What to do with relapse of varicocele after surgery, than to treat
The man who was operated on for varicocele is not immune to relapse.
The disease can again manifest itself even if the surgery was performed according to the latest techniques.
Therefore, no one will guarantee against repeated varicocele. Let's try to figure out whether the varicocele can happen again.
What is the likelihood of relapse?
In most cases, recurrence of varicocele after surgery occurs in children. 20% of boys who underwent surgery re-enter the operating table. The relapse rate in men is just over 9%.
According to statistics, if the operation was carried out on modern equipment using a microscope, the recurrence of the disease is minimized. Also, in order to prevent relapse, it is necessary to undergo a complete diagnosis of the body before surgery to identify the patient's weaknesses, determine whether there can be repeated varicocele and prevent the causes.
The patient will have a spermogram, and only on the basis of her testimony will they decide whether to perform another operation. In very rare cases, relapse may occur a third time. In general, the recurrence of the disease is observed in 10-40%.
There are several rules by which you can avoid repeated varicocele of the testis after surgery.
- It is forbidden to wear too narrow underwear.
- It is recommended to lead a mobile lifestyle or exercise daily to prevent stagnation of blood in the pelvic organs.
- For inflammatory processes or infections, be sure to consult a doctor.
- Men after 40 years of age should visit a urologist at least 2 times a year for diagnosis and examination.
Causes of Relapse
A recurrence of the disease most often occurs due to the health characteristics of the man, as well as improper compliance with the regime after the operation. Repeated varicocele may reappear on the operated side, but there is a high probability that it can occur on the healthy side.
The main causes of relapse include:
- Congenital features of the location of veins and arteries.
- The presence of duplicate veins.
- If there are no valves.
- Genetic predisposition associated with the special structure of the venous walls.
- Weakness of the venous wall.
- In rare cases, slow blood flow becomes the cause.
- It is likely that the surgeon missed the ducts during the manipulation.
- Perhaps insufficient distribution of the substance if the patient underwent sclerosis.
Very rarely, relapse can provoke manipulations with laparoscopy. The most common reason is the traditional method of operation. This is due to the fact that after surgery on the testicle, collateral veins from anastomoses begin to develop rapidly.
Due to their small diameter, it is impossible to carry out an operation on modern equipment using specialized tools.
There is a problematic visualization that contributes to relapse.
Errors of a technical nature occur, which are the impetus for a new appearance of the disease.
Symptoms of secondary varicocele
There are no global differences in symptoms between primary and repeated varicocele. This disease is generally characterized by a smoothed condition without pronounced symptoms. For this reason, men do not always seek help from a doctor at the initial stage of the development of the disease.
The most common symptoms of varicocele recurrence include:
- After physical exertion or long walking, slight pain.
- Heaviness in the testicles during intercourse.
- Perhaps a slight increase in the scrotum.
- Constant pulling pain.
In most cases, the patient goes to the doctor, noticing the enlargement of the scrotum and constant pain, which are not pronounced. Is it possible to treat the disease with medications Despite the fact that most doctors are inclined to surgical intervention in the treatment of varicocele, there are non-surgical methods that can be used, if the disease is not very neglected.
The patient can do such procedures:
- Testicular massage. It can be carried out if the disease belongs to 2 or 3 degrees.
The patient should lie on his back and raise the pelvis, placing a pillow under it.
This is necessary in order to establish blood flow in the pelvic area. Massage should be done carefully so that there is no pain.
The most effective method in the fight against varicocele is surgery. Before using any method, the patient is given a test that will determine whether the man is capable of conception or is infertile. Only after this and the collection of other necessary tests is the patient undergoing surgery.
There are several types of surgical treatment, which include:
The features of relapse treatment are the use of such techniques in which the effect will be maximum and recovery will take a minimum amount of time.
All surgical methods to eliminate secondary varicocele are vascular ligation for a qualitative distribution of blood flow to healthy arteries.
Several more effective and safe treatments can be distinguished.
Manipulations are carried out using a stethoscope, which is inserted into the abdominal part to close the veins. This is the safest method with the shortest recovery time for the patient.
- Bandaging of a vein and its excision
The operation has a high percentage of positive results, a low level of complications after it and a high probability of cure.
- Ivanissevich’s technique
This is the most common treatment for varicocele. Its disadvantages are a high percentage of subsequent complications and low efficiency.
- Bypass surgery
After this operation, a complication in the form of blood clots in the created shunt is possible.
The healing effect is 97% after this treatment. Moreover, the operation is characterized by a minimum percentage of injury.
With recurrent varicocele, this is the most effective operation with minimal side effects. The only drawback is the possible scarring and blockage of the vein, which will block the blood flow to the diseased testicle.
If a varicocele is detected, the man should consult a urologist. Timely treatment started will allow you to cure the disease without surgery or to carry it out with minimal complications.
Relapse of varicocele is often experienced by individuals who have had surgery in childhood.Statistics report a 20% recurrence of the disease. The rate of disease recurrence in men is slightly lower, that is, no more than 10%. Modern equipment will reduce the risk of secondary disease. You can remove the risks by monitoring and ensuring the identification of the weakest areas in the patient.
Repeated treatment of varicocele is carried out due to surgery. When identifying the first signs, you need to contact a surgeon or urologist. It is better to visit the doctor who performed the operation.
Persons of fertile age are recommended to undergo a spermogram. Based on the information obtained during such an examination, they decide on the advisability of surgical interventions. Rarely, in patients with an individual predisposition to the disease, relapse can occur 3 times.
Relapse is a fairly common situation detected in 40% of men. A similar manifestation is observed in the form of a resumption of the disease. More often the manifestation of the disease is possible in adolescents because surgeons recommend that you wait until the onset of puberty and begin to determine the indications for intervention. Most often, the pathology progresses sluggishly, and its symptoms may bother the man 6-12 months after the radical technique.
Reasons for Relapse
The main means of controlling varicocele 3-4 degrees is surgery. However, the risk of a secondary manifestation of the disease, provided that surgery is used, cannot be ruled out. Most often, such changes are manifested due to the incompetence of the surgeon. Reasons for re-development may also consist in the severity of the course of the disease and the patient's particular characteristics. Relapse of the disease can most often be triggered by problems that occur during the rehabilitation period.
The disease can recur when providing intervention according to a traditional technique called varicocelectomy. Such risks are associated with the fact that in the area of the operation there is an impressive amount of small anastomoses and collateral veins that are injured by a scalpel during excision. The error may consist in defective ligation or illiterate elimination of injured veins.
Violation of the sclerotherapy technique may consist in the introduction of a small amount of sclerosant. Particular structural features of the patient’s body can also provoke the appearance of a repeated pathology, namely, the venous walls have lost their tone, insufficient blood flow in the pelvic veins. Often the cause of development is the patient's non-compliance with the recommendations of a specialist.
The list of main reasons is as follows:
- features of the anatomical structure,
- lack of valves
- duplicate veins
- genetic factor
- slowing blood flow and stagnant processes,
- venous wall weakness
- loss of blood flow at the time of surgery,
- incomplete distribution of the component during sclerotherapy.
Often, the appearance of acute reactions is associated with laparoscopic manipulation. When mistakes are made, the risk of complications increases several times.
Symptoms of Relapse
Secondary varicocele does not differ in symptoms from the primary manifestation of the disease. Varicocele has a steady course and at an early stage of its progress does not provoke the appearance of severe symptoms. This condition aggravates the treatment, men do not go to the surgeon until they experience acute discomfort.
The list of main symptoms of the re-manifestation of the disease looks like this:
- groin pain intensifies after heavy exertion,
- a feeling of heaviness manifests itself in the testicles during coitus,
- there is a change in the size of the scrotum,
- a man is bothered by a pulling pain.
Often patients go to the surgeon to detect changes in the size of the scrotum.Symptoms of secondary varicocele are not observed intensively, because often men ignore them and hope that the situation stabilizes on their own. In fact, only a radical treatment using technological equipment will help eliminate the negative reaction.
The neglected forms of varicocele can cause infertility and changes in the normal spermographic picture.
Surgery for relapse should be done as soon as possible. Procrastination in this case worsens the patient's condition and increases the risk of postoperative complications. In some cases, recurrence of varicocele can be treated with conservative methods.
How is the treatment
To eliminate relapse, it is recommended to use methods that can eliminate negative reactions in a short amount of time. All surgical techniques are based on vascular ligation to ensure the normal distribution of blood flow to healthy arteries.
The list of the most effective methods of therapy includes:
- Laparoscopy. An operation using a stethoscope, which is inserted into the abdominal part of the constricted vein. This method is safe and has a short recovery period.
- Bandaging veins with excision. The method has a low level of complications and provides a high probability of a full recovery.
- The technique of Ivanissevich. This method is often used to treat varicocele. The disadvantage of this method is the likelihood of complications and not high efficiency.
- Bypass surgery. After using the technique, blood clots may form.
- Sclerotherapy. This is a new treatment for varicocele. Sclerotherapy provides patient recovery in 98% of cases. The method is not considered to be traumatic.
- Embolization. With recurrent varicocele, this method is optimal. The main disadvantage is vein blockage followed by scarring.
If the first signs of varicocele are identified, you need to visit a doctor. Timely therapy will allow the patient to get rid of the disease without surgery or using less traumatic techniques.
Complications of Re-Intervention
When applying modern technologies by experienced surgeons, complications after manipulation are not traced. Many individuals may experience changes such as:
- edema on one or both sides of the scrotum, which is eliminated after a short time (patients are recommended to wear a special design to prevent puffiness)
- pain and heaviness in the scrotum, which disappears after using non-steroidal anti-inflammatory compounds and antibiotics (glucocorticosteroids are prescribed by a doctor in extreme cases),
- hydrocele is a common complication encountered by 50% of patients (pathology disappears after 10 months without treatment),
- hypotrophy and atrophy of the testicles can be traced during interventions by some radical methods.
