Natarajan, B (2009) Outcome of Surgical Management of Varicocele in Infertile Men. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Varicocoele is an enlarged tortous spermatic veins above the testicle The patient present with a soft mass or swelling above the testis which he usually notes when he stands (or) strains. More commonly cases are detected during a routine clinical examination in the infertility clinics. Varicocele typically decrease in size and may disappear when the patient is supine. They give a characteristic ‘Bag of Worms’ feeling on palpation and give a characteristic thrill on cough impulse. Varicocoele is a well established and analyzed cause of male infertility. It produces oligospermia with characteristic morphological changes in the sperms. Similarly, long standing varicocele are known to produce histopathological changes in the testes leading to infertility. Ligation of varicocele is known to cause marked improvement in semen parameters and also improve the fertility and conception rate. AIM OF THE STUDY: 1. To analyze the effect of varicocele on the semen composition characteristics by seminal analysis before and after varicocele ligation. 2. To asses the improvement in fertility status after varicocele ligation. METHODOLOGY: This study is based on the screening, identification, evaluation and treatment given to the patients attending the infertility clinic at the Urology Department of Government Royapettah Hospital and Kilpauk Medical College Hospital, Chennai, over a period from August 2006 to June 2008. The following is the detailed description of the methodology adopted. All patients attending the infertility clinic were clinically screened for varicocoele. Patients with oligospermia and suspected subclinical varicocoele were subjected to more confirmatory investigations (USG scrotum, the Doppler study) before they were diagnosed to have varicocoele and then they were included in the study. DISCUSSION: A varicocele is an abnormal tortusity and dilatation of the testicular veins around the spermatic cord. In our study of varicoceles majority of the patients belonged to the 20-30 years age group with a median duration of infertility of 3 ½ years. 94 % of the varicoceles in our study belong to the left side. Differences in the venous drainage of the left and right testicular vein may account for the left side predominance. The left testicular vein drains into the left renal vein whereas the right testicular vein drains into the inferior vena cava. In addition there is a higher incidence of abnormal venous valves on the left side than on the right side. The left renal vein may be compressed between the superior mesenteric artery and the aorta. Majority of various patient in our study were diagnosed clinically (70 %) whereas 30% of the patients with subclinical varicocele were diagnosed by ultrasound and Doppler study. Among the clinically diagnosed varicocele majority were G II Majority of patient who were smokers had impaired spermatogenesis in the presence of varicocele. Majority of patient in our study had normal testicular size and semen volume, viscosity. there by implying that there is no correlation between them and varicocele. CONCLUSION: A varicocele – which is an abnormal tortuosity and dilatation of the testicular veins within the spermatic cord – is the most common surgically correctable cause of male infertility. All the patients attending the infertility clinic should be screened, evaluated and treated for varicocele, if any. The surgery of the ‘Subinguinal Ligation’ of the internal spermatic vein is a simple operation with minimal morbidity which is followed by a marked improvement in semen- analysis parameters. This operation is thus indicated in all subfertile or infertile men with significant varicocele and abnormal semen – analysis findings. However, varicocele is also found in healthy, fertile, asymptomatic men for which no treatment may be necessary.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Varicocele ; Infertile Men ; Outcome ; Surgical Management. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:09 |
| Last Modified: | 12 Oct 2017 01:09 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3443 |
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