Varikosel Ameliyatı

             
   
 

False knowledge about varicocele and scientific truths:

 
 

1- Varicocele is the most frequently encountered reason of the male infertility that we achieve better results as a result of a successful microsurgery. Nowadays, the importance of varicocele treatment for male infertility is scientifically conclusive, and microsurgery was presented to be the most successful method of varicocele treatment. Varicocele and particularly Microsurgical varicocele operation is definitely not a simple surgical intervention to be applied! Microsurgery technique is only successful in hands that is educated. Inadequate practices of microsurgery, as in every method, may also lead to very important complications, even organ loss.

2- Varicocele should be diagnosed only with manual examination, not with ultrasound. Unnecessary operations are performed by incorrect detecting of varicocele in many persons with Doppler ultrasonography. Varicocele which is not detected with the manual examination should definitely not be operated. Varicocele starts at ages of adolescence, and its negative effects may lead to infertility by gradually increasing within the time. When varicocele and its adverse effects are detected even if not urgent, the microsurgical varicocele operation should be performed as soon as possible.

3- Primarily, assisted reproduction methods such as in vitro fertilization, ICSI, intrauterine insemination should not be recommended for the person where varicocele was detected. Varicocele reduces ability to fertilize egg of spouse by impairing chromosomal structure of sperm cell (DNA fragmentation); even if fertilization occurs, possibility to abort increases. Varicocele is detected in some males who does not get a result with repeated trials of in vitro fertilization, and pregnancy can be achieved as a consequence of operation. The application of in vitro fertilization should not be forgotten, which should be considered only as a last resort. It increases risks of congenital anomaly and disease up to 30% in baby, has from early menopause to more serious risks for of mother. The first treatment for infertility patients in whom varicocele was detected is to remove varicocele with the microsurgery.

4- The most successful method of varicocele surgery, with the lowest possibility of complication, is microsurgery. The technical success in my personal series over 3000 operations and in series of specialist centers about this issue in the world is microsurgical varicocele operations can be over 99%. Serious complication rate decreases down to 0%, insignificant complication rate to 3-4%. Varicocele remains to exist with other operation techniques in 40% of patients after operation, the risk of hydrocele rises up to 40%, and arterial injury up to 5%. The embolization method for radiologic intervention is not preferred due to low success rate and higher rates of serious complications. Varicocele has no medicinal or herbal treatment.

5- Varicocele does not recur, this expression is used incorrectly when performed surgical intervention is inadequate. If varicocele persists due to inadequate surgery, the microsurgical correction operation can be performed. Inadequate surgery and the relapse can elevate up to 40%, and complication rates increase significantly with other methods.

6- We encounter many patients whose varicocele continues after unsuccessful varicocele operations performed with microsurgery and other old techniques or who have problem due to complications and confront serious problems such as hydrocele and atrophy of testis. Even though some of these patients whose sperm quality or spermiogram results impair even more, decrease even down to zero benefit from correction microsurgery; unfortunately, a part of them cannot be helped.

7- Varicocele may persist with inadequate application of microsurgery; serious complications such as hydrocele and organ loss may be seen due to arterial and lymphatic duct injuries. The quality where the technique is applied and the success is essential as well as technique applied. I recommend those who will undergo varicocele surgery to be operated by specialists who are educated and experienced about matter of microsurgery. Andrology Laboratory in The Istanbul Faculty of Medicine and and Tumlab (www.tumlab.com) are the laboratories which I trust the most for scientific spermiogram analysis, the most important examination for male infertility.

8- Varicocele may also be the reason of pain. Even though pain is not guaranteed to regress, pain disappears in many cases after microsurgery

9- After I came back from abroad in 1992, I took part in teaching the microsurgical varicocele operation to many assistants in The Istanbul Faculty of Medicine and I performed over 3000 operations. The microsurgical varicocele operation became the most preferred method in recent years particularly among faculty lecturers relevant to Andrology of university clinics, and also, the most outstanding clinics of the world adopted the microsurgical technique for varicocele operations.

10- As I operate international patients frequently, short stay packages are available. An appointment, a spermiogram test and if necessary the microsurgical varicocele operation (including one night stay in the hospital) can be arranged for the same day. Please send a mail to teoman@kadioglu.org for communication.

 Treatment of Male Infertility and Microsurgical Varicocele Operation
Difficulty of having a child at will is experienced in about 15-20% of marriages. Factors depending on only male infertility problem of couples are about 20%, the problem found in males is added to the problem in female in about 40% of couples; a problem in male occurs to contribute partly to infertility problems in 50-60% of couples experiencing difficulty of having a child. Even though most of problems in male can be understood with examination and sperm analysis, some situations may require special examinations.

Having a child with normal sexual intercourse can be provided by solving the problem of many males after treatments. Infertility treatments for female without examination of male by an Urologist and assessment of spermiogram performed in an expert laboratory by an experienced Urologist is an incorrect application seen frequently. Male infertility should not be forgotten to be the first finding of an underlying and life-threatening disease in some situations.