When choosing sclerotherapy as a method of exposure in a man, an allergy to the introduced sclerosant can be traced. To exclude anaphylactic shock, Quincke's edema and other generalized reactions, the patient is recommended to remain in the surgical department under the supervision of medical personnel.
The exact information about the causes of the recurrence of the pathology is not yet determined by doctors, therefore it is difficult to talk about effective means of prevention. When varicocele in men is associated with genetic abnormalities, the likelihood of a recurrence of the disease is quite high. Relapse can be prevented provided that a thorough examination of the patient is carried out before the initial operation and careful selection of the optimal therapeutic agent.
A full examination will eliminate the possibility of leaving the affected vessel not blocked. The patient must also take into account the requirements of the surgeon in the postoperative period, namely to abandon nicotine addiction and alcohol.Serious physical activity is contraindicated at an early stage after surgery. It is extremely important to visit the surgeon on a planned basis, and when the first signs of the disease appear. Compliance with the rules described by the doctor will ensure quick recovery and eliminate the development of complications, namely relapse after a stable remission.
Patient reviews report that the likelihood of recurrence of varicocele after surgery is quite high. It is impossible to choose a method that allows you to remove the risk of occurrence.
Vitaliy, 32 years old, the city of Tambov.
Two years ago, I noticed a change. The scrotum increased in size, and I was faced with pain during intercourse. Like everyone thought it would pass by itself, but the situation worsened daily. A month later, he went to the doctor, and determined the date of the operation according to Ivanissevich. The recovery period passed unnoticed by me. I thought that the disease completely receded, but relapse manifested itself a year later. I went to a private clinic and went for sclerotherapy. So far I am satisfied with the result, I hope the third time the disease does not return.
Eugene, 36 years old, the city of Penza.
The first varicocele operation was performed to me when I was 12 years old. Relapse was 2 years ago. Probably the first operation was carried out too early. This time, the laparoscopic method was used. Now I feel good, no complaints.
Artyom, 27 years old, city of Moscow.
Varicocele appeared in me two years ago. All this time I suffered and did not go to the doctor. The surgeon said that earlier the disease can be cured by taking pills, and now only surgery. I think which method is the safest and most acceptable; I really want children.
When revealing the first signs of varicocele, you need to visit a urologist or surgeon. Timely diagnosis will allow you to get rid of the disease without radical methods or to choose the safest method of surgical intervention. Procrastination will cause a progressive deterioration in the well-being of the patient.
Repeated varicocele: relapse after surgery
Varicocele is a serious pathology of the veins, which in most cases requires surgical intervention. Unfortunately, this disease may appear again.
This feature is due to the fact that during the surgical intervention, impaired blood flow through the internal removable vein cannot be completely stopped or there is no way to detect additional veins.
It is these reasons that cause varicocele relapse. What to do in this case? What are the features of the recurrence of the disease?
Why can the disease appear again?
Doctors are constantly studying various pathologies of the vascular system, developing innovative methods and treatment regimens. But, as practice shows, relapse of diseases is possible in any person. Repeated varicocele is diagnosed in isolated cases, most often after surgery in children and young men. Such patients are re-treated with the same clinical manifestations. The percentage of relapses varies from 20 to 40%. In adulthood, this figure is minimal and equal to 2%.
After analyzing the situations in which the symptoms of varicocele were repeated, doctors distinguish the following reasons:
- failures or pathological changes in the circulatory system. Most often, patients with this disease are simultaneously diagnosed with various deviations in the work of the cardiovascular system, improper functioning of the veins in the genital area,
- wrong choice of surgical method. Very often, such problems arise when choosing a traditional method of surgical intervention. Doctors manage to completely block the main trunk of the veins, while additional ones remain in operation. For example, when using the laparoscopic method, an established clip may not completely block the blood flow.Very often, surgeons strive for an aesthetic effect, therefore, perform a minimum incision, which makes the review of the surgical field insufficient.
Despite the fact that there is a risk of re-emergence of the disease, surgery should be carried out, since it is one of the most effective methods of treatment.
How does relapse manifest?
Any operation for the body is stress, so during the recovery period unpleasant sensations and pain can occur. To understand how long the postoperative period lasts, how quickly the area of the scrotum and ovaries is restored, you need to consult a doctor.
As soon as the doctor confirms that the wound has completely healed and the body is working in a normal, natural mode, there should not be specific, unpleasant manifestations.
Relapses may have the following clinical manifestations:
- an increase in the size of the scrotum veins, which are visualized or palpated upon palpation,
- pains of a pulling nature in the inguinal region,
- pain in the testicles.
Pain sensations can have different intensities throughout the day, it all depends on the patient being in a certain position, physical activity. According to patients, if a person has a repeated varicocele, the pain always subsides if the patient lies down.
Most often, patients immediately recognize the symptoms of repeated varicocele, since they are absolutely similar to preoperative ones.
What does medicine offer in this case?
Repeated operation with varicocele can only be microsurgical. This is a more complex type of intervention, and the result will be positive.
Remember! Repeated operation will always be the last with varicocele, because after it the relapse will not happen again.
Many doctors offer a specific scheme that helps to avoid relapse in the postoperative period.
According to this scheme:
- It is necessary to carefully choose the surgical method of intervention. The doctor should offer several options for intervention, tell the advantages and disadvantages of each of them. If you can immediately use microsurgery, then you can’t refuse this.
- The correct timing for the intervention. If it is possible to wait for puberty, then you need to do it. Such patients have a minimal risk of recurrence of pathology.
- Observation by a doctor in the postoperative period. All doctors must give recommendations to their patients. They must be observed with accuracy to avoid complications or relapses. Also, regular medical examinations by a doctor will help in time to detect possible problems and take measures to eliminate them.
- Choosing a qualified doctor. This is one of the most important components of a successful treatment. The surgeon should directly specialize in this pathology, have a practice and his own methods of research and elimination of varicocele.
Varicocele is a disease that requires qualified help from a surgeon. In itself, it is harmless, but can lead to serious consequences, such as testicular ischemia or testicular hypoxia. All these complications always lead to infertility in men.
Knowing all the features of varicocele, its manifestations and relapses, every man should monitor his health, visit a doctor on time.
What is varicocele
This is a male disease in which vein expansion is observed in the spermatic cord. Many men do not even suspect its presence, since the disease does not have pronounced symptoms. Most often, they learn about their condition during a comprehensive examination. Symptoms of the disease include:
- a slight increase in part of the scrotum,
- pain in the place of localization of the disease, aggravated by exertion and walking,
- swelling of the scrotum.
If the disease is not treated, the pain will become constant, and the scrotum will react unpleasantly to movement.If the varicocele flows into an acute form, the pain syndrome persists even in a supine position.
Reasons for Relapse
The return of the disease may be due to the individual characteristics of the patient or may be the result of surgery. Among the most common causes of relapse include:
- Problems in the work of blood vessels. As a rule, the disease develops with pathologies of the cardiovascular system, impaired blood flow and vein weakness. The younger the patient, the higher the risk of recurrence of stagnation.
- Wrong treatment method. With the traditional method of performing the operation, it is not always possible to find damaged veins. As a result of this, the main trunk can be ligated, but its branches are not. This leads to the fact that blood flow disorders persist. With laparoscopy, relapse is possible when the clip, which closes the vein, is removed or due to its insufficient capture during clamping.
Relapse of varicocele that occurs after surgery manifests itself after a year and a half and is manifested by the expansion of the veins located in the scrotum, and the pain that occurs when walking, exercising and during sex.
In this case, the operation is advisable in the second or third stage of the re-disease. It is best to choose the surgeon who observed the patient for the first time.
Treatments for relapse
The same methods that are used in the primary disease, that is, surgical intervention, will help to solve the problem of the newly emerged varicocele.
During the operation, the veins that were damaged are ligated, after which measures are taken to normalize blood supply.
Depending on the clinical picture of the disease and the general condition of the patient, different methods of treatment can be applied.
The operation is performed by inserting a stethoscope into the abdominal cavity. The patient easily tolerates all the necessary manipulations and quickly recovers during the rehabilitation period.
The first two weeks should avoid sexual contact and serious exertion. If varicocele is the cause of infertility, a year after recovery, the patient will be able to have children.
The main disadvantage of this method is the high risk of dropsy and frequent relapses.
- Microsurgical ligation and removal of affected veins
A more advanced version of the popular Ivanissevich technique. The outcome of the operation in almost all cases is positive, and the risk of possible complications is minimized. Among the minuses can be noted a high risk of damage to the arteries and the duration of the surgery.
The most popular treatment. The surgeon makes an incision, bandages the vein and all its affected parts. The operation can be prescribed at any stage of the disease, but it has significant disadvantages: low efficiency, high likelihood of complications.
Injury is associated with the fact that all subcutaneous layers are dissected, and it takes a lot of time to restore them. In addition, the doctor may not dress all veins, which is the main cause of relapse. In the period after surgery, the patient is prescribed painkillers and antibacterial drugs.
It is also recommended to wear a special suspension.
A shunt is made for the patient, which blocks and redirects blood flow, restricts blood flow to the damaged vein and directs it to the full vessels. This technique is rarely used, as it is considered ineffective. In addition, it can cause a dangerous complication such as the formation of blood clots.
A fairly rare technique, which is associated with the possibility of scarring in the area of damage. Moreover, its effectiveness is very high.
In our country, this method of treatment is not widespread due to the lack of necessary equipment. During the operation, a gluing agent is injected into the damaged vein, which allows you to restore all its functions.Relapses after such an intervention are observed much less frequently than after other methods.
Varicocele Relapse - Causes, Symptoms and Treatment
Pathology develops due to the individual characteristics of the male body or non-compliance with the recommendations of a medical specialist after surgical treatment. Relapse does not necessarily appear on the same side, a healthy part of the body can suffer. The main causes of repeated varicocele are as follows:
- Individual characteristics of the body: the location of venous and arterial channels.
- The presence of duplicate veins.
- Lack of valves.
- Hereditary factor, which is associated with the structure of the walls of the veins.
