A varicocele is a varicose dilatation of the veins of the spermatic cord in the scrotum. It can be defined as the presence of varicose veins in the testicle and spermatic cord.
It occurs in approximately 11% of the general population, 25% of men with abnormal sperm analyses, between 35% and 40% of men with primary infertility (those who have not yet had any children) and between 70% and 80% of men with secondary infertility (those who have difficulty having children after having had a child previously).
It is much more common on the left side (90%), due to the special anatomy of the gonadal veins on that side where, more specifically, compression at the mouth of the spermatic vein usually occurs, causing a progressive expansion in the cord and testis.
The varicocele is often accompanied by a decreased testicular size and consistency. It causes progressive damage and results in progressive sterility. The incidence of discomfort and pain associated with testicular varicocele is between 2% and 10%.
Surgical repair of varicocele stops deterioration of the function of the affected testicle and in over 70% of cases improves fertility, improves sperm parameters, reduces sperm DNA fragmentation and increases the percentage of pregnancies. Current evidence suggests that treatment of varicocele should be considered first in infertile couples with no other cause of infertility, due to its low risk and the good relation between cost and benefits.
Varicocele can be treated in many ways: by interventional radiology, laparoscopic, or by conventional surgery using retroperitoneal, inguinal and subinguinal approaches. The best procedure is currently subinguinal microsurgery because this technique achieves the highest rates in healing, in seminogram and spontaneous pregnancy; it also has a lower percentage of complications (recurrence, persistence, hematoma, infection, hydrocele and testicular atrophy).
The intervention on Varicocele is performed using an operating microscope or optical magnification, allowing a better differentiation of the ions and preventing secondary damage during the surgery, which is more common in conventional methods (not micro-surgery).
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