Varicocele is one of the common clinical diseases in male medicine, mostly seen in young and middle-aged men, with an incidence of 15%, 40% in male infertility and 20% in combined pain and discomfort. It is an important factor known to cause male infertility. Our male department performs more than 300 cases of microscopic spermatic vein ligation every year, which can significantly improve the quality of semen and relieve the pain of patients. It has attracted widespread attention from patients and the media, and a large number of patients have consulted on issues related to the surgery.
1.Why does varicocele cause male infertility?
It is believed that the mechanism of male infertility caused by varicocele is related to abnormal sperm quality, reduced testicular volume, reduced testicular perfusion and testicular dysfunction. However, the exact mechanism causing infertility is not fully understood so far, and it is generally believed that it may be related to the following factors: A increased intra-testicular temperature; B hypoxia: C renal and adrenal metabolite reflux; D reactive oxygen damage; E testicular microcirculatory disorders; F nitric oxide (NO) mechanism; G other: including increased reproductive toxins, increased levels of antioxidants, reduced DNA polymerase activity, the presence of sperm-binding immunoglobulins G other: including increased reproductive toxins, high levels of antioxidants, reduced DNA polymerase activity, presence of sperm-binding immunoglobulins, anti-sperm antibodies and other comprehensive pathophysiological changes, which may eventually lead to testicular spermatogenesis disorders and gradual testicular function decline, thus leading to male infertility.
2.Does varicocele cause sexual dysfunction and inflammation of the reproductive system?
There is no evidence that varicocele can directly cause sexual dysfunction or inflammation of the reproductive system. However, varicocele may affect the size of the testes over time, and androgens (testosterone) are secreted by the testes, and a decrease in testicular size may lead to a decrease in androgens in the body, which may cause a decrease in libido, etc. Therefore, sexual dysfunction is only possible if the testicular volume is significantly reduced.
3.Is this disease progressively aggravated without treatment and is there a risk of potentially serious diseases (such as cancer)?
Spermatic vein will definitely worsen gradually without treatment, but there is no possibility of serious diseases and never cancer.
4. Do I have to have surgery to restore my reproductive function?
Varicocele is one of the factors known for sure to cause a decrease in semen quality. Although medication may temporarily improve semen quality, the efficacy is not very certain and it is likely to be temporary. We often use an analogy with patients, for example, the spermatic vein is a water pipe, and if this water pipe is swollen and dilated due to various reasons, it is impossible to reduce it by any means. By the same token, if the spermatic vein is dilated, it is impossible to shrink it by any medicine. Therefore, surgery is necessary to restore the reproductive function.
5.Do all varicocele patients need to be treated by surgery?
Not all patients with varicocele need to undergo surgery. Before understanding the indications for surgery, we need to know the clinical classification of varicocele.
Clinical degree I: The varicose veins are not obvious on palpation, but can be palpated when the patient holds his breath and increases abdominal pressure;
Clinical degree II: the varicose veins can be palpated under non-palpable conditions but have a normal appearance;
Clinical grade III: varicose veins are like a mass of earthworms and are extremely obvious on palpation and visualization.
Spermatic vein ligation is necessary in the following cases.
Patients with combined oligozoospermia of degree II to III or more;
Patients with a combination of oligospermia or weak spermatozoa between Ⅰ and Ⅱ degree and no significant improvement after 3 months of conservative treatment;
Ⅰ～Ⅲ degree combined with scrotal swelling and pain discomfort affecting the quality of life.
6.Is it necessary for patients without fertility needs?
Varicocele may lead to two consequences, one is the decrease of semen quality, and the other is the local pain and discomfort of scrotal and testicular swelling, for patients without fertility needs, if there are obvious pain symptoms, it is also necessary to do the surgery.
7.What kind of surgery is used to treat varicocele and is the surgery risky?
There are three main surgical procedures for varicocele: open transinguinal surgery, laparoscopic spermatic vein ligation and microscopic spermatic vein ligation. Microscopic spermatic vein ligation can ligate the vein more thoroughly, preserving the arteries and lymphatic vessels, improving semen quality significantly after surgery, with fast recovery, low recurrence rate and few complications. It has obvious advantages compared with traditional surgery and has become the gold standard for varicocele surgery. At the same time, microscopic spermatic vein ligation is less traumatic and the risk of surgery is minimal.
8.How long does the surgery usually take and how much does it cost?
Microscopic spermatic vein ligation usually takes about 1 and a half hours for unilateral surgery and 2 hours for bilateral surgery. All costs are about 8000 RMB for unilateral and 10000 RMB for bilateral.
9.Is there a high recurrence rate after surgery?
The surgical incision of microscopic spermatic vein ligation is chosen under the external ring, and there are very few venous traffic branches under it, and the surgery under the microscope can ligate the vein more thoroughly to avoid leakage, so the recurrence rate is also extremely low. Currently, the recurrence rate of microscopic spermatic vein ligation is ≤1% in a large global sample, which is significantly lower than the recurrence rate of about 15% in the other two surgical methods.
10.Do infertility patients need medication after microseminal vein ligation?
Microscopic spermatozoal vein ligation can obviously solve the fundamental problem of oligozoospermia, however, there is a process to recover semen quality after surgery, generally speaking, the improvement of semen is most obvious 3-6 months after surgery, and it is better to use some spermogenic drugs during this process, Chinese medicine has obvious advantages in improving semen quality, therefore, we suggest patients to cooperate with Chinese medicine treatment for 3 months after surgery.