Varicocele is a vascular disease caused by enlargement of the testicular veins (plexus pampiniformis), and seen in 30-45% of infertile male, 45--81% of which with secondary infertility. On the other hand, it is observed around 15-22% in normal population.

varicoceleThe cause of varicocele is unclear. Tall height, overweight, prolonged standing, increased intra-abdominal pressure (due to chronic constipation, chronic lung disease, chronic cough, heavy sports, etc.) may be risk factors for varicocele formation.

Varicocele causes a continuous and increasing damage over time on testis. The effects of varicocele on sperm are explained by the following mechanisms:

  1. Disrupted oxidative stress control mechanism
  2. Increased scrotal temperature affects sperm production
  3. Back flow of toxic substances from kidney and adrenal gland into the testicle
  4. Decreased testicular blood flow.

Varicocele is diagnosed by physical examination. With semen analysis and Doppler ultrasonography, the degree of varicocele and its effect on sperm production are evaluated.

Treatment methods of varicocele are:

  1. Open surgery
  2. Radiological methods
  3. Laparoscopic / Robotic (endoscopic surgery) methods
  4. Micro surgical methods

Among these methods, the method with the highest spontaneous pregnancy rate and the lowest recurrence rate is observed with microsurgical varicocelectomy. With this application, 41% spontaneous pregnancy rate is reported around 41%, while the recurrence rate was around just 1.2%. Additionally, improvement in pain was determined as the highest with 90%.

Not all cases with varicocele need surgery. Clinical and radiological varicocele must be demonstrated together in the patient before the operation.

Surgery is recommended for following conditions:

  1. If it causes infertility: Female factor must be excluded, and infertility must be revealed in semen analyzes
  2. If it causes pain in the patient
  3. If testicular atrophy is detected; especially if there is a difference in size between two testicles
  4. In patients with deficiencies in their testosterone levels)
  5. If there is a decrease in testicular size in varicoceles detected during adolescence
  6. Patients with unsuccessful assisted reproductive technique / IVF application
  7. Prior to micro TESE (m-TESE) application in patients with azoospermia
  8. Patients with unsuccessful m-TESE application

Semen parameters improve in 50-80% of patients after varicocele treatment.

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