It is a condition that occurs as a result of excessive enlargement of the veins of the testicles. The deterioration of the valves in this vein is effective in the emergence of varicocele. Varicocele appears as a soft, swollen mass just above the scrotum or in the groin area.
While it is seen in 5-15% of men, it is very rare in boys under 10 years of age. However, this rate increases gradually towards adolescence. It is reported to be on the left side in approximately 80-90% of the cases, and it is reported to be bilateral in 2-20%, and 1-7% if it is only on the right side. The fact that varicocele is mostly seen on the left side depends on some anatomical features.
Varicocele symptoms are very important for the diagnosis and treatment of the disease. Varicocele on testis;
- Swelling
- Puffiness
- Testicular pain
- It may give symptoms in the form of shrinkage in the testis.
Varicocele is present in 30% of male patients who cannot have children at an advanced age. Varicose veins affect testicular functions and impair sperm and testosterone production by deteriorating testicular temperature, accumulation of toxic substances in dirty blood in the testis and disrupting testicular blood flow.
The best method in the diagnosis of varicocele is the examination of an experienced doctor. The physical examination should be repeated in a warm environment with the patient standing and lying down. In both positions, it should be felt how much the veins expand in the normal and straining examination.
According to the examination, varicocele is divided into 3 stages.
- Grade: It is the situation in which the patient who is examined in outpatient has no symptoms and a varicocele is detected manually when straining.
- Grade: Mild varicocele is seen with the standing eye. It is the situation in which the veins become clearly visible by hand as a result of the pushing maneuver.
- Degree: It is the situation in which the veins are visible without any straining on the outpatient examination, and this image becomes more evident at the end of the straining maneuver.
Afterwards, the same examination method with ultrasound should be performed and vessel diameters should be measured. By taking three dimensions of that testis, it should be seen whether the testis is affected or not. Spermogram can be done if the child's age (close to adult) is appropriate. However, the surgical necessity is given by looking at the child's complaints (especially pain) and whether the testicle (consistency, size) is affected. Detection of more than 20% reduction in the volume of the affected testis on ultrasound compared to the contralateral testis is a very important surgical criterion.
Varicocele surgery is performed by microsurgical methods. That side should be entered with an open cm incision from the inguinal region, the vessels should be found and tied one by one. Depending on whether the operation is unilateral or bilateral and the number of vessels connected, the duration varies between 1.5-2.5 hours. Different surgical techniques have been described by various methods. Each technique has different complication rates. The most common complications are; Recurrence of varicocele or accumulation of fluid (hydrocele) around the testicle. Therefore, it is important that it is done by experienced pediatric urologists.