Marmara operation with varicocele indications, pros and cons

A photo. Postoperative suture at the incision site

The term varicocele means varicose veins in the spermatic cord vein. In this case, testicular function is impaired, accompanied by azoospermia.

To restore impaired testicular function, the following operations are performed:

  1. Ivanissevich. Until recently, the most common method for removing varicocele. The method consists in bandaging and subsequent removal of the left vein and testicle. As a result, the blood ceases to stagnate in the deformed veins, its reverse current is excluded. The operation is done under local or general anesthesia, since it is introduced into the abdominal cavity when its wall is dissected. It is short-lived, easy for the surgeon, does not require special equipment and instruments. The positive is that it can be done by everyone, without restrictions. The disadvantages of the intervention according to Ivanissevich are frequent complications, prolonged recovery, the possibility of relapse.
  2. The microsurgical technique of Marmara or endoscopy is a more modern type of surgical treatment of varicocele, which consists in surgical intervention with the use of local anesthesia. A small incision is made in the groin, a catheter is inserted into it, with the help of which the blood flow is restored in the vein of the testicle. The operation is done under general anesthesia. Its feature is the use of microsurgical instruments, the damaging effect is minimal. Relapses of the disease are practically absent. The rehabilitation period is short, the patient quickly restores the efficiency and function of the testicle as an organ of spermatogenesis. A similar technique minimizes the risk of complications.
  3. Laser coagulation. Refers to endoscopic. In this type of effect on varicose veins of the testis, an endoscope is inserted into the vessel and the affected area is found using the fiber optic system. The operation consists in coagulating the affected vessel with a laser beam. There is a cessation of blood flow through the problem vessel. The advantage of the method is the absence of incisions in the groin area, minimal traumatic effect.
  4. Microsurgical revascularization. The goal is to restore venous circulation in the vein of the testis. Make an incision on the abdominal wall. After that, the testicular vein is removed into the incision, bandaged, removed. In its place, the epigastric vein is sutured, through which an outflow of blood from the testicle will pass. The advantage is a quick and complete restoration of blood supply. Optical devices allow you to give an enlarged image, which allows you to sew the testicular veins into those veins of the abdomen that are closer to the surface. In these veins, there is usually no varicose extension. The disadvantages are its high price, the need for a specially equipped operating room, a long recovery period.
  5. X-ray endovascular surgery. It is carried out under the control of an x-ray machine. A catheter is inserted into the femoral vein, through which a scleroting substance is introduced into the testicular vein. There is a cessation of outflow through the varicose vein, blood supply begins to occur along the collaterals. The disadvantage of the operation is the high likelihood of relapse.

Surgical treatment of varicose testicular veins is not difficult to perform. It should be noted that the “classical” technique according to Ivanissevich, which began to be used earlier than others, begins to recede into the past due to the length of rehabilitation and the presence of complications.

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Basic Contraindications

There are 3 degrees of varicocele:

  1. Grade 1 is characterized by the absence of characteristic visual changes, but is accompanied by subjective complaints of the patient about pain in the scrotum, testes or inguinal region;
  2. At the 2nd degree of the disease, a man has visual changes in the form of swollen veins on the scrotum, which appear in a standing position and, as a rule, disappear in a prone position. The size of the testicles is within normal limits, their consistency is ordinary;
  3. For the 3rd degree of the disease, the presence of swollen veins on the scrotum with a change in the size of the testicle from the affected side to its decrease is characteristic. The consistency of the testis is changed, with palpation it is softer than healthy.

With stage 1 disease, surgical treatment is not indicated. Adequately selected conservative treatment can stop the processes of change in the vessels.

Among the indications for surgery, there are:

  • 2 degree of the disease, which is accompanied by severe pain or lack of sufficient effect from conservative therapy;
  • 3 degree varicocele;
  • pain syndrome that does not stop medically at any stage of the disease;
  • violation of spermatogenesis, accompanied in men by a violation of sperm quality or infertility;
  • severe cosmetic defect;
  • cessation of testicular growth on the affected side during puberty.

Marmara surgery for varicocele is one of the most effective and less traumatic methods of surgical treatment of the disease.

This operation gained popularity due to the fact that it is:

  • minimally invasive, with a small incision up to 2 cm;
  • effective, with a low recurrence rate of not more than 5% of cases;
  • safe, with little tissue trauma.

