Edema of the testicle after surgery varicocele
After surgery for varicocele complicationsare rare. With the advent of new treatments for varicocele, such as microsurgical and laparoscopic methods, the percentage of specific complications has significantly decreased.
One of the early complications of surgical treatmentvaricocele is the lymphostasis of the left half of the scrotum, which is manifested by an increase in half of the operated side. Ligation and lesions of lymph vessels during surgery lead to lymphostasis.
Hypotrophy and atrophy of the testis or azoospermia are the mostthreatening and rare complications of varicocelectomy. Atrophy of the testicle after surgery is rare enough - 2: 1000. Nevertheless, even one case of testicular atrophy among 1000 operations can be a dramatic complication for a young patient.
Disappearance or reduction of pain symptomsis observed in the vast majority of patients (more than 90%) after the operation. However, approximately 3-5% of patients in the postoperative period have pain in the testicle and in the course of the spermatic cord, which can persist for a long time. Overflowing with venous blood of the epididymis leads to stretching of the capsule and the appearance of pain.
The incidence of hydrocele after surgery for varicocele varies from 0.5 to 9% of cases.
The main reasonpostoperative hydrocele, many consider the intersection of lymph vessels accompanying the testicle artery and vein, or resulting from the violation of venous outflow from the testicles, a chronic venous stasis in the epididymis, which leads to congestive venous epididymitis.
Recurrence of varicocele after surgery in children varies from 10 to 87.2%.
However, in adults these figures are much lower. In many publications the recurrence of varicocele in adults is 2-9%.
Typical complications of embolization of the testicular vein are as follows:
- an allergic reaction to a contrast agent (3.5% of cases);
- temporary pain syndrome in the left ileal region (29%);
- thrombophlebitis of the veins of the plexiform plexus (4%);
- Perforation of vessel walls (frequency not determined).
Complications with laparoscopicmethod are found when creating pneumoperitoneum, performing manipulation or after surgery. These complications are extremely rare and the literature describes single cases of bleeding after surgery. Complications from the introduction of trocars and manipulation are extremely rare.
When varicocelectomy is important to consider the possibilitysubsequent sterilization of the patient. Very often, the only source of testicle nutrition after dressing the vessels of the spermatic cord is the arteries of the vas deferens and cremasteria. In this case, subsequent vasectomy leads to testicular atrophy. Therefore, men and parents of adolescents before the operation for varicocele should be warned about the impossibility of vasectomy in the future.
At present, based on the accumulated sufficient experience, a number of factors have been identified that allow forecast results of treatment of patients with varicocele with infertility:
- the age of the patient is a fundamental factor in the detection of varicocele, since it has a direct correlation with testicular damage in a long-term disease;
- spermatogenesis is directly proportional to the volume of the testicle: 2/3 of its volume consists of the luteal part;
- One or two-way varicocele is oneof the main prognostic factors, since bilateral disease can even be the cause of azoospermia, which is able to regress after surgical correction;
- degree varicocele can be determined by differentways. Despite contradictory data, it is also an important prognostic factor: the higher the degree of varicocele, the greater the number of patients with infertility;
- the study of the endocrine system, in particular the determination of the level of follicle-stimulating hormone and TS can give important information about spermatogenesis;
- the presence of an autoimmune process in the testicle. In these patients, by eliminating only varicocele, spermatogenesis can not be improved;
- spermatogenesis is obviously very importantprognostic criterion, but can undergo great changes with age. Therefore, it is necessary to correlate with the testicle volume and the patient's age;
- morphology of the sperm is central to thethe study of ejaculate in patients with varicocele, in which the ratio of normal and pathological forms of spermatozoa does not exceed 40%. In addition, the morphological examination allows to reveal an anomaly of the head of spermatozoa. Reduction of these anomalies in 3-6 months. after surgery is an important factor in the success of the operation;
- features of the venous system. The presence of multiple trunks of the spermatic vein and collaterals, or the osmotic type of hemodynamics, may be the cause of recurrence of varicocele;
- Intrathytic varicose occurs in about 5-8% of patients with a marked varicocele. These patients have more severe hemodynamic disorders and edema of the testicle parenchyma.