varicocele

The condition in which the veins in the bags called the scrotum, where the testicles are located, widen and backflow occurs is called varicocele.
The reproductive system in men is responsible for the production, storage and transportation of sperm. Sperms are produced in the testicles and transported through the genital ducts and are kept in a part of the urinary tract until the sperm are expelled.
Insufficiency or absence of vessels that prevent the backflow of blood in the spermatic veins,
Excessive pressure here due to the angle at which the spermatic veins on the left enter the left renal vein.
Rarely, there is an increase in pressure due to the pressure of masses in the left kidney and enlarged lymph nodes in the retroperitoneum. It is usually seen on the left side due to anatomical differences. It is seen 90% of the time on the left and 2% of the time on the right. Additional research is required for varicoceles that occur only on the right side.
The frequency of varicocele has been reported to be 2-11% in pre-puberty males and 15-16% after puberty. Its frequency reaches up to 40% in patients presenting with infertility.

Pain is the most common symptom, especially in advanced cases.
The enlargement of the veins becomes visible from the outside after a while, and the veins may take a shape similar to varicose veins seen in the same legs.
The most important diagnostic tool is a manual physical examination, and it is sufficient. Varicocele is classified into 3 degrees according to its size. Grade III varicoceles are visible externally. While Grade II varicoceles can also be detected by examination, scrotal Doppler ultrasound may be required in smaller varicoceles. Varicocele that cannot be detected during manual examination should not be operated on.
Diagnosis can be supported, ovarian volume can be calculated and with color scrotal Doppler ultrasonography and whole abdominal ultrasonography. The presence of a condition that takes up space in the abdomen can be excluded.
A 10-20% (2 cc) volume difference between both testicles during adolescence, persistent pain, and grade 3 varicocele are indications for surgical treatment.
Varicocele is not an emergency and does not require emergency surgery.
It can be operated on by open and laparoscopic (closed) methods.

Microsurgery is technically the most successful method for varicocele surgery and has the lowest chance of complications. The success rate of this surgery is over 99%.
In other surgical methods, the risk of hydrocele (water hernia) is up to 40% and arterial damage is up to 5%.
At Istanbul Medeniyet University Göztepe Training and Research Hospital Pediatric Surgery Clinic, varicocele treatment is usually performed through surgery from the groin, but it can also be treated closed.
If the varicocele progresses and is not treated, It may also cause a decrease in testicular size and disorders in the production of testosterone, the main male hormone. In addition, varicocele impairs sperm production by affecting the microcirculation following the increase in temperature in the testicles and the reflux of blood in the vein to the organ; number, mobility, structure and fertilization negatively affects its capacity. It is the most common and treatable cause of male infertility.

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