Marmara operation with varicocele – technique:

  • access for surgical intervention is chosen subingual: an incision of no more than 2 – 3 cm is performed in the area of ​​the external inguinal ring. An indent of 1 cm is made from the base of the male penis. In this case, the trace after healing is located below the level of underwear, which turns it into a cosmetic one;
  • microsurgical instruments are used for surgery;
  • the incision is performed in layers;
  • dissection of the skin with subcutaneous fatty tissue;
  • in the received access the spermatic cord and veins are displayed;
  • under the microscope, the surgeon performs a dressing of each affected vein. Microscopic accompaniment avoids trauma to nerves, arteries and lymphatic vessels;
  • the use of a microscope allows you to dress invaginally located collateral veins, cremaster vein and internal spermatic vein without damage to the spermatic cord.

This type of surgical intervention in men is possible with left-sided and right-sided lesions of varicocele. After the microsurgical operation, the patient can be discharged home on the day of the operation.

The duration of the operation is an average of 40 minutes. The postoperative rehabilitation period is reduced to 2 days. After the operation, it is recommended to avoid increased physical exertion and sexual intercourse for several days. Further, after control, a man can lead his former lifestyle.

Studies have shown that infertility caused by varicocele after Marmara surgery was 2 times more likely to disappear than with other types of surgical interventions. Moreover, pregnancy in the first year after surgery occurred in 43% of cases, in the second year in 69% of cases according to the professor of the New York hospital Mark Goldstein. 1500 men were examined. Relapse occurred in less than 1% of patients.

In the presence of varicocele after Marmara surgery, patients leave positive reviews.

The following aspects are distinguished:

  • the availability of surgery;
  • high efficiency of the operation with minimal trauma;
  • fast rehabilitation period;
  • the possibility of quick discharge home;
  • subtle trace after surgical treatment;
  • low risk of recurrence of the disease.

Negative reviews are associated with the development of recurrence of varicocele. This is due to the fact that during the operation, collateral vessels were not bandaged or with the advent of new collaterals.

The main indication for the operation is the development of varicose veins in the field of the spermatic cord at stages 1-3. In addition, indications for the procedure may be as follows:

  • The development of pain during urination.
  • Constant pain in the scrotum.

It is known that the disease may not manifest itself for a long period of time and the patient does not even suspect the presence of such a problem. One of the serious complications of this pathology is the development of male infertility. In such a situation, only surgical intervention will have the proper therapeutic effect. Therapy should be started as soon as possible after the detection of pathology.

The operation of the marmara allows the treatment of both right-sided and left-sided forms of varicocele. After the procedure, there is no need to stay in the hospital. The patient can return home on the same day.

Marmara operation is carried out as follows:

  • The surgeon makes a small incision in a place located under the inguinal canal. There, the testicular veins are divided into several main trunks.
  • Then, using a special microscope tool, the doctor identifies and bandages each section of the trunks individually. Lymph nodes are not affected.
  • During the execution of all manipulations, the structures of the spermatic cord are under significant optical magnification, which allows you to perform all actions as accurately as possible, without injuring the surrounding tissue.
  • The duration of all manipulations takes about 35-45 minutes.
  • In the future, the patient should remain under the supervision of medical personnel for several hours. In most cases, the patient is discharged home on the same day.

In most cases, doctors prefer local anesthetics and refrain from using general anesthesia. When performing a marmara operation, the patient does not feel pain in the testicles. In some cases, you may experience a feeling of light sipping, which does not cause significant discomfort.

Particular attention should be paid to preparing the patient for the operation of the marmara. The patient should shave the hair in the scrotum and pubis 12 hours before the procedure.

If during the treatment of varicocele the operation will be carried out under general or spinal anesthesia, then the patient should not eat food and any liquid 6-8 hours before the procedure. The operation of Marmara is carried out in this case strictly on an empty stomach.

Marmara surgery allows you to cure a patient in just 1 day without a significant risk of complications or a recurrence of pathology. The recovery period after marmara surgery is quite easy for most patients, without complications. After carrying out all the manipulations, a man should not significantly change the daily routine or established lifestyle.

During the first few days after the operation, patients are advised to refrain from any physical exertion. Excessive physical activity will also have to be significantly reduced over the next few months.

In rare cases, the following complications have been reported after surgery:

  • Bleeding.
  • Wound infection.
  • Dropsy development.
  • Re-development of the disease.

After the operation is completed, the patient will be advised to regularly undergo an in-person examination with his attending physician so that he is convinced of the effectiveness of the therapy. Also, the patient will change the bandage and control the healing process. Suture removal is carried out after 1 week – 14 days after the procedure.

