Diagnosed in 15% of all men and 40% of those who apply with infertility problems, varicocele (dilatation of the testicular veins, varicose veins) is the most common cause of infertility and the most successful results are obtained after microsurgical operation. Varicocele disrupts sperm production by affecting microcirculation after the temperature increase in the testicles and the backflow of blood from the veins to the organ; it affects the fertilization potential quite negatively as a result of the effects on the number, mobility, structure and chromosomal structure.
What are the causes of varicocele and how does it occur?
Varicocele is a vein disease that begins to appear during puberty and progresses over time. Although it sometimes presents with pain and visual impairment in those with a suitable genetic structure and who stand for a long time, it is diagnosed during a manual examination performed for infertility and other reasons. The valves that form the valve system inside the veins and prevent reverse flow become inadequate as a result of the expansion of the vein diameter, resulting in increased pressure at the vein outlet of the testicles. As a result of the increased pressure, blood circulation (microcirculation) within the testicular tissue is disrupted, affecting sperm production.
What are the symptoms of varicocele?
Varicocele can be noticed by the pain felt from the ovary to the leg and the tortuous vein structure that becomes apparent in the scrotum in a warm environment. It can also be diagnosed by manual examination during tests performed only for infertility.
What Problems Does Varicocele Cause?
Varicocele does not cause any health problems on its own. It affects sperm cells and requires treatment because it causes infertility and sometimes pain. In patients who do not have pain and infertility is not a problem, no treatment is needed.
How is Varicocele Diagnosed?
The diagnosis of varicocele, which can occur in different severities, should be made by an experienced Urology-Andrology specialist with a detailed examination under the right conditions. Surgery for varicoceles that can only be diagnosed with Doppler ultrasonography is not beneficial, and except for very special cases, no other examination (ultrasound, etc.) should be requested for the diagnosis of varicocele other than a sensitive examination.
How is Varicocele Treated?
For patients diagnosed with varicocele, microsurgical varicocele surgery is recommended as the first choice for infertility problems. It would not be right to apply drug treatment or in vitro fertilization methods as the first choice for those diagnosed with varicocele. With the correct diagnosis and successful implementation of the microsurgical technique, there is a statistically significant improvement in spermiogram parameters of varicocele patients who are treated with more than 80% and most of them can have a baby without requiring any other treatment. A significant portion of the rest will be able to benefit from a technique that is easier and more economical than in vitro fertilization, such as intrauterine insemination.
Although a significant portion of patients who have previously undergone varicocele surgery but have not achieved positive results have been diagnosed with a condition called recurrent varicocele, it is not possible for varicocele to recur after surgery. In these patients where the surgery is inadequate due to technical reasons, successful results can be achieved by performing microsurgical correction surgery.
It has been reported that by operating on varicocele before in vitro fertilization (micro-injection) treatment,pregnancy rates increase by eliminating the effect that negatively affects the fertilization ability of sperm cells and increases the fragmentation rate in chromosomes.
It should not be forgotten that varicocele diagnosis in men applying for infertility is made more than necessary as a result of incorrect application of examination and doppler ultrasonography techniques and sometimes even with commercial approaches and unnecessary operations are performed. Although microsurgical varicocele surgery has been performed since 1993 in Turkey, it should be explained to hundreds of people who apply for surgery with an incorrect varicocele diagnosis that they do not need to have surgery.
This special surgery performed with the application of delicate microsurgical techniques is not eliminated in an average of 40% of patients who undergo varicocele surgery due to other methods applied instead or unsuccessful application of the microsurgical method. In some patients, very serious and irreparable complications such as hydrocele due to ligation of lymph channels or even atrophy of the egg due to ligation of arteries may occur. Varicocele surgeries, which have a benefit rate of over 80%, may drop to 20% due to unnecessary and unsuccessful applications. For this reason, patients who are recommended surgery should not take the issue lightly. It is appropriate to conduct a detailed examination and consult with specialists.
Misconceptions About Varicocele Are True
Varicocele is the most common cause of male infertility and the most positive results are achieved with successful treatment. Varicocele diagnosis should be made with manual examination, not with Doppler ultrasound. Many people can be diagnosed with varicocele incorrectly with Doppler ultrasound. For this reason, unnecessary surgeries are performed. Varicocele that cannot be diagnosed with manual examination should not be operated on; this does not provide any benefit.
In men with varicocele, assisted reproduction methods such as in vitro fertilization, ICSI, and insemination should not be applied to them first. Varicocele disrupts the chromosomal structure of the sperm and (DNA fragmentation) reduces its ability to fertilize the egg; even if fertilization occurs, it increases the miscarriage rate. Apart from these, in vitro fertilization should only be considered as a last resort. It should be kept in mind that the risks of congenital anomalies and diseases in the baby increase by an average of 30% and that it is also risky for the mother.
The most successful method and the technique with the lowest complication risk in varicocele operations is microsurgery. In microsurgical varicocele surgery, technical success exceeds 99%, the major complication rate approaches 0%, and the minor complication rate approaches 3-5%. In other surgical techniques, the risk of hydrocele increases to 40% and arterial damage to 5%.
It is not possible for varicocele to recur after a successful surgery, but the operation performed may not be sufficient and in these cases, microsurgical correction surgery can be applied. In operation techniques other than microsurgery, the rate of inadequate surgery increases up to 40% due to the technique applied.
It should not be forgotten that microsurgical varicocele surgery is not a simple surgical procedure; it can be successful with experienced doctors who are specialized in microsurgery, but like every method, incorrect and inadequate applications can cause serious complications and organ loss. There are many patients who experience problems due to complications after unsuccessful varicocele surgeries and whose spermiograms deteriorate even more.
Varicocele may not be eliminated with every microsurgery performed, complications such as arterial and lymphatic channel damage, hydrocele and organ loss may occur; the quality of the technique is as important as the technique itself.
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