Varicocele - A Risk Factor for Male Infertility
Varicocele is an enlargement of the veins in scrotum that carry impure i.e. oxygen-depleted blood away from the testicle. The enlargement of veins occurs due to malfunctioning of valves in veins in scrotum, much like varicose veins in legs, which prevent blood from flowing properly.
As a result, accumulation of blood in varicose testicular veins takes place which forms Varicocele that causes swelling and pain in the scrotum. Varicocele develops slowly and continuous accumulation of blood in varicose testicular veins may impair sperm production and cause male infertility.
The development of Varicocele may also affect the normal development of testicles and may cause them to shrink. Varicocele is usually formed during puberty and occurs on the left side due to the position of the left testicular vein.
Varicocele - A cause of male infertility
The varicose testicular veins in the scrotum i.e. Pampiniform Plexus present in the spermatic cord. Pampiniform Plexus holds the Vas Deferens and Testicular Artery that supplies blood to the testicles.
The function of the pampiniform plexus is to cool the arterial blood before it reaches the testicles through heat exchange mechanism. For efficient production of sperms, it is important to keep temperature at around 34.5 degrees Celsius i.e. 94.1 degrees Fahrenheit i.e. lower than normal body temperature.
When varicoceles are formed, accumulation of blood in them increases temperature of testicles that affects the formation and quality of sperms which may be the possible cause of male infertility. It has also been observed that increase in temperature of testicles may also lead to a decrease in the production of testosterone, which is the male hormone involved in the production of sperm.
The decrease in testosterone leads to a reduction in number of sperm produced and may also affect motility sperms that may contribute towards male infertility.
How Varicocele can be treated?
Varicocele can be repaired through four main procedures that include:
1. Varicocelectomy i.e. Open surgery - performed through groin, abdomen or pelvis to clamp or tie off the abnormal veins. For efficient varicocelectomy surgeons use Doppler ultrasound that guides the procedure.
Varicocelectomy is also performed using Microsurgical Subinguinal approach that achieves higher success rates as compared with other surgical methods.
2. Laparoscopic surgery – Minimally Invasive Procedure performed using a laparoscope to view and repair varicocele.
By using small clamps or cauterizing with heat, the ends of veins are sealed off; following which the laparoscope and tiny instruments are removed.
- Percutaneous Embolization or Varicocele Embolization – Minimally Invasive Procedure performed on outpatients by inserting a catheter into the body through the neck or groin.
- Radiologic Balloon Occlusion – is not a common procedure and is performed using a Silicone Balloon Catheter which is passed into the varicose testicular vein, under X-ray guidance.
After insertion, the balloon is inflated and left in place to permanently to block the engorged veins and repair the varicocele.
Success Rate Of Varicocele Surgery
Although varicocele surgery i.e. Varicocelectomy has been shown to achieve a success rate of about 90%; however microsurgery and Percutaneous Embolization have produced better and long-term success rates ranging from 90- 99%
Varicocele Surgery Recovery Time
Varicocele Surgery, recovery time usually depends upon the surgical procedure adopted for repairing varicocele. Most patients return to their normal activities in maximum 4 weeks.
With Laparoscopic and open surgery i.e. Varicocelectomy approaches the usual recovery time is 2-4 weeks. Varicose embolization is an outpatient non-invasive procedure, patients can go home same day and will take lesser duration in recovering.
About Indian Med Guru Consultants
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