The technique of marmara with varicocele has a number of contraindications, which must be taken into account:

  • Marmara surgery is not performed if the patient has a history of uncontrolled hypertension.
  • With exacerbation of chronic diseases: for example, stomach ulcers and duodenal ulcers. In this case, the operation of Marmara can be delayed until remission and improvement of well-being of the patient.
  • With serious violations of the normal functioning of the blood coagulation system. In the event that the patient is taking medications from the group of anticoagulants, then their use should be discontinued no later than 10-14 days before the operation of the marmara.
  • The recovery period (at least six months) after a heart attack, stroke or coronary heart disease.

The Marmara technique is also not involved in the case of acute respiratory infections or flu.

Subingual microsurgical varicocelectomy is intended exclusively for varicocele, a disease in which the venous vessels of the plexiform plexus expand. The pathological process in some cases may affect the internal spermatic vein.

Vascular disease is observed in 15% of the male population. Moreover, in 35% of men, the pathology is characterized by the appearance of primary infertility, in 75-80% it is accompanied by a secondary form of infertility. Because of such statistics, varicocele is called the main cause of infertility in men.

Marmara varicocelectomy is performed with the following indications:

  • the presence of a symptomatic picture of the pathology: pain and discomfort in the scrotum;
  • the development of oligospermia, characterized by a low sperm count;
  • impotence for 2 years or more;
  • the inability to have children with a married couple, the etiology of which is unknown and cannot be explained by other reasons.

Varicocelectomy is prescribed for male adolescents with progressive testicular function, if the disease is confirmed by the results of several urological studies.

The main goals of treatment

The course of the postoperative period with varicocele depends on the type of surgical intervention performed.

Operations according to Ivanissevich and Palomo belong to intracavitary, which increases the time of postoperative recovery to 7-14 days. Rehabilitation for these types of operations for men is the longest. Postoperative complications can occur in 25 – 40% of cases. Most often, they are associated with the occurrence of hydrocele, or dropsy of the testicle from the surgical intervention.

When carrying out endovascular embolization of the testicular vein with sclerosant substances, the rehabilitation period is 2 to 3 days. The risk of varicocele recurrence is 10-15%. Another risk is perforation of the testicular vein during embolization.

Laparoscopic access in the treatment of varicocele reduces the rehabilitation period to 1 – 2 days. Relapse of the disease is possible in 10% of cases. Preservation of the intact testicular artery avoids the appearance of complications in the form of testicular atrophy.

The recovery period for microchirurgic varicocelectomy, or Marmar surgery, is 2 to 3 days. The likelihood of relapse of varicocele is up to 2%.

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In the period after varicocele surgery in men, the following is recommended:

  • wearing a suspensorium for 14 days;
  • exclusion of sexual intercourse 7 days after surgery;
  • 6 months prohibited active physical activity;
  • rest 48 hours after surgery;
  • bathing is prohibited 5 days after surgery.

There are cases when after the operation the varicocele veins remained. The causes of this complication may be:

  • anatomical feature of testicular veins when not all affected vessels are ligated;
  • the presence of collateral vessels that were not bandaged during surgery;
  • the occurrence of venous collaterals feeding the testicle;
  • restoration of blood flow in bandaged vessels.

In the case when a man’s varicocele remains or recurs, after a thorough diagnosis, a solution to the issue of repeated surgical intervention is necessary. This issue is solved only on the basis of the conclusions of research methods by a highly qualified specialist.

Removal of varicocele after surgery reviews has both positive and negative. Reviews from men at the same time vary depending on the type of operation performed. The more modern the type of surgical intervention, the more positive reviews it has.

Positive reviews relate to the following aspects:

  • disappearance of subjective complaints of patients;
  • elimination of a cosmetic defect;
  • lack of relapse of the disease;
  • lack of postoperative complications;
  • fast recovery period.

Negative moments after operations:

  • relapse of the disease;
  • postoperative complications;
  • duration of rehabilitation.

In order for reviews after surgery to be positive, a man with varicocele must strictly follow the doctor’s recommendations. If you have any complaints, immediately inform your doctor about this and do not self-medicate.

Marmara surgery refers to minimally invasive methods of therapy, and therefore does not require extensive incisions, in comparison with other abdominal operations.

During varicocele therapy, the operation of marmara sets the following main tasks:

  • Perform ligation or excision of the affected vein in the testicles.
  • Restore normal blood flow to the lesion site.
  • An operation from varicocele for marmara is performed to eliminate the cause of the problem and to reduce the risk of relapse.

In the treatment of varicocele, all manipulations are performed using general or epidural anesthesia, or using local anesthetics. The strategy for anesthesia and other manipulations using the Marmara technique is discussed with each of the patients individually, taking into account the degree of development of varicocele and the results of the examination.

