High varicocelectomy, let's learn professional knowledge together

I believe many men have heard of high varicocelectomy, which is a professional surgery for treating varicocele. This surgery is relatively mature in medicine, especially for those severe patients who usually adopt this method of treatment.

1. Overview

Varicose veins are a common disease in men. The incidence rate in the normal general population is about 15%, while the incidence rate in the infertile population is about 35%. Animal experiments and clinical studies have shown that varicocele can cause progressive testicular dysfunction. 75% to 85% of patients with varicocele will develop secondary infertility. Varicose vein ligation is currently the most common surgery for treating male infertility.

Varicocele can improve the semen quality of 60% to 80% of patients, and the pregnancy rate after surgery is 20% to 60%. It can also increase the serum testosterone level of patients with infertility and decreased serum testosterone (Suetal, 1995). A randomized study showed that the pregnancy rate of two groups of patients with varicocele was 44% after one year in the surgery group and 10% in the non-surgery group (Madgaretal, 1995). The effect of surgery is related to the degree of varicocele. The semen quality of severe varicocele is significantly improved after surgery, but the pregnancy rate is not significantly different from that after surgery for mild varicocele. It is estimated that severe varicocele has a more obvious impact on semen quality before surgery. Data show that the earlier the surgery is performed, the better the effect, and it can reduce the further damage of varicocele to testicular function. Complications such as recurrence of varicocele, testicular artery damage, and postoperative edema will affect the effect of surgery.

2. Indications

Varicose vein varicocele does not necessarily affect fertility. Varicose vein ligation is mainly used to treat infertile patients. The impact of varicocele on fertility is related to the course of the disease, so early surgery is recommended to minimize the impact of varicocele on fertility. Especially asymptomatic varicocele rarely attracts the attention of patients, who may only request treatment because of infertility. There is no unified standard for the indications of surgical treatment of varicocele. In principle, there are the following points:

1. Varicose vein with infertility;

2. Patients with severe varicocele;

3. Patients with bilateral varicocele;

4. Mild to moderate varicocele accompanied by abnormal semen quality or obvious symptoms (such as bloating, pain) or testicular shrinkage and softening.

5. Adolescent patients are limited to those with severe varicocele, obvious symptoms (persistent pain) and delayed development and reduced size of the ipsilateral testicle.

3. Preoperative Preparation

1. Semen analysis to understand whether there is spermatogenesis inhibition;

2. Examinations of reproduction, endocrine system and anti-sperm antibodies to understand whether there are other factors causing semen abnormalities;

3. Clean the skin after surgery;

4. Patients who undergo spinal anesthesia or epidural anesthesia should abstain from eating or drinking as usual before surgery.