VARICOCELE (ovarian heir)

In men, the ovaries (testes) carrying the dirty blood veins (veins) due to the deformation can not work well and due to the dirty blood in the body does not send back to the proper.
Male infertility (male infertility) is the most common and
is one of the reasons that can be corrected. It is seen in 20% of adult men in the community. It occurs in 35% of men presenting because of not having children. Varicocele is a progressive disease and may cause regression in testicular development, disrupt sperm production and cause infertility. Although it is mostly seen on the left side, it should be investigated whether it is bilateral or not.

Varicocele can cause the following negative conditions in the semen: a spermiogram:

  • Reduction or complete loss of sperm count (oligospermia) (Azospermia)
  • Impairment of sperm movements (Astenospermia)
  • Deterioration in sperm form (teratospermia)

Bu olumsuzluklara şu mekanizmalarla sebep olur:

  • Testiste atılamayan kanın birikmesi sonucu ısı artışı olması
  • Testisten atılması gereken zararlı ürünlerin bozuk damarlardan atılamayıp testise geri dönmesi (reflü)
  • Yumurtalıklarda küçülme ve fonksiyon kaybı

Varicocele ratings

It was divided into 3 classes as outpatient examination and color ultrasound of ovary (RDUS) as follows:

1. Grade I : It is the lightest grade and it is observed in the outpatient examination with maneuvers like coughing / straining
2. Grade II : It can be understood by hand examination during outpatient examination without the need to increase intra-abdominal pressure.
3. Grade III : It is the heaviest type and has varicose veins visible to the eye.

Advanced varicocele is manifested by feeling varicose veins by hand. The second step in the diagnosis is scrotal color doppler ultrasonography in the presence of conditions that make physical examination difficult. With this examination, the diameter of the patient vessels, whether these blood vessels return dirty blood, testicular reveals whether there is loss of volume and the severity of varicocele is determined by this method.

Sperm analysis (spermiogram)
varicocele; sperm may cause number, movement and deformity (morphology). 2 times sperm analysis (spermiogram) is ideal for patient evaluation; there should be no less than 7 days and no more than 3 weeks between two sperm assays.

Subclinical Varicocele
It is a varicocele that cannot be detected in the examination of the urologist but revealed by scrotal color doppler ultrasound. The varicocele that appears in this way is obvious especially on the left and the surgical intervention in subclinical cases on the right increases the chances of success.

  • Varicocele is a disease that usually does not show symptoms but is determined by married couples who refer to a urologist because of not having children. However, 1/4 of the patients pain and / or discomfort in the testicles are encountered. Pain alone does not require surgery; however, surgical treatment may be considered if the pain does not resolve by other methods.

When should varicocele surgery be performed?
• In couples who do not have children, men with varicocele where the female partner is normal or recoverable

  • Patients with abnormal findings in a sperm test (spermiogram) in a man
  • Patients who had previously had children but were not present and diagnosed as varicocele
  • Single patients with high grade (grade 2 and grade 3) varicocele due to progressive disease
  • Adolescent patients who are seen in adolescence period and can not have spermiogram due to ethical reasons, in this case, if there is a volume reduction between the two testicular volume more than 10% of the operation should be considered.

Varicocele operation is not recommended in patients with azospermic or 5 million / ml value, because the success rate is very low.

Varicocele surgery
The current surgical treatment of varicocele is to reach the testicular vessels with a 2-3 cm incision made from the inguinal region and to abort the patient vessels by ligating them. it is to protect. In the best method applied in the treatment of varicocele; Varicocele recurrence, arterial injury and postoperative hydrocele formation (fluid collection within the testis) should be the lowest complication rate and postoperative sperm parameters improvement and pregnancy rates should be higher than other methods.
Therefore, this advanced technology surgery İK MICRO SURGERY ”technique should be performed using the operating microscope. While the probability of recurrence (recurrence) is 1% with micro surgery method, this rate is 15% if no surgical microscope is used. In addition, as a result of the surgery performed with micro surgery method, pregnancy rate can reach to 60% in the second year from 43% in the first year.
The most common complication after varicocele surgery is sel Hydrocele;; hydrocele is the collection of fluid in the testis. It is caused by ligation of lymph vessels during surgery. The incidence is 8%. This surgery can be performed with general or regional anesthesia.

Which patients benefit more from treatment?
• those with advanced varicocele (grade II and grade III varicocele)
* with normal / near normal testicular volume

  • Patients presenting early for infertility
  • Sperm number more than 5 million

* Patients without molecular disorders

Daily work can be done after 1-2 days of rest at home after varicocele surgery. Sexual activation is allowed after 1-2 weeks, heavy work life and sports activities are allowed after 2-4 weeks.

After varicocele treatment, the patients should be followed up regularly. Pre-adolescent patients are followed-up once a year by routine examination and examination, while adult patients are followed up at the urology outpatient clinic every 3 months until they have children. Even if there is no child after varicocele surgery, it also helps reproductive treatment methods such as vaccination or IVF.