When detecting varicocele, the operation of marmara has a number of significant advantages, in comparison with other types of operations and treatment methods. These include:

  1. Marmara surgery can be performed on an outpatient basis and does not imply hospitalization.
  2. During marmara surgery, the doctor makes a very small incision in the groin area. In the future, the scar formation will be in the area with increased vegetation.
  3. After the operation of marmara, the risk of re-development of the pathology is minimal and is less than 4-6%.
  4. The rehabilitation period after the operation of the marmara takes a little time. A man can quickly return to his usual lifestyle after the operation.
  5. The operation occurs without significant blood loss.
  6. The surrounding soft tissue is practically not prone to excessive injury.
  7. During the operation, the doctor uses a special microscope that allows you to bypass the arteries. During the execution of other surgical therapies for varicocele, the risk of damage to the testicular arteries is up to 35-45%, which leads to a violation of its nutrition and the development of serious complications.
  8. After the operation, varicocele not only does not recur, but there is also a restoration of male fertility.
  9. Modern experts prefer this particular method of therapy.

After the operation of marmara is performed, the patient has practically no pain. The inflammatory process develops extremely rarely and mainly due to non-compliance by the patient with the recommendations of the attending physician.

Patients can familiarize themselves with the technique of performing the Marmara operation before performing the procedure.

Unlike therapy methods, for example, according to Ivanisevich, the Marmara technique demonstrates the following advantages:

  • Low trauma.
  • The length of the cut does not exceed a few centimeters.
  • This method is more modern and effective.
  • There is a layered access to the area of ​​the inguinal canal.
  • During the procedure, there is no need to penetrate the peritoneum.
  • The doctor should not perform a dissection in the abdomen.
  • After performing all the manipulations, there are practically no scars and scars.

According to the result of international studies, this minimally invasive technique helps to restore reproductive function in male men several times more often than other surgical methods of therapy.

Advantages

Unlike other methods of treating the disease, including the Ivanissevich method, the Marmara technology has several of the following advantages:

  1. Minimal risk of injury: the doctor makes only one incision 1 cm long from the base of the penis. To get to the necessary venous vessel, the surgeon deepens the incision by 2–4 cm.
  2. Thanks to the microscope, the surgeon can accurately bandage the veins without excising nearby nerve endings, lymph nodes and arterial vessels. After the operation, the patient does not lose sensitivity.
  3. Low probability of recurrence of venous expansion.
  4. There is no need to enter the abdominal cavity during surgery. The doctor does not dissect the peritoneum to gain access to the inguinal canal. A medical specialist cuts tissue in layers.
  5. Recovery after surgery lasts no more than 48 hours. Moreover, the man does not stay in the department longer than 3-4 hours after the operation.
  6. If necessary, the surgeon during the operation can simultaneously bandage both the cremaster and the internal seminal vein. It is possible to dress the inguinal collaterals and the venous vessel of the testicular ligament of the testis without additional surgery.

After tissue repair in the area of ​​operation, scarring scars are almost invisible. Since the incision is made at the exit site of the spermatic cord, the postoperative trail will be under the underwear. This location of the scar allows you to hide cosmetic defects.

During clinical studies, it was found that after microsurgical intervention, reproductive function in men is restored 3-4 times more often than with other surgical methods of treating varicocele.

Surgery according to the Marmara technique is required to be performed on an outpatient basis or in a hospital. Before the operation, the patient must undergo an examination, which includes the following steps:

  • passing a general blood test to determine the level of hemoglobin and blood group;
  • checking the functional activity of the kidneys and liver;
  • urine delivery for general analysis;
  • the passage of an electrocardiogram is necessary to determine the electrical activity of the myocardium and identify cardiac pathologies.

Patients who have been prescribed surgery to restore fertility are required to undergo a spermogram.

The patient must undergo an ultrasound examination (ultrasound) to identify the stage of the disease – the degree of expansion of the venous vessels. Clarification of the complete clinical picture is necessary to establish a further treatment algorithm.

There are several recommendations that will help you properly prepare for surgery:

  1. It is necessary to inform the therapist, surgeon and anesthesiologist about all medications and homeopathic medicines taken, and folk remedies. Some medicines can increase the chance of bleeding. In addition, the patient may take drugs that are pharmaceutically incompatible with agents for general anesthesia. Such a negative interaction can be fatal, therefore, it is necessary to notify doctors about the drugs taken in advance.
  2. When taking blood-thinning medications (warfarin, acetylsalicylic acid, clopidogrel), you need to inform your doctor about the operation. A cardiologist will help to properly discontinue medication.
  3. Before visiting the hospital, it is recommended to take a shower. Do not use deodorants, lotions or colognes.
  4. Do not eat or drink water on the day of surgery. The next day you can drink broth and tea. If nausea and vomiting are absent, it is recommended to expand the diet.
  5. Need to remove jewelry, piercings and contact lenses.
  6. When performing the operation on an outpatient basis, the patient should ask relatives or family members to take him home after the procedure.