- The cause of relapse may be slow blood flow.
- Low probability of a medical professional error during surgery.
The re-development of the disease occurs due to the use of traditional methods of surgical intervention, after which collateral venous channels develop in the area of the testicles.
Due to the small diameter of the veins, surgical intervention using equipment is not always possible. Relapse can be caused by technical errors.
As already noted, a relapsing course of the disease can be observed even in forty percent of cases. The reasons for this unfavorable phenomenon for men's health are as follows:
- some genetic features of the male body (for example, the presence of the so-called double veins in the body, some differences in the structure of the walls of the veins, hypoplasia of venous valves, etc.),
- insufficient ligation of the testicular vein,
- erroneous ligation of veins (i.e., bandaging the wrong vein)
- violation of the outflow of blood, especially along the pelvic veins,
- leaving clips.
Untreated recurrent varicocele leads to unpleasant consequences:
- the development of persistent pain syndrome that interferes with normal life and negatively affects the sexual activity of a man,
- decreased fertility due to the fact that the testes are in adverse conditions for normal spermatogenesis (pressure, poor blood supply, high blood pressure),
- reverse sperm reflux
- the accumulation of a large number of free radicals in the tissue of the testicles,
- atrophy of germ cells.
Studies show that in different men, deviations in normal sperm counts can vary from minimal to almost complete absence of germ cells in a portion of sperm. This is why relapse should be treated as early as possible.
Causes and symptoms
Repeated varicocele disease occurs quite often. According to statistics, from 10 to 40% of ill men experience relapse, with the highest probability of relapse in adolescent patients. It is for this reason that adolescents are not in a hurry to do operations, recommending that they wait until the end of puberty.
As a rule, varicocele does not return immediately, but only after months or even years. The first signs of a recurring disease appear no earlier than a year later.
The reasons due to which relapse develops can be due to both individual characteristics of the patient’s body and may be a consequence of surgical intervention.
However, a relapse of the disease associated with the patient’s genetic predisposition is rare. Basically, the disease returns due to missed inflows during the operation, insufficient distribution and action of sclerosing drugs or loose vein ligation.
In addition, relapse can be associated with the dissolution or movement of a substance that blocked the affected vein.There have also been cases in medicine when, due to insufficient visualization, the intervention was performed on vessels in adipose tissue that are not related to varicocele, and accordingly, recovery did not occur.
Relapse begins to manifest itself 12-18 months after the operation, and is accompanied by expansion of the veins in the scrotum, pain during walking, sexual intercourse and power loads. In such cases, the operation is performed when the re-disease has reached stage 2 or 3.
The main method of struggle is surgical intervention. Before conducting any operation, the patient is tested whether he is able to perform a child-bearing function or if he is infertile.
A number of analyzes are also collected, then a decision is made which type of surgical intervention will be used in this case. The emphasis is on the types of surgical treatment, which differ in the maximum degree of effectiveness, and recovery takes the shortest possible time.
Any type of surgery is to normalize blood circulation by ligation of blood vessels. Medical specialists identify a number of effective operations for the treatment of varicocele.
Relapses are treated in the same way as the primary disease. The main method of therapy is surgical. During the operation, the affected veins are ligated; efforts are made to restore normal blood flow.
The following types of operations are applied:
- Intervention by the methodology of Ivanissevich and Palomo. Although this operation is often used, its effectiveness is highly doubtful due to the significant number of postoperative complications.
- Mini operation. Differs in high efficiency, insignificant invasiveness and fast rehabilitation of the patient. However, it also has a significant drawback: the intervention is very long and is associated with the negative impact of x-rays on the patient's body.
- Bypass surgery. Installing a shunt makes it possible to block blood flow in undesirable places and direct it to where it should be. However, the technique is difficult to implement and often ineffective. In addition, bypass surgery often leads to blood clots.
- Percutaneous embolization. Despite the high efficiency in the treatment of varicocele, embolization is used infrequently, since its side effect is often scarring of tissues.
- Laparoscopy. During the operation, a statoscope is used, which is inserted into the peritoneum. Laparoscopy is attractive for its short rehabilitation period and high level of effectiveness.
- Microsurgical revascularization. This is the most effective method of surgical treatment of varicocele. During the operation, an adhesive is injected into the vein, restoring its functionality. Relapses after microsurgical intervention are extremely rare, and the recovery period is very short. However, in domestic conditions, revascularization has not yet received sufficient distribution due to a lack of appropriate equipment.
Secondary recurrent varicocele is subject to surgery if the disease has reached the second or third stage. To find out the need for such treatment, men should do a so-called infertility test. The same is done after the operation. Such measures are connected with the fact that the main goal of the operation is to save the man to have children.
If hypotrophy of the testicle develops, and especially if irreversible changes in their functions have occurred, and moreover, the man does not plan to have more children, then surgery is hardly necessary. The same can be said if there is no atrophy, and a pronounced pain syndrome does not bother the man, provided that other functions of the testicle work normally.
In most cases, a microsurgical method of treating recurrent varicocele is prescribed.Provided that the volumes of varicose veins are small, it is possible to introduce into the lumen of an altered blood vessel a drug that glues the lumen of a vein. In this case, it gradually overgrows. This introduction is combined with compression.
Surgical intervention is minimally invasive and does not require the patient to stay in the hospital. The entire volume of therapeutic measures is carried out in one day.
After a microsurgical operation, the patient is discharged, and comes to the doctor only for dressing and mandatory consultation. In some cases, the doctor considers it necessary to place the patient in a hospital.
A person is discharged the next day, provided there are no complications and a satisfactory course of the postoperative period.
It is necessary to distinguish between relapse and complications in the postoperative period. Complications are primarily characterized by such phenomena.
- Lymphostasis, developing very often on the second day. Associated with it is swelling of the scrotum (it increases in size). This condition goes away without treatment after a few days.
- There is a high risk of developing dropsy (i.e., hydrocele), when a little fluid accumulates in the testicle shells. Not every man can find this pathology, so after the operation it is necessary to undergo an ultrasound examination to make sure there are no complications.
- Hypoatrophy of the testis.
- Temporary sperm deterioration.
- Inadequate bed rest after surgery may contribute to the appearance of a hematoma.
- The man who was operated on for varicocele is not immune to relapse.
- The disease can again manifest itself even if the surgery was performed according to the latest techniques.
Varicocele does not pose a clear threat to the health of men. Some may live for decades with this disease and not experience any unpleasant symptoms.
Problems begin with the appearance of pain, or with the likelihood of developing male infertility.
- The course and duration of the postoperative period directly depends on the chosen method of operation.
- There are several ways to perform operations: from abdominal (open) to minimally invasive (without wide access).
- The more “traumatic” the operation will be performed, the more time will be required for the rehabilitation period.
Compliance with the recommendations of the attending physician in the postoperative period is the basis for the prevention of complications and a possible relapse of the disease.
Varicocele is the expansion of the veins of the spermatic cord. It is one of the most common diseases of the male reproductive system. According to statistics from the World Health Organization, this pathology is diagnosed in 15% of men.
The expansion of the veins itself does not pose a great danger, however, a formidable complication should be taken into account - male infertility. But timely treatment at an early stage (in the absence of signs of testicular atrophy) will help to avoid it.
In urology, the following causes of the disease are distinguished:
- 1. Weakness of the wall or absence of testicular vein valves. As a result, blood is not able to enter the main vessels, but instead accumulates in the vaginal plexus, which contributes to varicose veins.
- 2. An increase in pressure in the veins of the pelvis and scrotum, which subsequently leads to anatomical and physiological changes in the vascular wall - the venous lumen narrows, therefore, the venous outflow from the veins of the testicle is impaired, which leads to pathological expansion of the veins.
- 3. Increased physical activity, chronic constipation (excessive tension of the abdominal muscles), lack of regular sexual intercourse.
Surgery for varicose veins of the spermatic cord is considered less traumatic, so the recovery period does not last long: from two to three days to two weeks. Depending on the chosen surgical technique, the patient can be released home after a few hours, or on the second or third day.
After the patient is discharged, his condition is monitored in dynamics.
To date, there are several ways to conduct this surgical intervention.
Depending on the impact of various factors, both external and internal environment, the recovery period may be delayed for up to two weeks, but the pain syndrome may disturb the patient for some time.
An abnormally dilated vein of the spermatic cord is bandaged and crossed by the operating surgeon. This prevents the return of venous blood through the testicular vein.
The operation is abdominal (retroperitoneal access is used, more often access is done on the left) and is considered the most traumatic. Surgical manipulation is performed under local anesthesia.
After the intervention, the patient is prescribed painkillers from the group of non-steroidal anti-inflammatory drugs (ketorol, analgin, nurofen) to prevent the appearance of edema.
An ice bladder is applied to the wound area.
The first week after the operation, stiffness of movements and the development of edema can be observed (even despite the observance of preventive measures). Suture material is removed no earlier than seven days after surgery.
- To reduce the rehabilitation period, the attending physician will recommend that the patient wear a suspensorium - a special dressing to prevent possible deformation of the scrotum.
- It is also recommended that you start walking as early as possible.
- In accordance with the observation of such a patient in dynamics, the attending physician can be prescribed antibiotic therapy, pain medications.
Complications after surgery
Relapse of varicocele is something that a man who has been operated on for varicose veins of the testicle and spermatic cord, when symptoms and varicose veins appear on the operated side again, may encounter.
- Relapse can develop both after Ivanissevich’s operation and after microsurgical aids.
- According to surgeons, the likelihood that varicocele in men will appear again after microsurgical operations is slightly less.
Also a common cause - venous wall weakness - manifests itself after surgical treatment in intact veins, which take on the function of the distant.
A very rare case when the cause of relapse is a slowdown in blood flow through the external spermatic vein and pelvic veins.
In addition, if the varicocele was operated on the right, the possibility of its occurrence on the left is not ruled out.
Table of contents:
Problems begin with the appearance of pain, or with the likelihood of developing male infertility.
