How to treat varicocele?

What is varicocele, how to treat it? Do I need surgery, doctor? Truong Vinh (35 years old, Ho Chi Minh City)

Reply:

The scrotal venous system of a normal person will have a valve system, helping blood flow in one direction. People with varicocele will have dilated valves that do not close tightly, causing the flow to reverse and affect the organs that use fresh blood, specifically the testicles. Furthermore, damage to this system will prevent the scrotum from cooling, affecting the ability to produce sperm. No research has shown which cause is dominant.

A micro-TESE surgery at the Reproductive Support Center, Tam Anh General Hospital, Ho Chi Minh City. Photo: Tam Anh General Hospital

10-15% of healthy men have varicocele. Symptoms include pain in the scrotum; pain when sitting for a long time, doing strenuous activities or after sex. In severe cases, symptoms include a different skin color, spots and roughness in the scrotum.

Currently, there are many methods to treat varicocele, such as microsurgery, using gel, metal coils to block damaged blood vessels or laparoscopic surgery. Among them, the surgical method using microsurgery (micro-TESE) brings the highest efficiency, with the lowest possibility of recurrence.

In some cases of varicocele, the veins can still be seen with the naked eye, but besides the veins, there are also arteries and lymphatic vessels. Therefore, if using a magnifying glass or the naked eye to operate on varicocele, there is a possibility of touching the arteries, leaving serious sequelae such as testicular atrophy, or a high risk of recurrence.

According to statistics, about 60-70% of cases after surgery recover spermatogenesis, 30-40% relapse, and some groups have no change. In case of azoospermia after surgery, if sperm is found to return, sperm should be stored immediately, do not be subjective, because up to 50% of patients with azoospermia relapse. Also according to medical records, these patients who have micro-TESE surgery still have a higher success rate than patients with azoospermia who have not had surgery.

Varicocele surgery is not recommended in all cases. If the patient is in pain and it affects their quality of life and activities, then this method should be considered. In addition, men with severe fluctuations in semen, even azoospermia, affecting their ability to become fathers, or in cases of testicular atrophy, should also undergo varicocele surgery.

If you have sperm, you can still have children normally through in vitro fertilization (IVF). Varicocelectomy helps preserve future fertility, resolve pain, testicular atrophy or affect sperm quality. A varicocelectomy takes about 60 minutes, the patient can go home the same day, and is painless.

MSc. Dr. Le Dang Khoa - Head of Andrology Unit
Reproductive Support Center Tam Anh General Hospital, Ho Chi Minh City

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