Technique of execution

Marmara operation with varicocele: technique and reviews

Periodically arising drawing pains in the scrotum and obvious asymmetry of the testicles may indicate the development of varicocele, a pathological expansion of the veins in the region of the plexus.

If left untreated, inadequate circulation in the affected area can lead to impaired urination. In severe cases, the disease affects the quality of seminal fluid, increasing the risk of infertility.

Marmara’s operation with varicocele is a minimally invasive surgical intervention and provides a complete elimination of the pathology.

The incidence of varicocele is detected in 15% of the entire male population. The expansion of the walls of blood vessels in the area of ​​the spermatic cord provokes excessive abdominal pressure, physical overload, injuries of the pelvic organs, tight underwear. In some cases, the process develops due to compression of the venous plexus by a growing tumor.

The initial stage of the disease is asymptomatic. The problem is detected only when there is a feeling of heaviness in the scrotum from the affected testicle. Discomfort increases during fast walking, running, sudden movements. Over time, swollen veins begin to appear through the skin, the patient experiences pain at rest, is not able to lead a full sexual life.

Surgical treatment is used in advanced cases. Marmar varicocele surgery has several advantages over other types of interventions:

  • access to the affected area is through a small incision in the groin, which avoids extensive injury to muscle tissue and adjacent vessels;
  • high accuracy with the use of optical technology preserves the integrity of the pelvic organs and does not violate their functions;
  • thanks to the gentle technique, there is no need for general anesthesia, the risk of massive bleeding is much lower;
  • a small incision in the projection of the venous plexus allows patients with a high degree of obesity and other pathologies to be operated on in this way;
  • the recovery postoperative period is several times shorter than with cavitary intervention.

Medical statistics record low rates of complications and relapses after using the technique. During the operation, the surgeon does not need to grope the affected area through the layer of soft tissues. Under thin skin, it is found much easier, you just need to carefully remove it and separate it.

The need for Marmara surgery is discussed by the patient with the attending physician if the progression of varicocele is established.

Preparation for the intervention involves collecting laboratory test results:

  • general analysis of urine and blood;
  • a detailed biochemical test for glucose, creatinine, bilirubin, urea;
  • blood coagulation analysis, if necessary coagulograms;
  • spermograms;
  • studies on HIV, hepatitis B and C, Wasserman reactions.

In order to detect cardiovascular abnormalities and infectious diseases of the lungs, an ECG, fluorography is performed. In the presence of chronic somatic and neurological diseases, acute inflammation, injuries, the patient is prescribed additional types of examinations by narrow specialists.

  • The date of surgery is postponed if any acute process is detected in the patient, including acute respiratory viral infections.
  • Surgical intervention is contraindicated in the presence of a patient:
  • hypertension;
  • severe heart damage;
  • kidney or liver failure;
  • impaired hematopoiesis or low coagulation.

A few days before the intervention, the patient may be prescribed a course of anti-inflammatory and antibacterial agents to prevent possible complications. In the last 12 hours, complete fasting, limited drinking are indicated.

The operation is performed on an outpatient or inpatient basis, depending on the general condition of the patient. The inguinal area is thoroughly shaved and disinfected.

  1. The patient is given drugs for local anesthesia or epidural anesthesia. Under general anesthesia, Marmar intervention is extremely rare.
  2. The surgeon cuts the skin and fiber below the inguinal ring, making an incision of 2,5–3 cm. With special retractors, the tissue layers are moved apart, the capillaries are pinched. The wound is drained with sterile material.
  3. An additional dose of anesthetic is injected into the lifting muscle.
  4. The doctor gropes and displays the spermatic cord, fixing it to the edge of the wound. When working with vessels, a special microscope is used. The affected areas of the veins are pressed with a ligature. Tissues are sprayed with papaverine to prevent spasm.
  5. After ligation of the main fragment, the patient is offered to tighten the abdominal muscles, making a sharp exhalation. The so-called Valsalbe test helps identify unrecognized varicose areas of blood vessels and bandage them.
  6. After a control check of the vessels and the end of the operation, the wound is sutured with absorbable material and closed with a bandage. Sometimes threads are used that need to be removed after the suture is healed.
  1. Subsequently, an almost imperceptible scar in the form of a thin line remains at the site of the cut.
  2. Among the possible complications of the intervention:
  • suppuration of an operational wound;
  • increased body temperature;
  • dropsy of the testicle;
  • severe pain during movement.