Tests:
The assessment in terms of infertility in male is diagnosed with at least two spermiograms assessed according to WHO criteria at the first stage by consultation with Urologist-Andrologist and giving sperm properly. Inappropriate application of scientific standards in laboratory examinations and particularly in area of Andrology, performing the procedures without quality control applications, study of sperms given in inappropriate conditions without proper protocols, as seen in many areas in Turkey, cause misleading results of infertility examinations; therefore, I only interpret spermiogram results of laboratories that I know and trust on these grounds.

I can show Andrology Laboratory of  the Istanbul Faculty of Medicine and Tumlab  Andrology Laboratory  (www.tumlab.com) as examples for trustful spermiogram result and insemination study.

If the problem is detected in the examination and sperm test in first assessments, further examinations will be performed. These can be detailed examinations performed with sperm, hormonal analyses, ultrasonography and some other radiologic and genetic tests. Treatments elevating fertilization capacity are performed by increasing numbers, movement and quality of sperm cells in the semen of male after examinations are completed.

A part of males with infertility problem may be treated with replacement of deficient hormones or by increasing sperm numbers with drugs for patients.

Sperm production of testicles and an obstruction in seminal ducts, by assessing patients without any sperm cell with detailed examinations despite of special examinations in sperm analysis. Part of patients without sperm cells in spermiogram despite evidence of sperm production in testicles, can be treated by special microsurgical or endoscopic methods and have children by normal sexual intercourse.

Varicocele and operation with the microsurgical technique:
Varicocele (enlargement in testicular vessels, varicosis) which is detected in 15% of all males and 40% of those who are with infertility problem is the most important factor impairing sperm production. Varicocele is the most common cause of infertility and the most successfully treated problem with surgery. My personal experience of 3000 operations, as in WHO studies which revealed varicocele to cause infertility, successful treatment contribute scientifically to infertility treatment. Varicocele impairs sperm production by influencing microcirculation after a rise in temperature and reflux of to testis; it decreases ability to fertilize by both normal sexual intercourse and in the assisted reproduction techniques such as in vitro fertilization (ICSI) and insemination due to effects on number, movement, structure and chromosomal structure of sperm, and increases possibility of abortion. I primarily recommend the microsurgical varicocele operation for infertility problem to my patients, I do not approve applying methods of medical treatment or in vitro fertilization. Varicocele, which may be seen in different severity, should be diagnosed with a detailed examination and must be performed under appropriate conditions by a specialized Urologist-Andrologist. As operation of varicoceles which can be detected only with ultrasonography does not avail, any other examination should not be demanded apart from a sensitive examination except very special situations.

Varicocele that may also be the reason of pain has importance in the event that it is detected in males who usually has no any health problem and just wants to have a child. Varicocele starting in the adolescence period may prevent development of testicles, its negative effects on sperm production gradually increase within the time. Having a child without feeling not too much varicocele effect but no having the second child due to varicocele effect lasting increasingly within years when a child is wanted again in further years is a frequently seen situation by means of marriages of males at young ages in our country.

Varicocele is the most encountered reason of male infertility, which can be treated successfully by using the microsurgical technique. Correction over 80% is achieved on the statistical significance in results of spermiogram in varicocele cases treated with successful application of the microsurgical methods by the right diagnosis, and many of these patients may have a child without requiring any other treatment; a significant part of remainders will reach to a benefit-able level from easier and economic methods than in vitro fertilization such as intrauterine insemination.

The incidence expressed as recurrent varicocele is detected in 30-40% of those who previously underwent a varicocele operation but, did not get a positive result. Positive results can be gotten by the microsurgical correction operation in these cases where performed operation is inadequate due to technical reasons.

When the effect on the chromosomal structure decreasing ability of sperm cells to fertilize is removed by operating with the microsurgical technique in the event of detection of varicocele before microinjection applications, the rate of pregnancy is detected to increase.

 

We know that varicocele diagnosis in males having problem with infertility is discussed quite a few due to the result of incorrect applications of manual examination and ultrasonography methods, and unfortunately sometimes commercial concerns, and that unnecessary operations are performed. Although I carried out about 2500 microsurgical operations since 1993 when i started the microsurgery technique in our country, i was obliged to tell to hundreds of people applying to me for operation by telling that varicocele was detected that they do not need to be operated.

Varicocele does not removed in 40% of patients who underwent varicocele operation due to other techniques applied instead of this very sensitive operation carried out with application of the special microsurgical methods, or unsuccessful application of microsurgery. Complications that are serious and unable to be corrected such as hydrocele (swelling as a result of accumulation of fluid in a large quantity between membranes of egg) due to binding of lymphatic ducts, even testicular atrophy due to binding of arteries, may occur. As a result of unnecessary and unsuccessful applications of varicocele operation whose rate of benefit to infertility problem is over 80%, this rate of benefit may decrease up to 20%. Therefore, i recommend persons advised for operation to consult with Urologists-Andrologists concerning about this matter by examining the matter in detail, considering not as simple.

 
 

Contact Information
Patients are accepted by making an appointment via phone number of 0 (212) 233 16 36 and operations are carried out in the special hospital.

 
 
Appointment (Clinic, Nisantasi) )   0 212 233 1636
Istanbul Faculty of Medicine. (Capa)   0 212 635 1203
Mobile   0 532 666 6666
E-mail   teoman@kadioglu.tc
 
  Please send a mail for international communication.