Амбулаторная хирургия (May 2022)
New approaches of patients with varicocele for different forms of pathospermia depending on age
Abstract
Introduction. Varicocele is a testicular varicose vein caused by pathological venous reflux. It is most common in infertile men. Clinically, varicocele is found in 15% of the male population, while in 35% of men with primary infertility and in 70–81% of men with secondary infertility. Varicocele, not accompanied by pain, is the most common cause of the development of pathospermia and infertility. Varicocele is detected at the age of 10 years in 1% of boys, increasing to puberty up to 15%. At the age of 50–80 years, the incidence of varicocele increases to 75–77.3%, thus adding an average of 10% every 10 years of life.Aim is to investigate the fertility restoration after surgical procedures and the prognostic criteria for its restoration depending on age and the proposed medical rehabilitation.Materials and methods. In the urological hospital for a short stay of the state autonomous healthcare institution of the Stavropol Territory “Regional Clinical Specialized Uro-Andrology Center” from 2011–2019. 1143 varicocelectomies were performed (244 laparoscopic varicocelectomy, 975 microsurgical varicocelectomy). The study is based on a comparative analysis of the results of examination of 100 patients with pathospermia and varicocele in the period from 2011 to 2019, who received surgical treatment and did not have concomitant pathology. All patients were followed up for 18 months after surgery.Results and discussion. The pain syndrome was stopped in 100% of cases in the studied patients. Progression of hypotrophy of the left testicle in the postoperative period was not detected. Relapses and other complications were not noted. Patients in the control group were also observed for 1.5 years with an interval of 6 months. Deterioration of spermatogenesis in this group was not detected.Conclusions. It was revealed that varicocele was the main cause of spermatogenesis and fertility disorders in the studied groups. Surgical treatment is a pathogenetically grounded and statistically proven method of restoring fertility in varicocele. After varicocelectomy, adequate medical rehabilitation allows to normalize the qualitative and quantitative parameters of sperm in most clinical cases as soon as possible (up to 3 months).
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