Varicocele is a dilated testicular vein or venous plexus that drains blood from the testicles into the main circulation.Varicocele can be found on the left and right side, but also on both sides. A varicocele is present in 15% of men in the general population. Varicocele is one of the most common causes of male infertility, 20 to 40%, and the rest are infections as well as hormonal and genetic reasons.
What is varicocele?
Dr. Nikola Lukač: ” The left testicle is most often affected by varicocele-in 80 to 90% of cases. The vein drains anatomically normally into the renal vein, at an angle of ninety degrees. This allows blood to return from the systemic bloodstream to the renal or testicular vein and increases the pressure in it. This prevents adequate drainage of blood from that testicle. Besides, there is another thing. On the left side, these veins have a smaller percentage of valves, so there are dilations of venous blood vessels. In the testicle itself, there is an increase in body temperature and the accumulations of metabolites from the adrenal glands and kidneys, which has retrograde flow or carries that blood flow to the left testicle and prevents its normal functioning or growth, sperm development and hormonal function. ”
What problems do patients feel?
Dr. Nikola Lukač: ” The symptom, which is characteristic of varicocele, is mainly a feeling of discomfort and pain in the left testicle. Patients often feel varicose veins. Varicose veins are described as worm-like changes in the scrotum. ”
Varicocele – diagnosis
Dr. Nikola Lukač: ” Patients who felt the changes come for a check-up, they feel discomfort and pain. The urologist diagnoses varicose veins, and this is most often done by clinical examination, ultrasound examination and spermiogram. The spermiogram is a valid test for us, which after abstinence, from three to five days, shows the fertility status of a man. ”
Varicocele can be congenital, but it is the most commonly acquired disease, and it is most often found in boys at puberty. Once the diagnosis is made, surgery is suggested.
Dr. Nikola Lukač: “ Indications for varicocele surgery are:
- Proven male infertility
- Testicular hypotrophy – most often the left, which causes hypogonadism or decreased testosterone levels
- Symptoms that impair the quality of life – pain and discomfort in the left testicle, especially after prolonged physical activity “
Which surgical method is the fastest and most effective for patients?
Dr. Nikola Lukač: “ There are three techniques that are most often used, and they are:
- Varicocele Ivanišević method
- Varicocele Palomo technique
- Marmar technique – a low scrotal incision is made with the help of a microscope.
Also, laparoscopy has recently been recognized as a method of treating varicocele, but I personally think that it is a very invasive method for treating this disease, which can be solved simply under local anesthesia in 20-30 minutes. ”
The expert team of Atlas General Hospital solved the problem of varicocele in about twenty minutes, under local anesthesia.
Varicocele surgery
Dr. Nikola Lukac: ” Surgical treatment of varicocele involves ligation of these veins and cutting. This prevents the blood flow of the systemic circulation to the venous vessels of the testicles and its normal functioning. Today we will operate on a patient who has grade 3 varicocele. Grade 3 varicocele is visible with naked eye. The Palomo technique will be performed with one inguinal incision, smaller than 3 cm under conditions of local anesthesia. The patient is discharged from the hospital after one hour. The postoperative course lasts practically a couple of days, in the sense of one rest, the use of analgesics and no physical activity. ”
This is a minor surgical intervention that allows a large number of patients to become fathers. If varicocele is not the only cause of infertility in men, further examination as well as treatment with hormones and supplements is needed.
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The price of varicocele surgery is 35,000 dinars if the intervention is performed under local anesthesia or 70,000 dinars if the intervention includes general anesthesia.
Preoperative preparation + Surgery + Local anesthesia + Hospital stay a few hours until recovery
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