Surgery for varicocele is one of the most effective options for eliminating pathology. But, before you lie down on the surgical table, you should be aware of all the possible consequences and complications that can occur in men after surgery against varicocele.
What are the operations
The recovery period after surgery and possible complications largely depend on the chosen treatment methodology. Currently, there are several ways to eliminate varicocele:
Operation according to Ivanissevich. During this procedure, an incision is made in the patient’s abdominal wall through which the dilated vein of the testicle is removed.
The procedure is quite complicated, after it the patient may experience pain for a long time, so after it is often necessary to take painkillers, as well as antibiotics to exclude infection.
This operation has the following complications: hydrocele, frequent relapses, infection, damage to a nerve or iliac artery.
Marmara technique. Less traumatic procedure, in which the affected area of the vein is eliminated through a two-centimeter incision.
The patient does not have to be in the hospital for a long time - after a couple of hours after the procedure he is sent home. Operation with varicocele by the Marmara method is considered one of the most easily tolerated, with it there is almost no risk of developing complications or relapses.
Sclerosis. During this procedure, a special substance is injected into the affected vein, which clogs (scleroses) the vessel, as a result of which the blood flow through it stops.
After this procedure, pain, numbness of the extremities, swelling may occur, and sometimes, if the amount of sclerosant administered was incorrectly calculated, tissue necrosis may occur with subsequent formation of trophic ulcers.
No matter how well the procedure for removing the dilated vein has been carried out, some physiological characteristics of the patient, or failure to follow the doctor’s instructions, can lead to more serious consequences:
- Dropsy of the testicle (hydrocele). This condition is characterized by an increase in testicle size. It occurs if during the surgery the lymph vessels were damaged, as a result of which fluid began to accumulate in the membrane. A similar problem is observed in approximately 10% of patients.
- Hypertrophy or atrophy of the testis, as well as impaired spermatogenesis. These phenomena are extremely rare. Sperm production returns to normal no later than three months after the procedure.
- Pain that can persist after surgery for weeks or even months. They arise due to the fact that venous blood stretches the egg appendages.
- Femoral nerve damage. This problem is very rare and is characterized by numbness of the skin on the inner surface of the thigh.
- Violations in the production of testosterone.
Relapses of the disease are the most common type of complications that may occur after surgery.
Rehabilitation: what you need and cannot do
The duration of the postoperative period depends on the type of operation, the age of the patient and the individual characteristics of varicocele. Usually the patient is discharged the next day, after which he must be at home for a week, observing a certain regimen:
- moderate physical activity
- taking anti-inflammatory, analgesic or antibacterial drugs,
- weight lifting prohibition
- temporary exclusion of heavy foods from the diet - fatty, fried, spicy, smoked, etc.
During the recovery period after surgery, the patient needs to visit the doctor several times - a week after the removal of varicocele, a month, 6 months and a half years later.
During the examination, the doctor examines the patient, examines the spermogram, and gives recommendations on lifestyle, nutrition and preventive measures.
Many men who have gone through the surgical path to eliminate venous pathology in the testis are interested in issues of sexual life, military service and sports after surgery.
- Sex and masturbation after varicocele. The first few days after treatment, it is necessary to exclude sex life or masturbation. In the future, when the doctor permits sexual intercourse, at first intimacy may cause slight painful sensations, but they are short-lived and will soon disappear without a trace. Neither the disease itself nor the operation for its treatment has an effect on erectile function.
- Military service. After any procedure to eliminate venous pathology, all patients are given a six-month deferment from the army.
- Sport.Immediately after the procedure for removing the enlarged vein, power sports, especially weightlifting, are strictly prohibited. Bodybuilding dramatically increases intra-abdominal pressure, which is fraught with the occurrence of relapse of varicocele.
Can a varicocele repeat and why
Relapse of varicocele in adolescents occurs in 20% of cases. In adult men, this figure is significantly lower and amounts to 10%. Doctors explain the resumption of the pathological process after surgical treatment by several factors:
- Incorrectly performed surgical intervention.
- Weak venous walls.
- Slow blood flow.
- The age of the patient.
- Incomplete examination at the preparatory stage.
- Failure to comply with the doctor's prescription during the recovery period.
Choosing a method for removing varicose veins in the scrotum zone, doctors prefer the following methods: sclerotherapy, laparoscopy and Marmara surgery. With such approaches, repeated varicocele develops in exceptional cases. When a specialist uses the ligation according to Ivanissevich, the risk of re-development of the pathology is quite high. Laparoscopy sometimes leads to complications, as the clips can move away from blocked vessels. To avoid negative consequences, the doctor must perform a resection of the vein after clipping it.
Weak venous walls or slowing blood flow are also the reason that, after surgery, varicocele develops again. In this case, the veins intact during the procedure take on the function of the veins removed. The vessels gradually begin to fill with blood, provoking varicose expansion.
Children's age is another factor that increases the risk of a recurrence of the disease, so doctors recommend surgery after the onset of puberty. Prior to this period, the genitals of young men are not always sufficiently developed.
The resumption of the disease is often observed with an insufficiently complete examination of the patient at the stage of his preparation for the intervention. As a result, collateral branches and satellite veins go unnoticed by the surgeon, and during the operation the doctor does not excise pathological areas. Blood passes freely through them, and the symptoms of varicocele after a while appear again.
The cause of relapse and complications may be the patient's ignoring of medical recommendations during the rehabilitation period. They come down to compliance with bed rest, exemption from sports. It is equally important at the recovery stage to take the prescribed anti-inflammatory and analgesic medications, follow a strict diet. Failure to comply with these rules leads to the formation of blood clots in the operated vessel, the appearance of a hematoma and the resumption of the violation.
Signs of relapse of varicocele practically do not differ from those with the initial manifestation of the disease. The main symptoms are the following disorders:
- pain and burning sensation in the scrotum,
- discomfort when moving,
- sexual dysfunction,
- swelling and enlargement of the scrotum.
Many men do not think about relapse of varicocele and whether such a diagnosis can be re-made. Therefore, they ignore the problems and do not seek medical help. Relapse can be eliminated only with the help of surgery. Varicocele in advanced form leads to infertility.
The re-development of varicocele usually occurs if blood flow remains in the internal vein of the testis, that is, after the operation, some dilated veins remain.
Relapse is also possible due to the expansion of the thin collateral vessels adjacent to the affected vein, which cannot be recognized without special devices.
To prevent a relapse of the disease, it is also necessary to choose the right method of treatment.The greatest risk of the recurrence of varicocele exists during abdominal surgery, so in most cases it makes sense to abandon it, preferring minimally invasive techniques - for example, sclerotherapy or varicoceleectomy.
How to prevent relapse
Since the exact reasons for the recurrence of varicocele after surgical treatment are poorly understood, it is difficult to talk about specific preventive measures. If the development of the pathology is due to genetic abnormalities, the probability of its return is high. Relapse can be prevented under the condition of a comprehensive examination of the patient before surgery and a competent choice of the method of intervention. A complete diagnosis helps to eliminate all affected vessels.
At the recovery stage, a man must strictly adhere to the doctor's recommendations. It is necessary to stop drinking alcohol and smoking. In the first few weeks, intense physical activity is strongly contraindicated. It should be planned to visit the surgeon. If symptoms of varicocele recur after surgery, you should immediately seek medical help. Only in this case can we hope for a favorable outcome and the absence of negative consequences of treatment.
What to do when the disease recurs
If you suspect a relapse, you should visit a urologist and surgeon, take a spermogram. Mandatory is an ultrasound of the pelvic organs. The decision on the advisability of reoperation is made only by the surgeon. In the process of intervention, as in the case of elimination of the primary disease, ligation of the affected veins is performed.
Depending on the patient’s state of health, the doctor chooses one of the following methods to eliminate the pathology:
- Percutaneous embolization. The effectiveness of this treatment method is high, however, it is resorted to in rare cases due to the appearance of scars in the area of damage.
- The introduction of the shunt. During the intervention, the surgeon blocks the blood flow in the damaged vessels and redirects it to healthy ones. This treatment option often causes complications in the form of blood clots.
- Laparoscopic surgery. The procedure involves the introduction through the peritoneum of special tools for research and further excision of the affected veins. Its important advantage is a short rehabilitation period.
- Microsurgical revascularization. During the operation, a gluing agent is injected into the affected vein, due to which it is possible to restore its functioning. The method is characterized by a high degree of efficiency, but is practically not used in Russia due to the lack of the necessary equipment.
Surgical intervention with repeated varicocele does not differ from surgery in the case of a primary disease, the doctor can only change the method of therapy based on the clinical picture. After the procedure, precautionary measures must be observed: you must abandon physical activity and intimate contacts for 3 weeks, avoid sudden movements, do not take a shower for 5 days after the intervention.
From 10 to 40% of males face a relapse of the disease, which is expressed in the resumption of the process of pathological changes. The likelihood of a similar problem is much higher in adolescent patients.
For this reason, varicocele in adolescents is operated only in extreme cases, most often experts advise to wait for puberty.
Relapse develops slowly, and its symptoms may appear 12 or more months after surgery. Symptoms of repeated varicocele are similar to its primary manifestations.
Ways to solve the problem
Today, medicine copes with this disease.In order to solve the problem of repeated varicocele, the same methods are used as with the primary disease, namely, surgical intervention. During the operation, ligation of the veins that were affected, and measures to resume the normal process of blood circulation, are performed.
Depending on the condition of the patient and the recommendations of the attending physician, the following methods of surgical treatment can be applied:
- Surgery according to the method of Palomo and Ivanssevich. This type of surgical treatment is used quite often. However, it is considered insufficiently effective and causes a huge number of complications in the operated patients afterwards.
- The mini-operation method. This method of treatment is used in combination with other therapeutic measures and is considered highly effective. In addition, the area of tissue damage during mini-operations is relatively small, which contributes to the speedy postoperative rehabilitation of the patient. The disadvantages of this technique include the fact that the operation takes a lot of time and the patient is exposed to the harmful effects of x-rays.
