Introduction
It is generally accepted that microsurgical varicocelectomy, carried out through a subinguinal or inguinal incision, is the most effective method for treating male infertility related to varicoceles. Compared to other procedures, this technique has a high success rate and minor drawbacks.
What Is Varicocele?
The medical condition known as varicocele is defined by vein enlargement in the scrotum, the skin pouch that contains the testicles (produce sperm and sex hormones). Deoxygenated blood is transported from the testicles through these veins. Blood tends to collect in these veins in cases of varicocele instead of flowing out of the scrotum effectively. Varicoceles usually appear during adolescence and get worse over time. While some people may feel pain or discomfort, many varicoceles do not show symptoms. They, however, may result in problems, including infertility, diminished sperm production, or poor testicular growth. Surgery could be suggested to treat the varicocele and any related issues if complications develop.
What Is Microsurgical Varicocelectomy?
Microsurgical varicocelectomy operations, whether conducted under local or general anesthesia, include using a powerful operating microscope. The surgeon's visual acuity and precision during procedures are greatly improved by the magnification of an operating microscope, which can range from ×6 to ×25. Testicular arteries and lymphatics may be precisely identified and preserved, and unintentional iatrogenic injuries can be prevented because of this increased magnification. An operating room visit for a right and left varicocelectomy should take approximately one hour, as the procedure takes roughly thirty minutes on each side. Usually, this treatment is carried out as an outpatient procedure.
What Are the Different Methods Used in Microsurgical Varicocelectomy?
The improved clarity and accuracy offered by the operating microscope can be applied to microsurgical varicocelectomy through either an inguinal or subinguinal (incision or a cut is made in the groin at a lower level) incision. Rerouting blood flow to healthier veins and sealing off the afflicted vein or veins is the main goal of this procedure.
The ilioinguinal nerve, a branch of the lower back's first lumbar nerve, is accessed by a carefully planned incision created using the inguinal approach. This method is usually advised if the varicoceles cause the patient any pain. Long-term pain relief can be obtained by cutting this nerve and treating the afflicted veins simultaneously. Conversely, the subinguinal technique entails creating a smaller incision in the groin region.
Both methods involve making tiny incisions, typically no longer than an inch. The aberrant veins are accessible through the spermatic cord (part of the male reproductive system and houses the vas deferens, which is a coiled tube that delivers sperm out of the testicle, as well as blood, lymph, and arteries) dissection during the surgical operation, after which they are either tied off or sealed. It is critical to reroute blood flow from the injured location to the inner thigh or pelvis.
Since varicocelectomy could have negative implications, extreme caution must be exercised during the treatment to avoid injuring the arteries that carry blood to the testicles. To preserve regular sperm production, it is also critical to protect the vas deferens and avoid damaging lymph nodes to avoid any negative effects on the immune system.
By giving a more accurate and thorough image of the surgical site, the use of microsurgical techniques greatly lowers the risks involved with the process. The procedure duration varies based on individual conditions, but each side usually takes about 30 minutes.
Which Method of Microsurgical Varicocelectomy Is Better?
Both the inguinal approach and the subinguinal technique provide access to the external spermatic and gubernacular veins (veins of the scrotum), elevate the spermatic cord to improve the view of its components, and make it easier to introduce the ipsilateral (same side) testicle for microscopic or biopsy investigation. On the other hand, the subinguinal technique offers a less painful and quicker recovery because it does not need the opening of any fascial layers. Sometimes anatomical circumstances require using the inguinal technique, even if the subinguinal method is favored, as it may result in a speedier recovery.
Smaller veins and the testicular artery's branches can make dissection and arterial preservation difficult at the subinguinal level. When this occurs, dissection and arterial preservation are made easier by the inguinal approach's access to larger, less branching vascular systems. This method is particularly useful in thin persons with a tight, low external inguinal ring, adolescents, and when there is concurrent hernia (the protrusion of a tissue or organ via an unusual opening) repair or recurring varicocele. Consequently, the inguinal approach is carefully chosen based on anatomical factors to maximize surgical outcomes, even though the subinguinal technique is still recommended in many circumstances.
What Post-surgery Care and Follow-up Are Advised for Patients Undergoing Microsurgical Varicocelectomy?
Most men can return home quickly after surgery because the operation is typically performed as an outpatient procedure. Usually, it requires two to three weeks to heal completely. Most patients with very sedentary work or desk jobs can return to work in a few days. In cases where infertility is the primary reason for a microscopic varicocelectomy, a semen analysis may be performed at a follow-up appointment to assess whether the quality and quantity of sperm have increased.
There are no drugs designed specifically to treat varicoceles. However, males or boys with the illness may be advised to treat any associated discomfort with over-the-counter pain medicines like Ibuprofen before considering a microsurgical varicocelectomy. If surgery is advised, it could be paired with less invasive methods that reduce scarring and discomfort following the treatment.
What Are the Complications of Microsurgical Varicocele?
Testicular pain, bruises, infections, and recurrent or persistent varicocele are possible after varicocele repair complications. Complications like a hydrocele, which is defined by an accumulation of fluid around the testis, are extremely rare.
Conclusion
The major goal of treating varicoceles is fertility, and the most popular surgical procedure for treating infertility in men is still varicocelectomy. However, for reasons other than infertility, such as pain relief, addressing low serum testosterone levels, and enhancing DNA (deoxyribonucleic acid) sperm quality, varicocele repair is frequently advised and pursued. Well-designed randomized studies have not yet been carried out to precisely define the benefits of varicocelectomy for men who present with indications other than infertility, despite strong evidence suggesting potential benefits. Given the growing body of literature and research interest in this area, further investigations are hoped to address past methodological flaws and offer more precise information regarding the effectiveness of varicocelectomy for other causes.
