Yes, varicocele can be cured with surgery. However, the success rate depends on the condition of the patient.
The success rate of surgical procedures for varicocele, varicocele embolization, and varicocelectomy is almost 90 percent, but 10 percent of patients may experience later recurrences.
There are no medical treatments to cure varicocele, but painkillers may provide relief from pain.
What is a varicocele?
Varicocele is a gender-specific disease that affects men. It is caused by enlargement of the veins in the scrotum (the loose bag of skin that holds the testis). The scrotum swells due to increased pressure in the veins, causing significant pain and eventually may lead to infertility if left untreated.
Although the condition could be painless at first, this does not mean that an individual should ignore it. A clinical examination can confirm the existence of a varicocele, and an ultrasound test can provide further information.
- Varicoceles affect about 10 percent of all men. However, the prevalence rises to 30 percent in infertile couples.
- Men aged between 15 and 35 years have the highest rate of incidence.
- Annually, up to 70,000 to 80,000 men in the United States may need varicocele surgery.
Varicoceles are not fatal. However, they are occasionally connected with the concern of the presence of a mass or tumor.
If a varicocele arises on the right side rather than the left, it is critical to rule out the cause, such as a possible tumor or other abnormalities in the abdomen.
What are the treatment options for varicocele?
Typically, varicocele treatment is not required. However, surgery could be advised if there are:
- Discomfort and pain
- Low sperm count
Varicocele embolization or percutaneous embolization is a minimally invasive outpatient procedure. It is an image-guided technique that involves inserting small coils or liquid material into an artery with a catheter to redirect blood flow away from a varicocele.
- Usually, this procedure is performed under intravenous (IV) sedation. However, some patients may require general anesthesia.
- A local anesthetic will be used by the doctor to numb the region, which is commonly the neck or groin.
- On the spot, the doctor will make a very small skin incision.
- A catheter (a long, thin, hollow plastic tube) is introduced through the skin into the jugular or femoral veins (major blood vessels in the neck or groin, respectively) and navigated to the location of the varicocele using image guidance.
- Tiny coils consisting of stainless steel, platinum, or other materials, such as liquids, are then placed into the vein to obstruct blood flow.
- The abnormal blood flow into the testicle is halted by restricting the sick draining vein, and the blood is redirected to healthy veins to allow the proper flow of blood from the testicles.
- If the blood flow is properly shifted, swelling and pressure inside the testicle will be reduced.
- When the treatment is over, the doctor will remove the catheter and apply pressure to the wound to halt any further bleeding.
The doctor may use a closure device to plug the tiny hole in the artery at times. This will help the patient to move around faster. There are no visible sutures on the skin. The nurse will apply a dressing to this little incision in the skin. This procedure is normally finished in an hour.
Varicocele embolization lowers discomfort and edema while perhaps improving sperm quality in infertile men. This treatment is frequently performed as an outpatient procedure. However, some individuals may require hospitalization after surgery. The patient should consult the doctor to know whether they need to be hospitalized.
Varicocelectomy is the only permanent and the best treatment for varicocele. It is an invasive surgical procedure that removes the swollen veins that cause edema. Varicocelectomy can be done in two ways, open or laparoscopic varicocelectomy. The best surgical treatment is advanced laparoscopic varicocelectomy.
The contemporary laparoscopic procedure is minimally invasive and painless for the patient. The laparoscopic procedure ensures that no nearby tissues are harmed and blood loss is minimal.
The laparoscope enables the clinician to do the surgery through a few tiny incisions. A tiny, illuminated tube or scope (called a laparoscope) is used during laparoscopy. In comparison to other therapies, the odds of recurrence are negligible, and the success rate is relatively high. Because there are no major wounds or sutures, the patient recovers quickly.
Due to the anesthetic effect, the patient feels no discomfort. The patient is administered with either local or general anesthesia depending on their general health.
One of the best aspects of laparoscopic varicocelectomy is that the patient does not have to stay in the hospital for a long time. It enables the patient to return home within 24 to 48 hours. The patient can return to their usual routine within a week. Monthly check-ups ensure that nothing goes wrong throughout the recovery time.
If a patient selects open surgery for varicocele, the scenario could be more complicated. Because open surgery requires larger incisions, the recovery period is lengthier compared to laser treatment.
Are there any risks associated with varicocele surgery?
These surgeries are usually safe. However, there could be certain dangers, as with any surgery, such as:
- Testicular atrophy
- Damage to the artery
- Edema or fluid accumulation in the region
- Abdominal discomfort
- A renal vein thrombosis may arise in rare cases; this can harm the kidneys and necessitate further surgery
- After surgery, the veins through which the blood flows may expand, and additional treatment may be required
What are the causes of varicocele?
Varicoceles are thought to be caused by faulty valves in veins in the scrotum. These valves usually control the flow of blood to and from the testicles. When regular flow is disrupted, blood backs up, causing veins to widen (enlarge).
This is particularly common during adolescence when the testicles are rapidly growing and require the most blood. It occurs in the left testicle in about 85 percent of patients. The accumulation of blood may raise the testicular temperature, which can act as a barrier to sperm production and damage or kill sperm that is produced.
Varicocele is classified into three grades based on their size:
- Varicocele grade I: Varicocele is not obvious and must be detected using a particular maneuver.
- Varicocele grade II: Varicocele is not visible, but a physician may feel it when the patient is standing.
- Varicocele grade III: Varicocele is apparent to the naked eye.
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Recent studies on varicocele management to improve infertility
Varicocele diagnosis and therapy are important for infertile men with abnormal sperm parameters. A systematic physical examination should be used to diagnose varicocele. Open, laparoscopic, and microscopic surgery and radiologic therapy are alternatives for varicocele treatment.
However, microscopic inguinal or subinguinal varicocelectomy had the highest pregnancy rate and the lowest recurrence and complication rates. Therefore, skilled doctors consider microsurgical inguinal or subinguinal varicocelectomy as routine treatment. Because of the small number of well-designed trials, the evidence regarding the influence of varicocelectomy on fertility is weak.
Consistently, evidence is indicating varicocelectomy improves sperm parameters. This implies that varicocelectomy may enhance the likelihood of spontaneous conception. Treatment of varicocele is generally indicated only for individuals with established infertility, clinically palpable varicocele, and aberrant sperm parameters.
However, symptoms other than infertility, such as testicular discomfort or a scrotal lump, could be indications of varicocelectomy because these symptoms are commonly associated with the deterioration of sperm parameters. Treatment should be administered to adolescents with risk factors, such as testicular volume disparity.
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