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| Varicocele | |
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A varicocele is an abnormal dilation of the testicular veins within the scrotum. In fact they are varicose veins and may look like a "bag of worms" within the scrotum just above the testicle. It is the most common cause of male infertility, with 40% of infertile males having this entity. 80 % of men who have previously fathered children and are now infertile will have a varicocele. Approximately 90% are solely left sided. Varicoceles are diagnosed by physical examination, and may also be evaluated by ultrasound devices. A varicocele causes progressive injury to the production and maturation process of sperm. Abnormal semen analyses (abnormal count, motility, shape) are noted in 80 to 90% of patients with varicoceles. Treatment is performed surgically in the majority of the cases. All of the surgical procedures are done on an outpatient basis, and include an inguinal incisional approach or laparoscopic (using small scopes which enter the abdomen through 3 to 4 small incisions). The inguinal incisional approach should be done with the aid of an operating microscope which is used to provide optical magnification in order to preserve the testicular artery and other important structures. Treatment results in 70% of patients having improvement in their semen analysis and 40% of patients achieving pregnancy. There is no difference in semen improvement and pregnancy rates between the methods of treatment. Recurrence rates are lowest in the standard boring incision with or without the aid of the microscope, and are approximately 2%. Recurrence rates for the laparoscopic or other approaches are 15 to 25%. As for complications, all of the procedures correcting varicocele carry 1 to 2 % risk of bleeding and infection. Scrotal swelling (hydrocele) is noted in 5 to 7% of patients undergoing varicocele repair. This complication is diminished to approximately 1 % when a microscope is used. The laparoscopic approach poses some unique risks. Laparoscopy requires general anesthesia and can be associated with significant abdominal complications. The microscopic or microsurgical groin incision approach is generally preferred for several reasons. The anatomy is well defined, the testicular artery spared and other important structures (lymphatics) can be preserved. The procedure is performed on an outpatient basis, meaning the patient will go home without spending a night. The procedure itself takes approximately 45 minutes and post-operative care consists or oral pain medication. Acetaminophen (Tylenol) with or without a narcotic is generally prescribed. Post operatively, activities should be minimized for 24 hours and no work should be performed for two days. No significant heavy lifting or straining for approximately one week. No bathing for at least a week after the operation is recommended, but one may take a-shower within 24 hours. |
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