Varicocele and the consequences of not treating it
Many men do not discuss their sexual problems with a doctor because of shame and embarrassment. This problem causes the disease to progress and leave irreparable complications. Complications such as sterility and sexual impotence, which ultimately lead to the destruction of the marital relationship.
An example of these diseases is varicocele. Varicocele disease or testicular varicose veins is seen in 10% of adult men and is the most common cause of male infertility and the only definitive treatment is surgery. Severe type or 3rd degree will have a permanent medical exemption from military service.
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What is varicocele disease? Varicocele is the most common disease of men after puberty and 10% of adult men suffer from it. Varicocele is the most common cause of male infertility. The onset of the disease is usually during puberty or immediately after puberty, but it can also occur at a younger or older age.
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What is the cause of varicocele disease? Varicocele disease appears with varicose veins and dilation of testicular veins, which are divided into primary and secondary groups. In the primary type, there is no specific causative factor, although the theory of defects in the pigeon nest valves of the testicular veins, the long path of these veins and the possibility of the compressive effect of other vessels and abdominal viscera is proposed, but a specific cause has not been proven yet.
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This type is the main cause of varicocele and 90% is on the left side. The secondary type, which is caused due to the presence of a specific factor causing obstruction in the intra-abdominal vessels, includes a small percentage of varicoceles, and its cause is often abdominal masses, especially malignant tumors, which are important and vital to diagnose.
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What are the symptoms of varicocele disease? The patient may present with a large complaint, or asymmetry of the testicles, or pain in the testicle, or after marriage, with infertility. But its most common form is asymptomatic, and it is discovered accidentally during examination. In the examination, the size and swelling of the testicular vessels is evident, especially on the left side, and it worsens when standing, or the increase in abdominal pressure and disappears when lying down (if the swelling of the vessels does not disappear when lying down, the secondary type should be suspected) did.)
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Differentiation of varicocele in terms of disease severity: Varicocele disease is divided into 3 degrees in terms of severity. In the 1st degree type, vasodilation can be felt and diagnosed by the doctor only during abdominal pressure. In the 2nd degree type, with abdominal pressure, vasodilation can be seen. And in grade 3 type, even without abdominal pressure, vascular dilation can be seen while standing. It should be noted that the 3rd grade type will be permanently exempt from military service law in Iran, and the 1st and 2nd grade types will be exempted from combat.
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What disease needs treatment? As mentioned, 10% of men have some degree of varicocele after puberty, but not all of them need treatment. If varicocele causes complications for a person, it is necessary to be treated. Otherwise, there is no need for treatment.
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What are the complications of varicocele? Complications of varicocele include pain, atrophy (shrinking the size and softening of the testicles) and infertility. Pain caused by varicocele is a pain with a feeling of heaviness, which is aggravated by activity and standing and improves with rest.
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Does a patient with uncomplicated varicocele need follow-up? Yes sir; As mentioned, if varicocele does not cause any complications, there is no need for treatment. But it is necessary for the patient to examine himself monthly. And if the size of the testicle shrinks, or changes in its consistency, it is necessary to be examined by a doctor.
Also, if the patient with varicocele is not married or wants to have another child in the future, he should be checked every 6 months with a sperm test, in terms of fertility, and he needs treatment if he starts having problems and the sperm weakens.
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Is there any medical treatment for varicocele? Answer: No.
Treatment of varicocele is only interventional measures (not oral treatment or receiving medicine by injection). In the simplest method of injecting substances that cause vascular blockage through the skin into the veins of the affected testicle, this method has a lower success rate and more complications of chronic pain or hydrocele.
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What are the methods of varicocele surgery? Varicocele surgery or varicocelectomy, as it is called medically, is the act of closing the veins of the affected testicles. After these veins are blocked, due to the lack of blood movement, the blocked veins shrink and disappear, and the varicocele is removed. This procedure can be done through a small incision on the skin of the abdomen, 2-4 cm long.
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What are the new methods of varicocelectomy surgery? One of the new methods of varicocelectomy is vascular occlusion through venous catheterization and occlusion of the affected vessels. Its cost is high and its success rate is not high, but it is performed on an outpatient basis with minimal pain.
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The laparoscopic varicocelectomy method has the advantage of a smaller incision and enlargement during surgery, but due to the lack of access of the surgeon to the secondary veins, the possibility of varicocele recurrence is higher, and three incisions are made on the skin instead of one.
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Microsurgical varicocelectomy method, which many believe is the best varicocelectomy method. Its advantages are enlargement during surgery and access to all the secondary veins, but the duration of the surgery is longer and it is also difficult from a technical point of view.