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9IMPROVING THE OUTCOMES OF SURGICAL TREATMENT OF VARICOCELE BY IMPROVING SURGICAL TACTICS
B. Z. Khamdamov I. M. Mamatkulov
Bukhara State Medical Institute
ABSTRACT
Varicocele or varicose veins of the spermatic cord, testicular and appendage veins is a rather common disease. According to statistics, from 2.3% to 37.7% of men suffer from this pathology. Most often it occurs at the age of 13 to 25 years. In studying the problems of varicocele, one cannot but dwell on its connection to infertility. Numerous studies show that in patients with varicocele, fertility disorders occur in 20-80% of cases, and varicocele was detected in 30-40% of infertile patients. According to various authors mechanical compression of the spermatic cord of varicocele by dilated veins leads to hypoxia and impaired microcirculation in the testis, which leads to a violation of the haematotesticular barrier with the development of autoimmune processes and impaired spermatogenesis. The only treatment for varicocele is surgery.
Keywords: varicocele; diagnosis; treatment; antegrade endovascular sclerotherapy; complication.
Introduction: Varicocele is a male disease caused by varicose veins surrounding the spermatic cord. The condition by itself is not life threatening and occurs in 10-20% of men. In more than half of the cases, it is completely asymptomatic. The main danger of varicocele lies in the fact that it contributes to male infertility: studies have noted that 70% of patients with this pathology noted deterioration of ejaculate parameters. Varicocele may occur in young and old age alike. The longer the varicose veins in the spermatic cord are not operated on, the higher the risk of complications [1-12]. In the most severe cases, the veins may become inflamed or rupture and bleed into the scrotum. The leading cause of this pathology is weakness of the valve apparatus of the spermatic cord veins. Normally venous valves prevent backflow of blood in situations of increased blood pressure - during physical exertion, standing in an upright position. Stagnation of blood in the vessels, its outflow disorder and the associated increase in pressure in the veins gradually leads to their enlargement - over time, the veins form tumour-like knots.
Phlebologists have identified several factors that contribute to varicocele in their research:
- congenital weakness of the connective tissue that forms the vein wall;
- underdevelopment of the testicular and spermatic cord vein valves;
- acquired vein pathology;
- Inferior vena cava pathology.
These causes are congenital and cannot be corrected with varicocele treatment.
Under certain circumstances the risk of testicular varices increases significantly. These circumstances include constipation, prolonged standing work, and vigorous exercise.
Purpose of the study: To improve the results of surgical treatment of varicocele by improving surgical tactics.
Material and Methods: We examined 60 patients undergoing inpatient treatment for varicocele in the urology department of the Bukhara branch from 2019 to 2021. Depending on the method of surgical intervention, we identified two groups of patients. The main group consisted of 30 patients who underwent endovascular LV sclerotherapy and received surgical treatment from 2019 to 2021. The control group consisted of 30 patients who underwent surgical intervention according to the conventional technique (Ivanisevich or Polomo operations) from 2019 to 2021. Results of the study and their discussion. Improvement in the choice of surgical treatment tactics for varicocele, surgical techniques, reduction of surgical trauma and other innovations developed and implemented in this study could not but affect the immediate results of the management of this category of patients. Thus, compared with 2015-2018, the incidence of postoperative complications decreased from 12 to 2.5%, i.e., almost fourfold. In order to assess long-term results, the patients were subjected to a thorough questionnaire, outpatient and inpatient examination [13-25]. One of the main indicators characterising the effectiveness of surgical intervention for varicocele is the recurrence rate of the disease. The haemodynamic type of varicocele was compared when studying the nature of recurrence.
Conclusions. Thus, the cause of varicocele recurrence was the failure to take into account different hemodynamic types of venous outflow through the internal spermatic vein during the primary surgery [26-35]. The prospect of improving the results of surgical treatment of varicocele is the individualisation of the surgical method taking into account the type of pathological reflux.
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