To reduce the risk of subsequent infection within a few days, the patient is prescribed a course of antibiotics. To relieve the load and maintain the venous plexus, it is recommended to wear a special bandage – a suspension. Pain in most cases disappear after 5-7 days.

If the outcome is safe, the patient is allowed to go home within 5–6 hours after the follow-up examination and conversation with the doctor. The surgeon can leave the patient in the clinic for observation for 2-3 days. Regardless of location: in a hospital or at home, a partial bed rest and a minimum of activity are recommended.

For a period of up to 10 days a disability certificate is issued. During this time, a refusal of physical work and sports is necessary.

Any activity leading to concussion or contraction of the inguinal region, spasms of the venous plexus should be excluded.

You can’t run, bounce, ride a bicycle, a motorcycle, visit a bathhouse, a sauna, swim in water. Periodically, the patient visits a doctor for follow-up examinations and wound treatment.

Until the end of the first month from the day of surgery, abstinence from sexual intercourse in any form is recommended. Immediately after the resumption of intimate life, short-term pain or a feeling of tightness in the affected testicle are likely. This is a normal reaction of blood vessels to increased blood flow, which gradually disappears.

The full rehabilitation period after varicocelectomy by the Marmara method takes 6 months. During this period, sparing mode is recommended. Avoid any debilitating stress, overheating and hypothermia, refuse to visit tanning salons, do not sunbathe on the beaches. Allowed water procedures: warm bath and shower, pool.

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Before the end of the rehabilitation, it is necessary to strictly monitor the diet, avoiding constipation and increasing intra-abdominal pressure.

Technique for Marmara surgery for varicocele

With varicocele, Marmara surgery is considered the gold standard for surgical treatment.

After it, relapses rarely occur, there is practically no risk of extensive postoperative inflammation.

The recovery process is several times faster than after abdominal interventions, the patient returns to normal life after a few days.

Its essence, price and patient reviews are all in this article.

Varicocele can cause three main problems: decreased fertility, decreased testosterone production in the testes, and discomfort in the scrotum. In some cases, varicocele can cause azoospermia or the complete absence of sperm in the ejaculate.

Varicocele is a fairly common pathology, often goes unnoticed throughout life.

Reviews of experts show that about 80% of men with varicocele are able to conceive a child with their partner without any medical intervention.

One of the important points is that larger varicocele have more side effects. Standard indications for microsurgical varicocelectomy include:

  • A palpable varicocele with typical symptoms, with one or more abnormal sperm counts.
  • Correction of male infertility.
  • Low serum testosterone.
  • Testicular pains.
  • Testicular malnutrition.
  • Poor quality of the seminal fluid genetic material (DNA fragmentation).

An individual approach to the treatment of varicocele is very important. The decision on surgical intervention in the form of a microsurgical varicocelectomy is based on the size of the varicocele, the goal of restoring fertility, symptoms of low testosterone, scrotum discomfort, and seminal fluid analysis.

Sometimes, the optimal decision for each couple must be taken in conjunction with a reproductologist to weigh the pros and cons. It is clear that a woman must be carefully examined (exclude her illness as the cause of long infertility), so that there is a result in the treatment of infertility.

The patient may experience a decrease in fertility.

Many experts are contradictory to the fact that varicocelectomy increases the fertility of men. Although there are studies and reviews of doctors confirming that the operation has a definite positive effect on improving sperm count and the frequency of spontaneous pregnancies.

There are several approaches to surgical treatment of varicocele. These include retroperitoneal and conventional inguinal open methods, microsurgical approaches, laparoscopic surgery and radiographic embolization.

But microsurgery is considered the “gold standard” because it is associated with the least risk of complications (dropsy, testicular atrophy). Microsurgical intervention is performed on an outpatient basis, that is, after the procedure and after the end of the anesthesia, the patient can go home.

Features of rehabilitation

After laparoscopy, a recovery period is necessary.

Surgery using microsurgery is less traumatic, so the recovery period of the functions of the genital glands is short. At the site of the surgical intervention, a small wound remains, on which an aseptic dressing is applied.

It is removed after two days, it is allowed to take water procedures. The stitches heal for a week, then suture threads are removed.

Although the operation is not complex abdominal surgery, some problems may arise:

  • hemorrhages under the skin at the site of the incision;
  • skin is tightened around the surgical wound;
  • there is a clear hyperemia of the skin;
  • from the wound stands an anemone.

Such postoperative symptoms are not a pathology and after a few days disappear without consequences, without requiring any treatment.

Painful manifestations that require medical attention arise as follows:

  • fever with fever for several days;
  • pain is felt at the site of the surgical intervention, visible edema appears, redness of the skin;
  • brown-yellow colored contents that have a specific odor begin to stand out from the wound;
  • Extensive hemorrhages form under the skin around the surgical wound.