- The introduction of the shunt. Bypass surgery allows you to block and redirect blood flow, limiting the access of blood to a damaged vein and directing it to healthy vessels. This method is not used often because of low efficiency. In addition, such an intervention often causes subsequent complications in the form of blood clots.
- The method of percutaneous embolization. This technique is also rarely used because of the possible appearance of scars in the area of damage. Moreover, the effectiveness of this type of treatment is quite high.
- The method of laparoscopy. In the process of laparoscopic surgery, a statoscope is inserted into the abdominal cavity to examine the affected veins and possible branches. The advantage of laparoscopy is that the rehabilitation period in patients does not take much time and the percentage of efficiency is quite high.
- Microsurgical revascularization. In Russia, this treatment method is not widespread due to the fact that in many clinics there is no equipment necessary for surgery. However, such an intervention is highly effective.
During the operation, a gluing substance is introduced into the affected vein, the action of which allows to restore its performance. Another advantage of microsurgical revascularization can be considered that relapses after this type of intervention occur much less frequently than when using other methods.
During the rehabilitation period, the patient is prohibited from lifting weights and other physical activities. In addition, in the first month after surgery, a man is better to refrain from sexual intercourse.
As a rule, varicocele is successfully treated, and in cases where the disease caused the patient's infertility, with a successful outcome, the viability of the sperm is restored.
Possible complications after surgery
In most cases, after surgery, complications do not occur, but in some patients the following manifestations may be observed:
- edema of one side of the scrotum, which after a while passes on its own, in order to prevent swelling, patients are advised to wear a special supporting suspension in the first postoperative week,
- scrotum pain that disappears after the patient has taken antibacterial and anti-inflammatory drugs,
- fluid retention in the scrotum (hydrocele), which is observed in almost half of patients in the postoperative period, but most often passes on its own after 8-10 months after the intervention,
- the occurrence of atrophy or hypotrophy of the testicles, which occurs extremely rarely after certain types of operations.
In addition to the listed general types of complications, there are consequences that occur after a certain type of treatment. For example, the result of endovascular intervention may be an allergic reaction to the substance administered, and bleeding is extremely rare after laparoscopy.
Is relapse of varicocele possible after surgery? The main causes and features of treatment
- Varicocele or venous expansion in the scrotum is a disease of the male reproductive system that can lead to infertility and a number of other dangerous diseases.
Reasons for repeated varicocele
Practice shows that the largest percentage of repeated varicocele is 20% and is observed in adolescents. The main reason for the re-emergence of the disease is considered not the complete elimination of varicose veins due to the characteristics of the operation.
By the endoscopic method, far from all branches of the additional veins can be detected in a timely manner, therefore, after some time, the varicocele appears again.
Another cause may be weakness of the venous wall or slowing of blood flow through the external spermatic vein and pelvic veins. It arises due to the fact that other veins take on the function of the distant.
Potential reasons include horse riding and frequent cycling. Long physical exertion can also provoke the occurrence of varicocele. However, the first symptoms usually appear about a year after surgery.
Sometimes, under a relapse of the right side, a tumor of the right kidney with germination is masked, a violation of geometry and compression of the renal vein, which prevents the venous outflow. Therefore, it is necessary to conduct a thorough examination and find out the cause of the deformation of the veins. Otherwise, an unnecessary operation may be performed.
The main signal that errors occurred during the operation are pain in the testicle and tumor of the scrotum after surgery. You must immediately consult a doctor to understand that this is not a protective reaction of the body to external influences.
What to do with relapse?
If you find similar symptoms some time after the operation, you must urgently consult a doctor. It is best to visit a urologist and surgeon right away. You will need to additionally undergo a spermogram and make an ultrasound of the testicle with a Doppler effect. The decision on the advisability of reoperation will be made by the surgeon.
If the disease is at the first stage of its development, then doctors can recommend waiting a year to see the dynamics of development. If there is no progress, then it will be possible to leave the disease without treatment, but in this case it will be necessary to undergo scheduled examinations annually.
As a rule, the patient is offered to do precisely the microsurgical surgical intervention for relapse of this disease. This allows you to remove all deformed veins in which blood flow is impaired.
Is it possible to treat with medication?
One of the medical treatment methods is aromatherapy. However, you must be aware that such treatment cannot completely solve the problem. It can only slow down the development of the disease, and in some cases completely stop it. It is used only for severity 1 and 2.
The use of large amounts of essential oils is recommended. Especially useful are lemon and cypress, as well as neroli, lemon balm, sandalwood and tea tree oils. Apply them in the form of inhalation or while taking a bath.
For inhalation, 3-5 drops of essential oil will be required. It is recommended to use immediately 5-7 types.The same amount can be used for bathing, but if desired, the dosage can be increased.
There are also several folk remedies that can stop the progress of the development of the disease. One of them is a decoction of apples. Three apples must be boiled in an enamel bowl and take the resulting liquid 3 times a day. A bath of oak, chestnut and / or willow branches and a compress of silver wormwood have a positive effect.
To improve blood flow in the veins and try to solve the problem without surgery, you should try special massages and exercises. In approximately 2% of cases, a positive trend is indeed observed.
Vitamins and various antioxidants are used as medicines. It is also worth taking drugs that improve blood circulation in parallel. Such treatment can cure about 10% of recurrent varicocele diseases at an early stage.
Are there any features during repeated surgery?
No, it goes the same way as the first one. Therefore, after its implementation, the observance of the same precautions is required, namely, a three-week sexual rest, the exclusion of great physical exertion and heavy sports, try to do without sudden movements, show up to the doctor, do not wet the bandage and do not take a shower or bath for 5 days after the operation .
Thus, the risk of varicocele a second time is quite possible. Therefore, doctors recommend that the prevention of this disease. If the symptoms of its development have appeared, then it is worth trying to treat medication at the first stage, and then it is necessary to resort to surgery if the drugs did not help.
It is best to use the microsurgical method of intervention to exclude the development of the disease for the third time. However, the use of other types of operations also does not contribute to repeated relapse. Practice shows that less than 1% of patients have varicocele a third time.
What complications may arise after repeated surgery
Complications may occur after repeated surgery.
Relapses after varicocele are accompanied by standard health complications. The reappearance of the disease provokes the appearance of the following pathologies
- Decreased sperm motility. Varicocele inhibits the functioning of the appendages and worsens the conditions necessary for sperm maturation. As a result, fertility is reduced.
- Local postoperative complications. These include hematoma, swelling, bruising, compaction, etc. They are attributed to the natural physiological signs of surgical intervention. These complications gradually disappear on their own.
- Testicular atrophy. Soft tissues atrophy in severe disease. This is due to a lack of oxygen caused by pathological changes in the structure of blood vessels.
- Hydrocele. This type of complication is also called dropsy. It develops with damage to the lymph nodes during surgery. Wearing a bandage helps to cope with the problem.
- Inflammatory process. It develops with insufficient hygiene after surgery or as a result of a violation of antiseptic norms.
- Reducing the size of the testicle. Such a pathology is practically untreatable. It occurs as a result of accidental damage to the seminal artery during surgery.
- Thrombosis. The disease occurs in case of hemorrhage in the area of a needle puncture during the injection of the treatment solution into a vein.
- Hormonal disorders. Male sex hormones are produced by the appendages. If their functioning is disturbed, a change in the hormonal background is noted.
What to do if after repeated surgery a man reveals infertility
Many men are interested in if a varicocele recurs, can there be repeated infertility. The likelihood of this complication is not excluded.It all depends on the nature of the course of the disease and at what stage it was diagnosed. Further actions in the detection of infertility after surgery depend on the degree of neglect of the pathology. There are forms of infertility that are not treatable. In this case, the only solution is artificial insemination using donor sperm.
If viable sperm cells are present in the ejaculate, the problem is solved with the help of medications. A man is prescribed intake of dietary supplements aimed at increasing fertility. Their principle of action is based on the content of vitamins, minerals and natural extracts. The most effective drugs include: Speman, Spermaplant, Velman and Semenaks.
The quality of the ejaculate is also influenced by factors such as the nutrition of men, the presence of bad habits, the level of physical activity, etc. Every day diet must always contain foods rich in zinc, selenium, folic acid, L-arginine, taurine and vitamins of groups B and C. It is advisable to refuse to take a hot bath and visit the sauna. It is also recommended that you limit your drinking and quit smoking.
How to avoid relapse
It is important to constantly monitor the state of the vascular system
So that varicocele does not appear again, it is necessary to adhere to preventive measures. Relapse in the form of a second episode of varicocele is a fairly common occurrence. Experts recommend adhering to the following preventive measures:
- It is necessary to consult a doctor regarding a future lifestyle. Patients who have undergone surgery twice are recommended to observe the basics of proper nutrition, exercise and give up bad habits.
- It is important to constantly monitor the state of the vascular system. For this purpose, preventive ultrasound studies using Doppler are performed. A spermogram is given to monitor fertility.
- During recovery after surgery, you should temporarily abandon sexual contact. This item includes not only sex, but also masturbation.
- Do not allow overheating or hypothermia of the testicles. To this end, special attention is paid to the choice of winter clothing.
- The selection of underwear should be based on an assessment of quality and practicality. It is advisable to focus on free models of natural materials. It is important to avoid pulling the genitals.
- Medicines prescribed by your doctor should be taken in accordance with the prescribed schedule. Even if the symptoms have disappeared, it is strictly forbidden to cancel the drugs.
Whether a varicocele can happen again depends on the patient himself and on the qualifications of the attending physician. In rare cases, the provoking factor is the individual characteristics of the body. With the right approach, the probability of a negative development of events is extremely small.
Medicine today is actively using more than one way to treat varicocele. Surgical intervention is just the general name of these techniques. During the operation, the affected veins are bandaged, measures are taken to normalize blood circulation.
Doctors use the following methods to eliminate varicocele:
- The method of Palomo and Ivanissevich. This method is often used, but today does not have much efficiency. According to statistics, after such an operation, the patient may experience many complications.
