05/05/2018
Kedves Érdeklődők,Betegeink!
Örömmel tudatjuk kedves Betegeinkkel, és minden érdeklődővel, hogy a herevisszér-tágulat (varicocele) legmodernebb,a spermakép javulása szempontjából legjobb eredményt adó, mikroszkópos műtéti megoldása már Nyíregyházán is elérhető, Magyarországon egyedülállóan!
Dr. Szécsi Attila urológus-andrológus Főorvos az európai szakmai ajánlásokhoz igazodva végzi ezt a beavatkozást, melynek ide vonatkozó része az alábbiakban olvasható:
Guidelines
5.CONDITIONS CAUSING MALE INFERTILITY
5.4.Varicocele
Varicocele is a common ge***al abnormality which may be associated with the following andrological conditions:
• failure of ipsilateral testicular growth and development;
• symptoms of pain and discomfort;
• male subfertility;
5.4.4.Disease management
Several treatments are available for varicoceles (Table 4). Current evidence indicates that microsurgical varicocelectomy is the most effective method among the different varicocelectomy techniques [134]. Microsurgical repair results in fewer complications and lower recurrence rates compared to the other techniques. This procedure, however, requires microsurgical training. The various other techniques are still considered viable options, although recurrences and hydrocele formation are more likely to occur.
Table 4: Recurrence and complication rates associated with treatments for varicocele
Treatment Ref. Recurrence/Persistence % Complication rates
Antegrade sclerotherapy [135]
9 Complication rate 0.3-2.2%: testicular atrophy,
scrotal haematoma, epididymitis, left-flank
erythema.
Retrograde sclerotherapy [136]
9.8 Adverse reaction to contrast medium, flank pain, persistent thrombophlebitis, vascular perforation.
Retrograde embolisation [137,138]
3.8-10 Pain due to thrombophlebitis, bleeding haematoma, infection, venous perforation, hydrocele, radiological complication (e.g., reaction to contrast media), misplacement or migration of coils, retroperitoneal haemorrhage, fibrosis, ureteric obstruction.
Open operation
Scrotal operation - Testicular atrophy, arterial damage with risk of
devascularisation and testicular gangrene, scrotal haematoma, post-operative hydrocele.
Inguinal approach [139]
13.3 Possibility of missing out a branch of testicular vein.
High ligation [140]
29 5-10% incidence of hydrocele (< 1%).
Microsurgical inguinal or subinguinal [141,142]
0.8-4 Post-operative hydrocele arterial injury, scrotal
haematoma.
Laparoscopy [143,144]
3-7 Injury to testicular artery and lymph vessels;
intestinal, vascular and nerve damage; pulmonary embolism; peritonitis; bleeding; post-operative pain in right shoulder (due to diaphragmatic stretching during pneumoperitoneum); pneumoscrotum:
wound infection.
5.4.5.Summary of evidence and recommendations for varicocele
Summary of evidence LE
The presence of varicocele in some men is associated with progressive testicular damage from adolescence onwards and a consequent reduction in fertility. 2a
Although the treatment of varicocele in adolescents may be effective, there is a significant risk of over-treatment: the majority of boys with a varicocele will have no fertility problems later in life. 3
Varicocele repair was shown to be effective in men with oligospermia, a clinical varicocele and otherwise unexplained infertility. 1a
Recommendations Strength rating
Treat varicoceles in adolescents with ipsilateral reduction in testicular volume and evidence of progressive testicular dysfunction. Weak
Do not treat varicoceles in infertile men who have normal semen analysis and in men with a subclinical varicocele. Strong
Treat men with a clinical varicocele, oligozoospermia and otherwise unexplained infertility in the couple. Weak
