Microsurgical varicocelectomy(MSV) is inguinal and sub inguinal exploration of the cord and ligating the veins( pampiniform plexus) under suitable magnification( 10-15X).
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| OUR ANDROLOGIST DR NAVEENCHANDRA ACHARYA PERFORMING MSV |
Clinically detectable varicoceles associated with abnormal semen parameters normal female partner or female partner with potentially curable infertility problem.
Palpable varicoceles in adolescent boys when accompanied by ipsilateral testicular atrophy.
We have also got encouraging results from MSV from patients with azoospermia( Non -obstructive specially with high normal FSH and late maturation arrest or hypospermatogenesis on testicular biopsy)
Procedure:
We prefer the subinguinal approach.We give a 2 cm incision on subinguinal area.
We isolate the cord and lift it with the Babcocks forceps.We open the cremasteric box and isolate the veins.We preserve the testicular artery( sometimes we need to use papavarine especially if the artery goes into the spasm),vas, lymphatics and nerves.
The cremasteric box is closed and the incision is closed with the subcuticular stitches.
With the advent of IVF and ICSI many patients go for these procedures without proper andrological evaluation.Even the gynecologists think that the varicoceles repair the outlook is gloomy.But in contrast it has been consistently noted ( two randomized controlled trials prove it) that the MSV not only improves the sperm parameters, pregnancy rate( and the take home baby rate) but also has a role to play in non-obstructive azoopsemia ( with favourable histopathological biopsy - like late maturation arrest/ hypospermatogenesis and near normal inhibin and FSH).We have cases were the sperms have appeared in azoospermic individuals.
We also firmly believe that the patients with azoospermia with grade 3 varicoceles with even bad histopathological patterns on testicular biopsy like Sertoli only cell pattern also can benefit in terms of improving the yield of TESA during IVF cycle.
Thus MSV can improve the fertility potential of man.The procedure is a day care procedure( the patients are kept for few hours or 24 hours), no side effects and complications.The recuperation rate is fast especially in subinguinal procedure.The patient can go back to work within a week and resume the sexual act within 2-3 weeks.The sperm count usually takes 3-6 months for the improvement.The procedure is cost effective if the cost of the IVF and ICSI procedures are considered.Also if the patients sperm parameters are improved; not only he can have hopes for natural conception but also it will help the couple for successive pregnancies.This advantage is not there in IVF procedures.
The aim of any medical and surgical procedure should be to restore the normal anatomy and physiology of the patient as it is the right of the patient.
We have also got encouraging results from MSV from patients with azoospermia( Non -obstructive specially with high normal FSH and late maturation arrest or hypospermatogenesis on testicular biopsy)
Procedure:
We prefer the subinguinal approach.We give a 2 cm incision on subinguinal area.
We isolate the cord and lift it with the Babcocks forceps.We open the cremasteric box and isolate the veins.We preserve the testicular artery( sometimes we need to use papavarine especially if the artery goes into the spasm),vas, lymphatics and nerves.
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| ITS ESSENTIAL TO IDENTIFY THE TESTICULAR ARTERY( TO PREVENT TESTICULAR ATROPHY),LYMPHATICS( TO PREVENT HYDROCELE),NERVES( TO PREVENT ANY NUMBNESS) |
The cremasteric box is closed and the incision is closed with the subcuticular stitches.
With the advent of IVF and ICSI many patients go for these procedures without proper andrological evaluation.Even the gynecologists think that the varicoceles repair the outlook is gloomy.But in contrast it has been consistently noted ( two randomized controlled trials prove it) that the MSV not only improves the sperm parameters, pregnancy rate( and the take home baby rate) but also has a role to play in non-obstructive azoopsemia ( with favourable histopathological biopsy - like late maturation arrest/ hypospermatogenesis and near normal inhibin and FSH).We have cases were the sperms have appeared in azoospermic individuals.
We also firmly believe that the patients with azoospermia with grade 3 varicoceles with even bad histopathological patterns on testicular biopsy like Sertoli only cell pattern also can benefit in terms of improving the yield of TESA during IVF cycle.
Thus MSV can improve the fertility potential of man.The procedure is a day care procedure( the patients are kept for few hours or 24 hours), no side effects and complications.The recuperation rate is fast especially in subinguinal procedure.The patient can go back to work within a week and resume the sexual act within 2-3 weeks.The sperm count usually takes 3-6 months for the improvement.The procedure is cost effective if the cost of the IVF and ICSI procedures are considered.Also if the patients sperm parameters are improved; not only he can have hopes for natural conception but also it will help the couple for successive pregnancies.This advantage is not there in IVF procedures.
The aim of any medical and surgical procedure should be to restore the normal anatomy and physiology of the patient as it is the right of the patient.
Thanks for sharing the information about the micro surgical varicocelectomy. Erectyle dysfunction treatment,Male Sexual Problem Treatment,Male Sexual Disorder Treatment
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