after varicocele surgery?

Varicocele

Sperm production after Varicocele

The duration of sperm production should be considered to evaluate the effect of varicocele surgery on sperm. The average time from the main germ cell to the production of mature sperm is considered as 90 days. Therefore, the sperm parameters are checked every 3 months after the operation. The best improvement in sperm production after varicocele occurs at 6th month. If there is an improvement in sperm parameters at 6th months, 9 and 12 months should be expected since it is the time when the production even gets higher.

However, if there is no change in sperm parameters in the 6 months after the operation, the patient should not expect any additional improvement due to surgery. The patient should be referred to other treatment alternatives. After the operation, 60-70% of patients have improved sperm parameters. 30% to 40% of patients do not have any improvement, while less than 1% of patients may experience a worse course after varicocele surgery. This is a very rare condition and occurs mostly in patients with bilateral varicocele.

What are the conditions that patients should be cautious after surgery?

In the early period after varicocele surgery, by following the doctor’s recommendation, it is necessary to abstain from sports activity, heavy exercise and sexual activity. it is appropriate to wait for a 15-20 day period for sexual activity and for 4-6 weeks for sports and other exercises that require effort. In addition, the treatment methods recommended by the doctor should be followed.

Is there any pain in the testicles after surgery?

In varicocele surgery there may be a kind of neural- nous pain, especially due to damage of neural tissues in the testis area. In addition, doing surgery to patients with only testicular pain complaints is not the right approach. In such patients, there is a great deal of underlying causes for pain. Pain continues in such patients after surgery, too. They are the patients whose surgeries failed not because of the infertility problems and yet have pain.

Is swelling after varicocele surgery possible?

Postoperatively, the testicular sagging can be normal due to relaxed testicular connective tissues. However, the swelling is the increase of the liquid more than the normal amount around the testis, which is also called hydrosel development. It is a situation which can be observed in other methods rather than microsurgical method. This situation is seen less than 1% after microsurgila method. Lymphatic circulation is not affected, therefore, there is no observed swelling around the testicles because the lymphatic vessels are clearly revealed during the operation and the processes such as binding or burning vessels are not applied.

Is there a possibilty to have a child after varicosel surgery?

After the surgery, 60-70% of the patients have an improvement in sperm parameter. If there is no improvement in sperm parameters at the 6th month, it may be useful to recommend the methods of IUI or IVF depending on the factors such as age and female according to sperm parameters. Varicocele surgery may be recommended for a young patient who has been diagnosed with varicocele and want to have a child in natural ways. However, it is more appropriate to recommend the patients, who have the same diagnosis and are older, to go for IUI or IVF  treatments instead of wasting time with varicocele surgery. The patient’s clinical status and age are also taken into consideration here. Infertility should be evaluated bilaterally, as the condition of not only the individual, but also the couples.

What happens if varicocele is not treated?

Varicocele is a chronic condition and does not cure itself. If it is untreated, progression may lead to shrinking of testicular size, varicocele size enlargement, a further decrease in sperm parameters and hormonal deterioration of the testis in the future. None of this may happen but it may last a lifetime as standard. It is not possible to operate each kind of varicocele.

 

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