- Mini operations. The advantage of such actions is that the area of tissue damage is minimal, and the patient is quickly rehabilitated after the intervention. But it will take a lot of time, to everything else, the patient is exposed to x-ray exposure.
- The introduction of the shunt. Bypass surgery makes it possible to block the blood flow and redirect it, so that blood access to the deformed vein is limited, directing the blood to already healthy vessels.But this method is not particularly effective. There is the likelihood of such a serious complication as thrombosis.
- Laparoscopy. A special device is inserted into the abdominal cavity to examine defective veins and potential branches. The rehabilitation is short, and the effectiveness relative to other methods is high.
- Percutaneous embolization. It is rarely used, since scars can remain of a decent size, but such manipulation, however, achieves the main goal.
- Microsurgical revascularization. Unfortunately, not all clinics perform such operations, as there is a lack of suitable equipment. The surgeon introduces a gluing agent into the affected vessel, and it allows the vessel to become operational again. Relapse of varicocele after such an operation occurs very rarely.
At least - one hundred percent. Edema may occur on one side of the scrotum, and fluid may also be retained in it, high probability and testicular atrophy. Soreness also occurs, but these sensations are usually stopped by the use of anti-inflammatory and painkillers.
Many men fear not these complications, but that they will overtake. And why the pathology manifests itself again, for sure the doctors do not know to this day. If the cause of varicocele is a genetic factor, that is, the natural structure of the organs suggests the development of an ailment, then the risk of varicocele is high.
Why does the disease reoccur
According to statistics, relapses do not appear so often, but even with improved operating procedures, repetition cannot be ruled out. With varicocele, an entire network of pathological vessels is formed around the affected testis. And this is the area where microsurgery is used. Not all clinics are equipped with the latest technology; not all patients come across experienced doctors.
Can provoke a relapse:
- Displacement or dissolution of the substance introduced into the vein with the aim of blocking it,
- Errors in the operation associated with inaccurate diagnostics,
- Shallow depth of cut
- Weakness of tightening the vessel,
- Incorrect installation of barrier elements.
In order to avoid relapse, preparation for surgery and the use of informative endoscopy are important today. We must be aware that the problems of the rehabilitation period can provoke inflammation and lead to reoperation. And often these problems are created by the patient himself, violating the recommendations of the doctor.
Can a varicocele repeat? Unfortunately yes. What then to do? Only to be operated again, there are no other options.
Doctors also note that more often repeated operations happen with young patients. Surgical treatment of varicocele in children and adolescents is always a risk of pathology again.
What are the symptoms of secondary varicocele
How does a man understand that he has this problem again? Symptoms of secondary varicocele will not differ from those signs that appeared the first time. Moreover, often pathology does not mean itself at all, a smoothed course is characteristic of it.
Therefore, at the initial stage of the disease, a man rarely goes to the doctor.
Symptoms of varicocele recurrence:
- Pain after physical exertion or long walking,
- Heaviness in the scrotum during intimate contact,
- Some increase in scrotum,
- The drawing pain that occurs from time to time can be prolonged.
If the disease is not yet very started, then in some cases, doctors prescribe non-surgical treatment, but it also requires constant monitoring, since there is still no guarantee that everything will be done without surgery.
You can do self-massage of the testicles, carefully and delicately. This allows you to normalize blood circulation in the pain zone. There are some phytoreceptions that can relieve symptoms. For example, this is a bath in which a decoction of willow, oak and chestnut branches.But relying on such techniques is not worth it: for some time they can be effective, but rarely is treatment only this.
Laparoscopic surgery is prescribed for patients with bilateral varicocele and concomitant inguinal hernia, as well as for obese men. Patients who had previously been operated on precisely in the inguinal zone also often resorted specifically to laparoscopy. Sometimes there are no clear prescriptions, just this type of intervention is chosen by the patient himself.
Preparation for operation:
- A standard medical preoperative examination, it takes place in the clinic about a week before the operation,
- Preparation of the intestine itself - the patient needs a cleansing enema,
- Neither in the evening before the operation, nor in the morning, you can neither eat nor drink.
The operation itself is not particularly traumatic for the patient. He is given anesthesia, he lies on his back on the surgical table, trocars are placed in the peritoneum. The first trocar is introduced into the zone of the umbilical ring, special video equipment is introduced into its lumen, which provides a demonstration of the operation field on the monitor. Two smaller trocars are introduced on both sides of the umbilical ring. Then the doctor selects the dilated vessels of the cord, bandages them. Today, medical veins are used to dress veins.
After the deformed veins are ligated, the lining of the spermatic cord is sutured. Trocars are removed, wounds are also sutured. Usually there is practically no pain after such actions. But if pain and anxiety appear, you need to notify the doctors. A few hours later, you can eat and drink. You can also get out of bed on the day of surgery.
How is the operation of Marmara
This is also a less traumatic operation, in which opening the abdominal tissues is not required, that is, the patient will not have scars and scars on the skin. Complications after such an intervention are minimized.
The advantages of the Marmara technique:
- Low invasiveness due to the small size of the section,
- Fast recovery of the patient in the postoperative phase,
- The cosmetic effect is gorgeous - it’s difficult to see the place of the incision,
- Extremely low likelihood of developing complications.
In particular, doctors say, the possibility of developing a repetition is practically stopped. After the localization of the main artery and the further intersection of small and large vessels of the spermatic cord, the disease can be drastically eliminated.
Preparation for Marmar surgery is minimal: all the same standard analyzes, ECG, fluorography. You may also need a study that determines the level of hormones and spermogram.
The technique for performing the operation is as follows: surgical operations are performed under local anesthesia, therefore a person is in a clear mind. When the anesthesia begins to act, the surgeon will make a mini-incision in the inguinal zone. Then, layer by layer, the doctor reaches the canal with a swollen vein. The vessel is bandaged, stitched and cross. The method requires precise and quick action by the surgeon. Because it takes a little time, the patient does not feel pain.
This is the most common surgical way to eliminate the ailment. In the process of the operation itself, the doctor determines the location of the lesion, then simply carries out the ligation of blood vessels in order to escape from the retrograde blood flow through the extracted testicular vein. The risk of relapse, this technique leaves, it must be said, considerable.
The operation is performed both under general and local anesthesia, the need for the use of this or that method is determined by doctors. After the anesthetic is introduced, the doctor treats the section of the incision with an antiseptic solution.
Stages of the operation according to Ivanissevich:
- The surgeon makes a skin dissection and then dissects the subcutaneous tissue. The incision is made longitudinal, it is located in the peritoneal zone, along the path of the inguinal canal. The width of the incision itself is not more than 5 cm. The doctor and the muscle aponeurosis dissect.The surgeon pushes muscle fibers.
- Then the doctor sees a plexus of blood vessels in which he will find the testicular vein. He fixes the veins with clamps and bandages the vessel.
- Then the doctor removes the blood by massage of the scrotum tissue, the distal end of this testicular vein is clamped. Blood residues are removed, the wound area is washed, after the vessels are ligated or coagulated (cauterized).
- The final point of the operation is hemostasis. If necessary, leave drainage. The doctor puts a sterile dressing on the seam itself.
Is varicocele relapse after surgery according to Ivanissevich? Just this surgical intervention most often leads to repeated pathology. According to some reports, in 30% of cases, the disease returns. Therefore, to operate already relapse, you need to turn to other methods of solving the problem.
Testicular vein embolization is considered to be a minimally invasive treatment for varicocele. More and more adherents are precisely in this operation. But its value will hit the wallet for many.
How is embolization performed:
- On a hip in Vienna they make a puncture
- A catheter 2-3 mm thick is inserted into a vein,
- Carefully, the doctor inserts a catheter into the spermatic vein area,
- A special contrast composition is introduced into the testicular vein area, so it will be easier for the surgeon to see the affected area,
- A sclerosant is introduced through a catheter, it glues together the vascular walls, which causes a blood clot to form, and under the action of a sclerosant, blood flow to the affected area stops.
A few hours after this surgical procedure, the patient should be under medical supervision. If in 2-3 hours there are no difficulties, the patient can go home. The likelihood of a repeat is minimal, there are no scars or scars after surgery. The introduction of general anesthesia is also not necessary. Perhaps the only drawback of this intervention is that not all clinics have such a service, and if there is one, its cost fluctuates in the amount of 30-50 thousand. rubles.
What if again? recurrence of varicocele after surgery: can testicular disease recur
The man who was operated on for varicocele is not immune to relapse.
The disease can again manifest itself even if the surgery was performed according to the latest techniques.
Therefore, no one will guarantee against repeated varicocele. Let's try to figure out whether the varicocele can happen again.
Varicocele after surgery: complications, relapses that cannot be done, treatment
More than 15% of men suffer from varicose veins of the penis. Due to the fact that the disease is distinguished by subtle symptoms, many people for a long time are not aware of the presence of an ailment. Representatives of the stronger sex prefer to ignore periodic discomfort in the inguinal region, swelling of the scrotum and pulling sensations. But in vain.
The consequences of the pathology can be very serious: narrowing of the foreskin, heart valve defects, flat feet, infertility. But the problem is solvable. An important role is played by timely diagnosis and adequate treatment. Most often, doctors resort to surgical removal of the affected vessels. In some cases, varicocele returns after surgery.
Varicocele: features of the postoperative period
The only way to treat varicocele is surgery. The choice of surgical intervention and its methodology is determined by a qualified doctor. The opinion of the patient is also taken into account.
In the postoperative time, the patient is under medical supervision for a certain period. Regular blood tests allow you to track the healing process of wounds.
In the early days it is advisable to avoid heavy physical exertion, bed rest is preferable.It is required to exclude tight clothes and hot baths, which affect the internal pressure in the genitals.
After about a week, the discomfort should subside. In case of severe pain, analgesics are prescribed.
