Vericocele Surgery
Varicocele:
The term varicocele refers to dilatation of a network of
veins that drain the testicle. This network of many small
veins found in the human male spermatic cord is formed by
the union of multiple spermatic veins from the back of the
testis and tributaries from the epididymis.
These small vessels normally range from 0.5-1.5 mm in diameter.
Dilatation of these vessels greater than 2 mm is called a
varicocele.
The testicular blood vessels originate in the abdomen and
course down through the inguinal canal as part of the spermatic
cord on their way to the testis. The veins of the body have
one way valves along their length, which prevent backward
flow of blood, allowing the blood to flow only towards the
heart.
In men with varicocele these valves do not work optimally
and as a result, the blood starts flowing in the backward
direction and pools in the testicular veins. This leads to
a dragging like or aching pain within the scrotum.
Causes of Varicocele formation:
The Varicoceles in most of the cases are seen to develop
during the growth spurt or the adolescence. During this phase
there is a sudden increase in the growth rate of the testes
and more blood flows into them. But due to defective valves
in the veins, this blood does not return back in the heart
and gets pooled in the scrotum leading to the formation of
varicoceles.
Symptoms of Varicocele:
- Dragging-like or aching pain within scrotum.
- Feeling of heaviness in the testicle(s)
- Atrophy (shrinking) of the testicle(s)
- Visible or palpable (able to be felt) enlarged vein, likened
to feeling a bag of worms.
- Infertility-Although no formal correlation has been established
linking Infertility with varicocele, many suggest that the
increased temperature within the testes is the main cause
in cases found with infertility.
Harmful Effects of Varicocele:
- The relationship between varicocele, altered spermatogenesis,
and infertility is now widely accepted. Decreased growth
of testicles, resulting in decreased sperm formation, leads
to infertility.
- Damage to testicles
- Dragging-like or aching pain within scrotum.
- Decreased formation of male hormone testosterone, responsible
for secondary male characteristics
Surgical treatment of Varicocele:
The goal of treatment of the varicocele is to obstruct the
refluxing venous drainage to the testis while maintaining
arterial inflow and lymphatic drainage.
Varicocelectomy, the surgical correction of a varicocele,
is performed by using either of these approaches:
- Inguinal (groin)
- Retroperitoneal (abdominal)
- Infrainguinal/ subinguinal (below the groin)
Subinguinal approach is most commonly used presently by male
infertility specialists. The major advantage of this approach
is more direct approach to the spermatic cord, external spermatic
veins. The small incision (corresponding to the length of
the testis) is more comfortable for the patient with less
postoperative pain since there is no incision of aponeurosis.
The patient is advised to wear a scrotal support for some time
after surgery.
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