The duration of the postoperative period with an open incision is about one month, if an endovascular procedure was performed, then this period is reduced to 1-2 days. It is impossible to exclude complications after surgery, since this manipulation is traumatic for the external genital organs.

Long-term consequences of the operation are:

  • dropsy of the testicles or hydrocele, which occurs due to damage during the operation of the lymphatic vessels, which violates the lymphatic outflow;
  • lymphostasis, which is expressed in the fact that the operated testicle increases in size;
  • blood overflow of the ep >

Violations of spermatogenesis are one of the reasons for deciding on varicocele surgery, therefore, restoration of sperm functional abilities occurs within a month or two after surgical treatment.

Features of rehabilitation

Restricted bed rest for some time.

The postoperative period depends on what type of surgical intervention was used for treatment. Techniques performed with penetration into the abdominal cavity require longer healing times than those where the traumatic effect is minimal.

The recovery period after the operation carried out according to Ivanissevich or its modification according to Palomo, despite its simplicity and effectiveness, has a long recovery period and has its own characteristics:

  • carried out in the urological department of the hospital;
  • it is necessary to limit mobility, observe bed rest from 3 to 5 days;
  • after the doctor permits to rise, it is necessary to wear a suppository to maintain the scrotum;
  • if healing occurs without deviations, then the surgical sutures are removed after 9 days;
  • stay in a hospital under medical supervision lasts 14 days;
  • after the patient has left the hospital, he is prescribed a regimen with motor restrictions, which lasts from two weeks to one month;
  • the first month, with a favorable course of wound healing, sexual activity is prohibited, since the seams can separate.
  • the patient is prohibited from lifting weights weighing more than 10 kg until the doctor makes sure that the surgical wound is completely healed;
  • to exclude the appearance of dropsy of the testicle, it is prescribed to wear a suppository;
  • if the patient experiences pain, it is necessary to consult a doctor;
  • postoperative varicocele bandage is used for most patients

Laparoscopy, as a gentle treatment method for the patient, has a short rehabilitation period, which has its own characteristics:

  • the patient is in a specialized urological hospital for 2 to 5 days, depending on the condition;
  • although the operation can be performed using local anesthesia, surgeons prefer general anesthesia, after which the patient goes through a recovery period in the hospital;
  • to prevent the development of complications and inflammatory processes, the patient is prescribed antibacterial, anti-inflammatory, analgesic and immunostimulating drugs;
  • during the month only light warm-up physical exercises are allowed according to a special program of physiotherapy exercises.

The video in this article shows an effective set of exercises for speedy recovery.

The method according to Marmar differs in that there is no penetration into the abdominal cavity, it is carried out on an outpatient basis under local anesthesia. Prior to the intervention, urine and blood tests are necessary. The surgical field is only 2-3 cm in length, then the surgeon reaches the vein affected by varicose veins, bandages and removes it.

By time, the operation lasts 30 minutes. After it, a sterile dressing is applied, and the patient can soon go home.

  • the external seam after examination and verification of the patient’s condition is removed after 5-7 days;
  • to prevent complications, the doctor prescribes a patient wearing a suppository to fix the scrotum;
  • in order to avoid complications and the occurrence of inflammation, it is necessary to take antibiotics, anti-inflammatory drugs, venotonics, vitamin complexes;
  • the patient is recommended to limit physical activity and sexual activity for a month, with regular medical examinations.
  • the usual period of full rehabilitation takes from 2 weeks to one month.

The recovery period after marmara surgery is minimal. If the patient has had an excellent procedure, then he will be sent home the same day or the next day. If the doctor considers it necessary, the patient may remain under observation for 2-3 days.

During the first few days, the patient will have to limit his life. Patients who are going to have an intervention are interested in the question of how much to recover after a marmara operation. Sutures are usually removed on the seventh day after surgery. Around this period, sick leave is given. The wound will heal within the first 9 days. The scrotum will fully recover in 4-6 months. During this period you will have to avoid:

  • immense sexual activity;
  • excessive physical stress;
  • cycling;
  • visits to baths, saunas.

Rehabilitation after marmara surgery may vary depending on the health and number of years of the patient, it includes the following measures:

  • therapy to prevent the development of inflammation;
  • selection of the optimal regimen of physical and sexual activity;
  • recommendations for the speedy restoration of testicular function.

To reduce the possibility of inflammatory processes after the intervention, the doctor prescribes antibiotics and a course of vitamins to maintain the immune system.