Types of operations
The choice of manipulations to remove the affected veins is wide. The typology of surgery for varicocele is stable for many years. The newest method for excision of dilated blood vessels is Marmar microsurgery. There are three main types of operational impact:
- Sclerotherapy - gluing the walls of problem vessels with a special solution. A method that does not require hospitalization is carried out under local anesthesia, in a medical office. Immediately after surgery, a man can go home. Based on the numerous reviews of doctors and patients, the effectiveness of this manipulation is quite low.
- An open operation performed by various methods (Marmara, Ivanissevich, Palomo, Endoscopy). First, an incision is made with a scalpel from below: in the abdomen or in the area of the epididymis. Then the dilated vessels are ligated, due to which the venous outflow is normalized. A scar remains, the length of which varies from 3 cm to 10, depending on the type of operation.
- Laparoscopic varicocelectomy. The basic principle of the procedure is the dressing of unhealthy veins. It is carried out using a special tube with a built-in lighting device and a camera. The process has a low morbidity and a low risk of consequences. Postoperative hospitalization lasts from 3 to 7 days, depending on the type of anesthesia chosen.
Recovery time after surgery varies according to the type of procedure. The longest rehabilitation period (up to two weeks) is after intracavitary manipulations, when the veins of the testicle are excised.
Likelihood of relapse
The minimum risk of developing a relapse of the disease, as well as other possible complications, is the Marmara procedure. The most serious consequences after varicocele surgery occur as a result of excision according to Ivanissevich and laparoscopy.
Younger boys and adolescents are more prone to the secondary occurrence of the disease. Re-manifestation of the disease is also treated surgically.
The absence of severe exacerbations after surgery largely depends on the qualifications of the doctor, careful observance of the technique.
Other possible consequences
With a high professional level of the doctor and patient compliance with all the rules during recovery, serious consequences are very rare. Sometimes, after surgical removal of the veins, minor deviations can occur, which will soon completely disappear without external intervention.
- swelling, swelling of the left or right testicle,
- aching pains and discomfort in the inguinal region, lower sides of the underbelly,
- the skin near the seam becomes reddish,
- isolation of the anemone from the wound,
- scrotum seal.
The above symptoms can not last a long time. Usually disappear spontaneously, without special treatment.
It is worth worrying if the following complications are observed after varicocele surgery:
- a sharp increase in body temperature,
- the occurrence of bleeding,
- wound infection
- swollen belly
- severe swelling of the scrotum on the left, dropsy of the testicle (hydrocele),
- recurrence of varicocele, appearing immediately or after some time,
- male infertility
- pain in the right kidney.
After surgery, the veins often take their normal shape and become subtle.
Attention! If the vessels enlarge or thin again, the left testicle hurts after varicocele surgery - this is an occasion to immediately see a doctor.
Life after surgery
When the varicocele operation is behind, what awaits the man in the postoperative period, experts will tell.At the end of the hospital stay, the patient continues to be under the supervision of a urologist.
Over a period of time, the patient must undergo a preventive examination three times:
- 3-4 weeks after healing,
- six months later
- after 18 months.
The attending physician gives recommendations for taking anti-inflammatory drugs, clarifies the regimen of sexual activity, physical activity, gives advice on diet. Recovery of testicular function is checked by spermogram results.
About the timing of the recovery period
The recovery period after varicocele surgery may vary in duration, depending on the method. With abdominal intervention, rehabilitation is from one week to 20 days. Microsurgical manipulation is characterized by a short postoperative period (two days). Suture threads usually resolve quickly.
If the material is not self-decaying, then to remove it you will have to visit the treatment room after about 7 days. The general recommendation is to maintain gentle treatment for three weeks. Doctors advise to exclude any load on the legs for the next 48 hours.
With some types of surgical intervention, a suspensory is required - a special bandage.
Many patients who have undergone surgical treatment are interested in what should not be done after varicocele surgery. At the end of the procedure for removing the enlarged vein, strength training, bodybuilding, weight lifting are prohibited.
Such exercises dramatically increase intra-abdominal pressure, which can trigger a relapse of the disease. It is advisable to eliminate or minimize horse riding and cycling during the year.
However, light physical activity, with a gradual increase, bring only benefit.
Intimate life and conception of a child
The first few days after treatment can not have sex and masturbation. Usually, after 3-4 weeks, the doctor "gives the go-ahead" to restore intimate life. At first, during the process of sexual intercourse, small painful sensations may remain. This discomfort does not require special treatment and goes away on its own. Surgical intervention does not affect erectile function.
Dutch scientists conducted relevant studies and found that out of 100 women, only 32 became pregnant in the first time after curing a varicocele from a partner. Testimonials of the remaining subjects testified to the impossibility of fertilization.
In some cases, a special diet is required in the postoperative period. In each individual case, the rules for eating are developed by the attending physician.
If there are no special indications, it is necessary to adhere to the basic principles of sparing nutrition: you can not eat fatty and spicy foods, drink alcoholic beverages.
Gastronomic restrictions should be considered during the entire rehabilitation period.
After any type of surgical intervention, a course of antibacterial drugs is prescribed to the patient. This is done to prevent the development of infection (laser correction is an exception). Medicines are selected by a specialist depending on many indicators: age, body weight, and the presence of complications.
To improve the state of blood vessels in the testicles, it is good to drink such medications as Agapurin, Trental, Arbiflex. Often prescribed venoprotectors: "Eskuzan", "Detralex", "Ginkgo biloba." Additionally, blood-thinning agents may be prescribed: Thrombo ACC, Heparin, Cardiomagnyl.
The listed drugs have many contraindications, therefore self-medication is unacceptable.
General recommendations for the prevention of complications
Prevention is carried out not only to prevent the initial development of varicose veins.In order to exclude relapse of varicocele and other postoperative complications, doctors also recommend that you follow some rules:
- stick to a balanced and balanced diet,
- eliminate possible stool disorders (constipation, diarrhea),
- practice regular sex,
- Avoid physical overwork
- sleep no less than 8 hours a day,
- maintain normal body weight
- do not touch cigarettes and alcohol,
- reduce the proportion of stress at work and at home.
Moderate physical activity (athletics, for example) positively affects the recovery of forces and can accelerate the return to the previous regime. Many men are embarrassed once again to seek advice from a urologist. This is an abnormal behavior that is fraught with health problems. Any disease is easier to prevent, and a routine examination will help early detection of pathology.
Varicocele is a serious disease that should be treated promptly. Otherwise, pathology can lead to complications: infertility and impotence. Half the success in treating this ailment depends on the speed of diagnosis.
When it starts to hurt in the groin, during movement or at rest, it is important not to ignore the possible symptoms and not to delay the treatment. The strategy and tactics for combating the disease are developed only by a qualified doctor.
Self-medication in this case is not appropriate.
The presence of the disease does not affect the draft in the army. The decision on release is made by the commission of the military enlistment office, based on the stage of pathology, the degree of manifestation of characteristic signs. Therefore, one should not have high hopes for an ailment, as the reason for deviation from conscription. It is better to get rid of the disease as soon as possible, and deal with the "civic duty" "as you get it."
What are the causes of varicocele recurrence and what symptoms are characteristic
Relapse of varicocele is a condition where the symptoms of varicose veins of the testicle or spermatic cord are repeated after an operation that was performed to cure this disease. According to statistics, relapse occurs in 25% of men.
In this case, the greatest risk of its occurrence is in children and boys who have not reached puberty. The development of relapse is manifested by the same symptoms as the underlying disease, and they can occur within a year or more after the operation.
What exactly are the reasons for the relapse - in detail in the article.
Signs of recurrence of the disease
Symptoms of varicocele recurrence can occur both on the side that was subjected to the operation, and on the other. Symptoms include the following points:
- Pain, burning, and sweating. These symptoms appear in the operated area of the scrotum.
- Swelling and enlargement of one side of the scrotum, asymmetry of the affected part and its sagging. To identify the symptom, it is enough to conduct an independent examination.
- Constant pulling pains at rest and the occurrence of sharp pain during exercise and intercourse.
- Inconvenience when walking.
- Violation of sexual function.
Drawing pain is a symptom of a recurring illness.
Since the symptoms of the newly started disease repeat the sensations that the patient experienced before the operation, it is not difficult to diagnose the disease.
Within two years after surgery, it is recommended that you carefully listen to your feelings and, when the first symptoms of the onset of the disease appear, consult a doctor. Regardless of the reasons, relapse of varicocele very rarely appears for the third time.
If symptoms occur for some time after the first or second operation, you should be aware that mild pain along the spermatic cord, physical inconvenience, and increased sensitivity of the operated area are normal.
The return of the disease is usually provoked by certain factors predisposing to this. There are a number of reasons that contribute to the development of varicocele after surgery:
- Wrong choice of surgery.
- Weakness of the venous wall.
- Slowing blood flow.
- Inadequate examination.
- Non-compliance with medical recommendations at the stage of the postoperative period.
Choosing the appropriate method of surgical intervention, doctors most often prefer methods such as sclerosis (injecting a substance that glues the vessel), Marmara's technique (removing the affected area through an incision) and laparoscopy (removing the dilated vessel through a puncture).
In these cases, the occurrence of relapse is less likely than with surgery according to Ivanissevich (ligation of the dilated vessel). The method of laparoscopy is fraught with the possible departure of the clips from the blocked vessels, but if the vein is cut off after clipping, the risk of the reappearance of the disease is minimized. The method is selected depending on the degree of the disease, symptoms and its course.
The possibility of relapse after treatment depends on how correctly this choice is made.
Weak vein walls can also cause re-development of varicocele. In this case, the intact veins assume the function of the distant, and the scrotum vessels begin to fill up from other veins.
As a result, blood flow resumes in the internal veins of the testicle, which causes varicose veins. One of the rarest causes of repeated varicocele is considered to be a violation of the outflow of blood through the external spermatic vein and (or) through the vessels of the pelvis.
As a result of improper blood flow, vessels begin to suffer, which provoke the development of a re-disease.
