(1) Indications for surgery of varicocele?
(2) Abnormalities in at least one semen parameter such as: vitality, density, malformation rate, etc.
(2) Discomfort such as soreness and slight pain in the affected scrotum, if the pain is severe, it is usually not caused by seminal varicose.
If the varicocele is combined with discomfort in the affected scrotum and/or abnormalities in at least one of the semen parameters, and other etiologies are excluded, then surgery should be considered, and surgery is not recommended for subclinical varicocele. In adolescents with combined seminiferous varicosities, the classical indication for surgery is that the development of the affected testis is affected, but the specific assessment may vary from doctor to doctor and is not consistent between Europe and the United States, so a careful outpatient evaluation is required.
2. Does varicocele require a testicular biopsy at the same time?
According to the 2011 edition of the National Urological Guidelines, testicular biopsy and varicocele surgery are recommended for patients with oligospermia with varicocele and non-obstructive factors to facilitate assisted reproduction. Thus, for patients with oligozoospermia, we recommend testicular biopsy. At present, testicular biopsy is mainly performed by open biopsy of the testis and puncture biopsy, but we mainly use puncture biopsy, which has less damage, faster recovery and fewer complications.
3.Is varicocele always the cause of infertility or scrotal discomfort?
Not necessarily, if other common causes are excluded, 60-70% may be.
4.Is surgery always effective?
The effectiveness rate is usually about 60-70%, and with the world famous masters, the pregnancy rate is only close to 70% two years after the surgery. This is often not because the surgery itself is not successful, but sometimes varicocele is not the cause, and it is difficult to clarify whether it is the cause before surgery. Likewise, the efficiency of surgery for scrotal discomfort symptoms is about the same. We usually introduce these to our patients before surgery, not to pass the buck, but because medicine has stages and limitations and is not a panacea, which is the state of medicine. We can proudly say that we offer the best technology at this stage, but not the almighty Dan technique. Many patients want their doctors to give a straightforward conclusion: to do or not to do? In my opinion, today, with a much higher degree of education for all, it makes the most sense to give patients the right to be fully informed, to fully understand the current state of medicine and its shortcomings, and to make a choice together.
5. Now the new standards for semen are very different from the fourth edition, which one is used?
The new standard and the old standard of semen parameters are used at the same time, and there were no semen parameters for Chinese people when the new standard was formulated, so there is no definite conclusion on which standard is used for Chinese people. It is generally recommended to make a comprehensive judgment in an outpatient clinic before deciding on a treatment plan. For patients who have never had a sexual partner or who have not tried to have a baby for more than 6 months, I would generally put a stricter indication for the procedure, because after all, abnormal semen parameters do not mean that the partner cannot get pregnant.
6. What is the procedure, the number of days of hospitalization, and the cost? Is it medically insured?
The unilateral procedure takes about 30-45 minutes, hospitalization is 5-7 days, and the total cost is about $7-8,000. The cost is about 9,000 yuan. However, in practice there are fluctuations between individuals and it is difficult to provide an absolute value.
The issue of medical insurance differs from place to place in terms of policy, so you can consult your local medical insurance office.
7.Common complications?
Recurrence, edema and testicular atrophy, very little edema and no cases of testicular atrophy have been seen yet.
8.Does the scrotal tortuosity and sagging disappear after surgery?
The principle of the surgery is to block the venous reflux, not to remove the veins in the scrotum, which would easily lead to edema and testicular atrophy, so the scrotal tortuosity generally decreases gradually after the surgery and some of them can disappear, but not all patients have this effect.
In the past, the surgery would usually suspend the levator muscle upward a bit, but it has been abandoned now, so the surgery no longer deliberately solves the problem of ptosis.
9.Will the quality of semen decrease after surgery? Is it possible that the symptoms of discomfort will worsen?
Theoretically, but very rarely, it may be seen in two cases: 1. post-operative edema and atrophy, which are related to the surgery; 2. varicocele itself is not the cause, but the cause still exists, such as radiation, environmental hormones, other etiologies, etc.
10. Are there other treatment modalities for varicocele? Advantages and disadvantages?
These include laparoscopic techniques, microscopic techniques (subepidural or transinguinal, we decide the route according to the height of the episcleral ring of the patient, transinguinal is usually chosen if the episcleral ring is too low), open techniques (subepidural, transinguinal, retroperitoneal route), interventional techniques (cascade or retrograde approach), etc. Objectively speaking, all these modalities are used by doctors, and it is difficult to determine the absolute advantages and disadvantages, and the surgical modality and results depend on the experience of the surgeon.
As for other treatments than surgery: medication will be effective in some patients, and a small number of patients who do not receive any treatment can also get pregnant, but overall studies show that surgery is better than medication and medication is better than no treatment.
11.Do I need to do both sides of bilateral varicocele?
If there is a problem with semen quality, we do both sides; if we visit for symptoms, we do the symptomatic side; these refer to the clinical type of varicocele; the subclinical type of varicocele (no findings on examination, only reflux on ultrasound) does not advocate surgery, but there is controversy in this area.
12.Cautions for semen examination?
It is generally clinically recommended to abstain from sexual intercourse for 3-7 days, but I suggest that about 4-5 days is best. Patients who may need semen examination in outpatient clinics are advised to calculate their abstinence time so that they will not be unable to be examined at the time of consultation. (Masturbation, seminal emission and sexual intercourse ejaculation are all counted as ejaculation)
13.Pre-operative routine examination
Such as electrocardiogram, chest X-ray, coagulation status, biochemical situation, common blood-borne diseases, etc. Adults usually do not need a chaperone.
14.About postoperative problems
Generally 1 month can return to sexual life, strenuous activities such as running and playing ball are recommended 2 months after surgery. I really have difficulty answering the question of local pain and discomfort after surgery, because it can be related to the surgery, but also may be a new situation, arbitrarily say no problem may delay the disease, so I can not make a positive answer! I can only recommend that you go to a regular hospital for consultation! Some patients have multiple ejaculations, so there is no need to worry.
15.If not, will it get heavier?
Such as varicocele performance, semen parameters, discomfort symptoms, etc. —- This point is controversial, it is difficult to be absolutely sure or negative.
16.Other precautions?
Some patients are secondary to seminal varices, such as those caused by renal tumor compression, must be excluded.