As for the regimen of physical and sexual activity, it is forbidden to actively work and have sex for the first 7-10 days, and lifting objects heavier than 4 kg is also not recommended.

And in order for recovery after marmara surgery with varicocele to be faster, doctors recommend that the following rules be observed:

  • the first day after the operation, it is desirable to observe bed rest;
  • a man will have to wear a special supportive bandage;
  • make short walks, which positively affects the passage of the blood duct through the legs and helps to establish the respiratory process after anesthesia;
  • get enough sleep;
  • eat healthy, non-fatty foods to prevent constipation and digestive upsets.

Lack of bowel movements in the first two days of recovery after marmara surgery is the norm. If you still have constipation, consult a doctor, he will prescribe a mild laxative.

If you want to reduce swelling and pain in the seam area, you can apply a compress with ice. Between him and the skin should be gauze or thin tissue.

In the postoperative period after marmara surgery, the first time a man should visit a doctor after 30 days, then after 6 months and a year.

Some men, faced with varicocele, worry that after the intervention the sexual sensation worsens. In fact, surgery increases the sensitivity of the genitals, and sex can be even better. By the way, it is intimacy that is the best prevention of re-development of varicocele.

The postoperative period after marmara surgery with varicocele provides a number of restrictions, most of which are introduced for a short time.

Medications

Medications during the rehabilitation period are taken as prescribed by the doctor

Postoperative treatment of varicocele, to prevent the development of inflammation in the area of ​​surgical intervention and scrotum, is carried out using drugs for various purposes. For each of them there is a corresponding instruction.

Appointment of drugsMechanism of action
NSAIDs non-steroidal drugs for inflammation
AspirinStop inflammatory processes, inhibiting the synthesis of inflammatory enzymes
Diclofenac
Ibuprofen
Sulfanilamides
StreptocideAct on biochemical processes in a bacterial cell, inhibiting the synthesis of enzymes and proteins
Sulfazine
Urosulfan
Etazole
Antibiotics
AzithromycinEffective against most bacteria, inhibit the synthesis of proteins and RNA, make their reproduction impossible
Spiramycin.
Sumamed
Anticoagulants and microcirculation stimulants
HepatrombinThey prevent the sticking of red blood cells and platelets, not allowing blood to clot, improve blood flow in the veins and capillaries
Ibustrin
Heparin
Troxevasin
Pentoxifylline
A nicotinic acid
Trental.
Venotonic agents
VazoketStrengthens the walls of venous vessels, increase their elasticity
Venolek
Ginkgo biloba
Detralex
Aescusan
Vitamin preparations
tocopherolGeneral strengthening and immunostimulating action
retinol
Ascorbic acid

The use of drugs is necessary in order to prevent the occurrence of inflammatory processes in the wound after surgery, improve blood circulation and strengthen the body’s immunity. Venotonic agents contribute to the improvement of venous outflow from the scrotum veins, prevent edema.

The importance of the postoperative period is to restore the functions of the genital area, interrupted by the disease and surgical intervention.

Causes of the disease

Increased pressure in the veins of the testis is associated with their location.

Most often, changes on the left side of the testicle are diagnosed, this is caused by the specific course of its vein. Venous valves no longer hold blood flow, its pressure rises and vasodilation begins. Over time, the stretched network of veins around the testicle forms a vascular bunch that spans the organ.

In order for the sperm to be full, the temperature in the scrotum must be lower than that of the whole body. The vasculature acts like a heating pad, turning off the function of the scrotum as a thermostat. The result of this pathology will be the absence of normal sperm production and, accordingly, infertility.

That is why the operation of Marmara with varicocele is needed.

One of the causes of the disease is the inherited pathology of vascular weakness. Hereditary factors are varicose veins in relatives, other diseases of the connective tissues.

Necessary examination

When treating varicocele, the Marmara technique is carried out only after a comprehensive examination:

  • General blood analysis.
  • General urine analysis.
  • Blood chemistry.
  • The implementation of the coagulogram.
  • Definitions of blood type and Rh factor.
  • After the detection of antibodies to hepatitis, HIV infection, after the reaction to syphilis.

Patients should take into account the fact that the tests also have an expiration date: no more than 14 days from the date of their implementation.

Conclusion

In some cases, in the process of performing all the described manipulations, complications may occur in the form of bleeding. A similar reaction develops if the surgeon seizes the sutures or touches the nerve endings located in the area of ​​the inguinal canal. In the event that the surgeon will strictly observe the entire technique of the procedure, such side effects can be avoided.

Among the disadvantages of this treatment method, a rather high cost of the procedure can be distinguished. However, given the degree of effectiveness, whenever possible, preference should be given to conducting quality treatment.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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