Another factor contributing to relapse is childhood. Most surgeons advise that the operation be performed after the boy has reached puberty, since before this period the child's genitals are not sufficiently developed.
On the other hand, varicocele often causes impaired testicular function, leading to infertility.
It is important not to delay the treatment and be observed by a qualified specialist who will help get rid of the disease and minimize the chances of its reappearance.
Quite often, an insufficient examination of the patient becomes the cause of recurrence of varicocele. As a result, additional vessels, collateral branches and satellite veins (satellites) go unnoticed.
This leads to the fact that diseased veins are not blocked and are not removed, blood flow continues to flow through them, symptoms resume, and the disease returns again.
In surgical practice, there are frequent cases when, after insufficient examination, other veins, such as hypogastric vessels, adipose tissue vessels or muscle venous branches, are removed, bandaged or blocked. In this case, the affected area is not operated on, and the disease continues to develop.
Ignoring the doctor’s prescription can cause a subsequent relapse of the disease.
The cause of recurrence of varicocele and the occurrence of other complications may be non-compliance with the doctor's recommendations after the operation.
Usually they consist in the appointment of a pastel regime, a ban on sports and weight lifting, taking antibacterial, anti-inflammatory and analgesic drugs, dieting.
Ignoring these rules can cause the accumulation of blood clots in the operated vessel, the appearance of a hematoma and subsequent relapse of the disease.
Thus, the occurrence of repeated causes of varicocele can be minimized at the stage of preparation for surgery.
To do this, endoscopic technologies and a special probe are used to help the doctor examine the pathology in detail and see all the branches from the main vein.
It is also important to observe your own feelings for 6-24 months after treatment and undergo additional scheduled examinations by a doctor.
Relapse of varicocele: causes, symptoms, treatment
Today, relapse of varicocele is effectively treated with surgery. But in some cases, after the procedure, the symptoms of the pathology return again.
Varicocele is a male pathology, which is a varicose vein in the area of the spermatic cord. This leads to impaired blood flow and pain in the scrotum.
Lack of proper timely therapy threatens testicular dysfunction and the development of infertility.
Possible complications after surgery
Often, if a varicocele appears a second time, surgery does not cause any complications in patients. In some cases, there are negative manifestations:
- Puffiness on one side of the scrotum, which disappears after a while without treatment. To prevent this process, patients after surgery are encouraged to wear a supportive suspension for a week.
- Pain in the scrotum, which disappears after the use of anti-inflammatory and disinfecting drugs.
- The accumulation of fluid in the scrotum (hydrocele). This complication appears in 50% of patients after surgery. Almost always goes away by itself after 8-10 months.
- The development of hypotrophy or atrophy of the testicles. It rarely appears after some operations to eliminate relapses of varicocele.
- In addition to the listed complications, the appearance of consequences inherent in certain therapeutic methods is possible. So, after endovascular therapy, an allergic reaction to the introduced substances sometimes occurs. Laparoscopy can cause bleeding.
Is it possible to masturbate with varicocele
Even if the operation does not imply a week stay in the hospital, the patient should still exclude any physical effort for at least two days. Usually he is issued a sick leave, and he rests for two days, lies down, moves less, eats well. Then gradually he returns to his usual way of life.
- You need to give up sexual relations for 2-3 weeks,
- Start sports activities no earlier than a month later in the mode of relaxation of training,
- Weightlifting, running, cycling, weight training, are contraindicated for men after surgery
- Hot baths are prohibited for 1-2 weeks,
- If there is no doctor's instructions, then you do not need to process the seam yourself, in particular, use antibacterial ointments.
Try to lie more until the sick leave is over. Do not create situations that border on overloads. Sleep a lot, move less, give up heavy food. If an upset stomach has occurred, which often happens after surgery, then take soft foods with a small amount of fat.
It happens that in the first few days after surgery, the patient notices that the seam “oozes” with a pinkish liquid. This can be attributed to the normal consequences of the operation, but still it is recommended to inform the doctor about this. Additional medication may be required.
Relapse of varicocele: definition, clinical manifestations and possible complications
Relapse can develop both after Ivanissevich’s operation and after microsurgical aids.
According to surgeons, the likelihood that varicocele in men will appear again after microsurgical operations is slightly less.
The recurrence rate of varicocele varies from 10% to 40%. These may be the consequences of an insufficient examination before surgery, when a vein-understudy is not detected, an additional influx of testicular vein.
Also a common cause - venous wall weakness - manifests itself after surgical treatment in intact veins, which take on the function of the distant. A very rare case when the cause of relapse is a slowdown in blood flow through the external spermatic vein and pelvic veins. In addition, if the varicocele was operated on the right, the possibility of its occurrence on the left is not ruled out.
The earlier the intervention was for varicocele, the higher the chances of a relapse. In this regard, with a small degree of varicocele in a child, it is recommended first to wait for puberty, and only then to carry out surgery.
It takes time to develop a relapse of the disease, clinical symptoms may occur more than a year later.
Clinically, recurrence of varicocele is manifested by the same symptoms as the underlying disease. Often this is an increase in the clearance of the veins of the testicle, an increase in the size of the scrotum, pulling pains and swelling of the affected side of the scrotum, pain along the spermatic cord.
In the postoperative period, lymphostasis associated with the lymphatic vessel may develop, when the scrotum on the operated side on the day after surgery increases in size and swells.
Lymphatic edema is not resistant and usually resolves within a few days.
Even in the postoperative period, hydrocele or dropsy may develop (when a small amount of fluid accumulates in the testicles). This can be detected during an ultrasound study. Dropsy may be accompanied by heaviness in the scrotum associated with stretching of the membranes.
In addition, there is the likelihood of complications such as testicular hypoatrophy and azoospermia after ligation of the testicular vein. This can be determined using a laboratory method.
As a rule, this type of complications manifests itself in the case of surgical treatment of varicocele at an early age.
Therefore, to prevent it, it is recommended to perform the operation after puberty, when the child becomes more adult.
The lack of compliance with bed rest after surgery is another option for complication, since blood accumulation in the bed of the operated vein and the appearance of an internal hematoma are possible.
Some patients after surgery for a long time may complain of pain along the spermatic cord, increased sensitivity of the operated testicle.
The total complication rate does not exceed 10% of the total number of operations, and manifestations should not last more than a month.
- What to do with relapse of varicocele in the first place? If, after some time after the operation for varicocele, you found yourself having similar symptoms, then this is a serious reason to contact your doctor, best of all the surgeon, in the institution where the operation was performed. The decision on reoperation will also be made on the basis of a spermogram.
- Can relapse of varicocele interfere with military service? The limitation of fitness for military service may be 3 tbsp. varicocele, and varicocele 2 tbsp. in case of relapse.
- Can a varicocele repeat a third time? Repeated relapse of varicocele develops extremely rarely.
- Could there be a varicocele a second time? Varicocele may develop on the side that has not been operated on, or recurrence of varicocele on the operated side may develop, due to the involvement of unoperated venous sites.
- With varicocele, relapses after surgery are possible in 10-40% of the operated.
- The causes of varicocele recurrence can be associated both with the characteristics of the patient, and with difficulties in the preparation and conduct of the operation.
- Patient characteristics are understood as genetically determined congenital structural features of the connective tissue of the venous wall, the presence of additional venous doubles, the absence or hypoplasia of vein valves, anastomoses, etc.
In the process of preparing for surgery, a thorough diagnosis of such features is important to prevent possible relapses. Very good results in order to avoid relapse are possible with endoscopic aids and intravascular operations.
Also during the operation, inflows that are not dilated in the supine position may be missed. Perhaps insufficiently dense ligation of the testicular vein. In the case of sclerotherapy, relapses are associated both with the insufficient distribution and action of the sclerosing drug, and with the peculiarities of the geometry of the vaginal plexus.
In addition, there is a secondary varicocele, when a retroperitoneal tumor of the right kidney with sprouting, a violation of the geometry and compression of the renal vein, which prevents the venous outflow, can be masked by a relapse of the right varicocele.
When recurrence of varicocele develops, the symptoms are similar to what happened before treatment. Within a year or more after the operation, an expansion of the veins appears in the operated half of the scrotum, which may be accompanied by pulling pains in the groin, along the spermatic cord and in the scrotum, which increase with heavy physical exertion, straining, and sexual intercourse.
Typically, secondary varicocele is subject to surgical treatment at 2 and 3 degrees.
An infertility test is also done to determine the need for the operation, since the main purpose of the operation is to preserve the fertility of the man.
If hypotrophy of the testicle has already developed with irreversible dysfunctions or if the man already has children and he no longer plans them, and the pain symptom is not expressed, then the need for surgery is doubtful.
In most cases, the patient is offered microsurgical intervention.
With small volumes of varicose lesions and the absence of communication with the central venous system after Ivanissevich’s operation, sclerosis is possible, which consists in introducing a special drug into the lumen of varicose vessels, which promotes the bonding and overgrowth of the lumen of the vein. The introduction of the drug is carried out in combination with external compression.
Intervention is carried out in one day. Depending on the conditions of the institution, it can be carried out in a hospital or day hospital. In an inpatient setting, the patient goes home after surgery and comes only for dressings and consultations, and in an inpatient setting, in the absence of complications, he is discharged the next day.
Prices for the operation to eliminate in Moscow, St. Petersburg and some other cities:
- Moscow: 20-90 thousand rubles
- Krasnoyarsk: 18-22 thousand rubles
- St. Petersburg: from 15 thousand rubles
- Tula: 15 thousand rubles
- Saratov: 5 thousand rubles
- Vladivostok: from 5 thousand rubles
Re-development of varicocele after surgery
With varicocele, nodes are formed in the scrotum, hampering the blood circulation in the small pelvis. The disease is accompanied by varicose veins of the spermatic cord. To eliminate it, use surgical intervention and medication. The selection of the treatment method is carried out taking into account the neglect of pathological processes. After treatment, relapse of varicocele is possible. It occurs in violation of the rules of the recovery period or as a result of poor-quality surgical intervention.
In the article we will tell: