A varicocele is an enlargement of veins within the scrotum (pampiniform plexus of veins) that often presents in upto 40% of infertile males. It is being cited as the most common cause of male infertility. Scientists usually attribute varicocle to the absence of valves within the major veins of the testis. They are usually asymptomatic but may present with dull aching pain in the scrotum.
Varicoceles are known to affect spermatogenesis. Severe Oligospermia or Azoospermia has been documented in 4.3 to 13.3% of men with varicocele. The effect of varicocele on testicular function is variable with effect on testosterone production being a point of semantics. Proposed mechanisms of impaired spermatogenesis include reduction in testicular oxygen supply, high blood pressure in the veins, elevated temperatures, increased oxidative stress (free radical production) and increased levels of catecholamines (steroids) in the veins.
The gold standard for diagnosing a varicocele is physical examination. A scrotal Doppler showing enlarged veins with reversal of flow on valsalva identifies varicoceles. Repair of varicoceles have positively shown to improve sperm concentration and motility and improve pregnancy rates. Even with the advent of assisted reproductive techniques, a modest improvement in semen quality after varicocele repair can significantly improve a couple’s fertility potential. The primary benefits of varicocele repair in azoospermic men with spermatogenic failure are the return of motile sperm in semen and the ability to avoid an invasive surgical procedure for testicular sperm extraction.
The best results for Varicocele repair are obtained with Sub Inguinal Microscopic Varicocelectomy. Dr.Karthik was initially performing Laproscopic Varicocelectomies with moderate success. After his training with Dr.Turek, he has adopted the Microscopic Subinguinal repair technique with outstanding results. The procedure is done under regional or general anaesthesia. Hospital stay is usually for a day.