Santiago Brugo Olmedo M.D.
Medical Director
Seremas Medicine for men and women
Seremas Home Seremas Surgery Seremas Translaparoscopic Varicocelectomy

Translaparoscopic Varicocelectomy

VARICOCELE
Distension and insufficiency of the spermatic cord veins is called varicocele. It is the most frequent disease as cause of infertility. In general, the man notices something “strange” in the scrotum, it even gets to cause pain on occasions, but it can also pass totally unnoticed. Independently from the size of the varicocele, the spermatozoa production might be mildly or severely affected. Between 15-20% of men suffer from varicocele, but when statistics are made among those who consult in order to have children, the rate goes up to 40%.

Why does it cause sterility?
Varicocele damages the testis because of three different reasons.

Firstly, because the amount of oxygen which gets to the testis with varicocele is less than normal and so it causes hypoxy, which is harmful for testis function.

Secondly, varicocele increases the testis temperature and this is harmful. It is important to remember that ovaries are inside the body because they need 37 degrees in order to work properly. Testis, instead, are outside the body since they need 1 ½ degrees below body temperature.

Finally, varicocele causes reflux, in other words, the entrance of toxic substances to the testis and this also harms them.
Because of the addition of these three causes, quality of ejaculate in these patients is affected, in quantity, motility and/or morphology of spermatozoa.

How is it diagnosed?
The diagnosis is easily reached with the patient’s physical examination and it is confirmed with the testis veins (spermatic veins) Doppler ultrasound. In most cases, varicocele is produced on the left side, because of an anatomical reason which makes the appearance of insufficiency easier on that side, but it can also be bilateral.

If varicocele is only found on the right side, one should be more careful since it could be in fact a renal tumour which is habitually noticed in this way.

How is it treated?
If the patient has problems in his semen, in terms of spermatozoa quantity, motility or morphology, he has varicocele, and other diseases which can cause problems in semen have been discarded (if no infection or hormonal disorders in blood are found), treatment will be surgical. In other words, any other disease which might be causing harm to the spermatozoa and has nothing to do with varicocele must always be discarded.

What is the surgery like?
Surgery of varicose veins can be performed in a conventional way, making an incision in the inguinal duct (groin) or it can be made by laparoscopy, which is much less traumatic, in other words, it gives the possibility to have a more pleasant and extremely short post-surgery period. When using this technique, the period in bed will be of one day, against 5-7 days when using conventional surgery.

Moreover, the patient will be able to re-start his sportive life –if he has one- almost immediately, whereas with the conventional method he will have to wait for approximately one month.

Surgical procedure involves blocking ill veins and in this way we make blood emerging from the testis choose other healthy veins.

After the varicocelectomy (varicocele cure) we will have to wait for a period of six months, since this time is necessary for the testis to start getting better.

Approximately 50% of patients improve their spermogram and most of them get their partners pregnant. In the case this does not occur, assisted reproduction will be required.

CIRUGIA | Varicocelectomía translaparoscópica

Collocation of trocars and endocamera ready to operate
the varicocele via laparoscopy

 

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