Varicocele • CTAmed
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Reproductive problems? There is a way out!

Pregnancy does not occur? Before you decide to begin a series of grueling reproductive treatments that will require the woman you love to take hormones that are riddled with side effects, it is also advisable to check your health.

Did you know that there is a possibility that your infertility problem is related to you?

It's time to get to know varicocele – the most common cause of infertility in men.

What do we mean by the term varicocele? Why is it so important to diagnose it on time and what innovations exist in the world of medicine to solve this problem? Dr. Alexander Belenky, a leading radiologist and founder of the innovative Israeli Angiology Center, has answers to all these questions.

Varicocele – it is the most common cause of male infertility and is responsible for more than 30% of cases of reproductive problems. We are talking about venous insufficiency as a result of a defect in the venous valves that drain blood from the testicular area. This blood must drain upward from the veins, against the direction of gravity, and the function of one-way valves is to prevent it from flowing back to the testicles. When these valves do not function properly, the blood that accumulates in the testicle cannot overcome gravity and leave it.

As a result of the accumulation of blood, pressure is created that interferes with the supply of oxygen necessary for the production of normal and fertile sperm. In addition, the pressure exerted on the walls of the veins causes them to expand and swell. Heating of the testicles as a result of swelling of the veins disrupts the process of sperm production, leads to testicular shrinkage, disruption of testosterone production and, as a result, causes memory impairment, fatigue, depression, decreased libido and enlarged prostate.

Prevalence of varicocele

One in six men will develop a varicocele during their lifetime. Among men over 55 years of age, varicocele occurs in approximately 50%; after 70 years, this percentage rises to 75% or more.

Varicocele can develop as early as 15 years of age, and this condition will only worsen over the years. Since this phenomenon increases gradually, it can also develop in men who have already become fathers, and make it difficult for them to have more children. Despite the widespread prevalence of varicocele, few people are aware of its existence. “Most of the patients who come to the clinic – These are ultra-Orthodox rabbis sent for treatment. But, unlike the ultra-Orthodox, who know more about this problem, perhaps because of the importance of observing the commandment to be fruitful and multiply, among secular men such awareness is absent,” – says Dr. Belenky.

Symptoms of varicocele

Varicocele is accompanied by pain in the testicle. In most cases, this pain occurs during prolonged standing or during physical activity, sometimes it radiates from the testicular area to the legs and lower abdomen. Varicocele is accompanied by testicular shrinkage (atrophy) and decreased testosterone levels. If left untreated, varicoceles can interfere with semen production. Therefore, if relevant symptoms are detected or reproductive problems are identified, it is important to perform a semen analysis and check for a possible diagnosis of varicocele.

How is varicocele diagnosed?

The diagnosis is made using duplex scanning of blood vessels, non-invasive examination of the veins of the testicles using Doppler ultrasound. This study allows you to study the structure of the veins, the direction and state of blood flow in them. The painless, risk-free procedure lasts approximately 15 minutes.

Treatment of varicocele

Varicocele treatment is designed to eliminate abnormal blood flow in the dilated veins of the testicles by ligating or blocking these veins through open surgery, microsurgery, or catheterization.

In the past, the accepted treatment was open surgery to ligate the dilated veins by making an incision in the abdominal muscles under general anesthesia, or closing the veins by inserting metal coils into the groin area (embolization). It has been proven that these treatment methods are not effective and the probability of varicocele recurrence is 70–80%. Subsequently, a new network of veins may form, or due to the fact that the testicular veins are extremely small, some of them cannot be identified, ligated and embolized.

Advanced and innovative methods of treating varicocele

In recent years, there has been a breakthrough in the treatment of varicoceles, and more innovative and effective methods have been developed.

Microsurgical treatment of varicocele

An operation performed under a microscope, which presents the surgical field under magnification and helps to find and ligate more veins. In addition, thanks to the use of a microscope, there is no need for an incision in the muscles of the abdominal wall: a minimal incision of only about 2 centimeters in length is sufficient, which speeds up recovery after surgery.

However, since such an operation requires the identification and ligation of a large number of veins, it is preferable if only one testicle requires treatment. If it is necessary to treat the veins of both testicles, this treatment becomes more complicated, lengthens, and is therefore not recommended.

Catheterization of the veins of the lower abdominal cavity

This most innovative and recommended treatment to date was developed in Israel. Doctor Belenky – one of the few doctors in Israel who perform this operation. We are talking about catheterization of the entire network of varicocele veins in the lower abdominal cavity in order to solve the problem of blood outflow from the testicle and ensure the production of normal sperm. “Through an inguinal approach under local anesthesia, we inject a sealing material, actually biological glue, into the veins of the testicles. This glue spreads through the vein and leads to its sealing; after a short time it is destroyed, resorption occurs, and the glue disappears,” – explains Dr. Belenky.

Catheterization lasts about an hour, does not require hospitalization and does not cause pain. The patient can return home after 4 hours of rest, and after about a week he can return to normal activities, with the exception of weight-bearing exercise. According to recently published studies, this treatment shows a high success rate and helps solve reproductive problems in 85% of those suffering from such disorders!

Approximately 4 months after the end of treatment, you can see an improvement in sperm production, quantity and quality. Unlike the risk of varicocele recurrence associated with surgery, catheterization in most cases solves the problem once and for all.

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