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» The role of varicocele in the development of infertility
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The role of varicocele in the development of infertility
Varicocele - varicose veins testicles due to reflux of blood through the spermatic vein system. Varicocele occurs in 15% of the total male population.
The combination of primary varicocele and infertility is observed in 35% of secondary infertility and varicocele in 80%. In some cases, to determine the venous reflux require further ultrasonographic studies.
It must be remembered that between the severity of varicocele and semen quality is a direct correlation is absent. When combined with any other varicocele clinical and laboratory changes except for the obstructive symptoms and ejaculatory dysfunction, the first stage it is advisable to carry out treatment of varicocele.
For the treatment of varicocele suggested several operational methods.
Necessary to distinguish between:
obstructive
non-obstructive methods of surgical treatment of varicocele.
By the obstructive methods include operations:
Ivanissevicha
Marmara
Palomo
laparoscopic varicocelectomy
trans femoral embolizitsiya testicular vein
microsurgical ligation of spermatic cord veins in minimal access.
By the method is non-obstructive
microsurgical venous anastomosis formation
testicular-inferior epigastric
The method of testicular-epigastric anastomosis allows blood to drain from the system grozdevidnogo plexus in the iliac vein with I, as well as types II and III, if the cause of reflux is not associated with valvular insufficiency of the venous system reset in the left iliac vein.
Currently, the indications for surgical treatment of varicocele are reviewed. As between the severity of varicocele and the degree of fertility decline is no direct relationship, we consider the indications for surgical treatment of varicocele steady decline in fertility semen, painful symptoms and distinct aesthetic defect in the scrotum.
In recent literature there are more reports that patients with varicocele and normal semen parameters observed after the operation the appearance of antisperm antibodies and semen parameters of the deterioration that appear to be associated with deterioration of trophic eggs after obstructive surgery. In light of this, we believe that microvascular surgery using the method in order to form the venous anastomosis and outflow of blood from the normalization of testicular vein is preferred over traditional methods obstructive.
