CC BY
10IMPROVING 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.
REFERENCES
[1] Ilkhomovna, K. M., Eriyigitovich, I. S., & Kadyrovich, K. N. (2020). Morphological Features Of Microvascular Tissue Of The Brain At Hemorrhagic Stroke. The American Journal of Medical Sciences and Pharmaceutical Research, 2(10), 53-59. https://doi.org/10.37547/TAJMSPR/Volume02Issue10-08
[2] Khaidarov Nodir Kadyrovich, Shomurodov Kahramon Erkinovich, & Kamalova Malika Ilhomovna. (2021). Microscopic Examination Of Postcapillary Cerebral Venues In Hemorrhagic Stroke. The American Journal of Medical Sciences and Pharmaceutical Research, 3(08), 69-73.
[3] Navruzova, N. O., Ikhtiyarova, G. A., & Karimova, G. K. (2020). Colposcoria as a diagnostic method for early detection of cervical diseases. Problems of Biology and Medicine, (1.1), 117.
[4] Ikhtiyarova, G. A., Navruzova, N. O., & Karimova, G. K. (2019). Modern diagnostic methods for early detection of cervical diseases. Doctor akhborotnomasi, (4), 78-80.
[5] Наврузова, Н. О., Ихтиярова, Г. А., & Каримова, Г. К. (2020). Кольпоскория как диагностический метод для раннего выявления заболеваний шейки матки. Проблемы биологии и медицины, (1.1), 117.
[6] Наврузова, Н. О., Каримова, Г. К., & Ихтиярова, Г. А. (2020). Современные подходы к диагностике патологии шейки матки. Тиббиёт ва спорт, (1), 74-77.
[7] Navruzova, N., Ikhtiyarova, G., & Navruzova, O. Retrospective analysis of gynecological and somatic anamnesis of cervical background and precancerous diseases. SCIENTIFIC PROGRESS» Scientific Journal ISSN, 2181-1601.
[8] Navruzova, N. O., Karshiyeva, E. E., Ikhtiyarova, G. A., Hikmatova, N. I., Olimova, N. I., & Muminova, N. K. (2021). CLINICAL AND LABORATORY MARKERS FORECASTING OF CERVICAL DISEASES AND ITS PREVENTION. Annals of the Romanian Society for Cell Biology, 13098-13110.
[9] Наврузова, Н., Ихтиярова, Г., & Наврузова, У. (2020). БАЧАДОН БУЙНИ ФОН ВА РАК ОЛДИ КАСАЛЛИКЛАРИНИНГ ГИНЕКОЛОГИК ВА СОМАТИК АНАМНЕЗИНИНГ РЕТРОСПЕКТИВ ТАХДИЛИ. Scientific progress, 7(2).
[10] Наврузова, Н. (2018). Бачадон буйни касалликларини ташхислаш ва даволашнинг замонавий масалалари.
[11] Агабабян, Л. Р., Гайибов, С. С., & Носирова, З. А. (2017). Особенности течения медикаментозного прерывания беременности у женщин с рубцом на матке. International scientific review, (2 (33)).
[12] Агабабян, Л. Р., & Насирова, З. А. (2017). Послеабортный уход-особенности контрацепции. In Фундаментальные и прикладные исследования науки XXI века. Шаг в будущее (pp. 48-50).
[13] Agababyan, L. R. (2019). i dr. Osobennosti chistoprogestinovoy kontratseptsii u zhenshchin s preeklampsiyey/eklapmsiyey. Voprosy nauki i obrazovaniya, (26), 75.
[14] Агабабян, Л. Р., & Ахмедова, А. Т. (2017). Возможности коррекции климактерических расстройств у женщин с противопоказанием к заместительной гормональной терапии. Problemy Reproduktsii, 23(3).
[15] Makhmudova, S. E., & Agababyan, L. R. (2016). The rehabilitation of patients, suffering vulvovaginal candidiasis (vvk), taking combined oral contraceptives (COCS). Национальная Ассоциация Ученых, (5), 32-32.
[16] Агабабян, Л. Р., Ахмедова, А. Т., Абдуллаева, Л. М., Насирова, З. А., & Махмудова, С. Э. (2019). Негормональная коррекция климактерических расстройств у женщин с эндометриозом. Вопросы науки и образования, (26 (75)).
[17] Makhmudova, S. E., & Agababyan, L. R. (2016). Effectiveness and acceptability of the prolonged combined oral contraceptives in women with anemia. In Новый вектор развития научной деятельности. Вызовы и решения (pp. 35-37).
[18] Махмудова, С. Э., & Агабабян, Л. Р. (2016). Контрацептивная эффективность и неконтрацептивные преимущества непрерывного режима приема кок у женщин с железодефицитной анемией. In ПРОФЕССИОНАЛ ГОДА 2016 (pp. 127-131).
[19] Nasirova, Z. A., & Agababyan, L. R. (2020). Reproductive behavior of women after cesarean section. International scientific review, (LXX), 88-92.
[20] Агабабян, Л. Р., & Хамзаев, Ф. И. (2018). Метаболические показатели у женщин с миомой матки на фоне избыточной массы тела. In ДОСТИЖЕНИЯ ВУЗОВСКОЙ НАУКИ 2018 (pp. 224-227).
[21] Махмудова, С. Э., & Атаева, Ф. Н. (2018). Опыт применения модульной системы для овладения педагогическими навыками в подготовке резидентов магистратуры по специальности" акушерства и гинекологии". In ЛУЧШАЯ НАУЧНАЯ СТАТЬЯ2018 (pp. 290-293).
[22] Makhmudova, S. E., & Ataeva, F. N. (2019). Evolutionary views on hypertensive disorders in pregnancy (literature review). In Advaced science (pp. 183-187).
[23] Махмудова, С. Э. (2017). Проблема диагностики экстрагенитального эндометриоза. Евразийский союз ученых, (10-1 (43)).
[24] Негмаджанов, Б. Б., Насимова, Н. Р., & Ганиев, Ф. И. (2019). Хирургическое лечение пролапса гениталий женщин репродуктивного возраста. Достижения науки и образования, (10 (51)).
[25] Махмудова, С. Э., Хамраев, Х. Х., & Ермонов, Р. Б. (2018). Современные представления о влияние пролонгированной оральной контрацепции на организм женщины. In ДОСТИЖЕНИЯ ВУЗОВСКОЙ НАУКИ 2018 (pp. 218-223).
[26] Махмудова, С. Э. (2017). Совершенствование методов контрацепции у женщин с анемией. In World science: problems and innovations (pp. 233-235).
[27] Агабабян, Л. Р., & Махмудова, С. Э. (2017). Современные подходы лечения железодефицитной анемии у женщин фертильного возраста. Вестник врача, 18.
[28] Махмудова, С. Э. (2016). Контраептивные и неконтрацептивные эффекты кок и принципы их применения после аборта. Евразийский союз ученых, (29-1).
[29] Наврузова, Н. О., Ихтиярова, Г. А., Каримова, Г. К., Наврузова, У. О., Шукуров, И. Б., & Аманова, Х. И. (2019). Современные диагностические методы для раннего выявления заболеваний шейки матки. Доктор ахборотномаси, (4), 77-82.
[30] Navruzova, N. O., Karimova, G. K., & Ikhtiyarova, G. A. (2020). Modern approaches to the diagnosis of cervical pathology. Medicine and sports, (1), 74-77.
[31] Karieva, E. S., & Maksudova, F. K. (2017). Use of Mathematical Planning Methods for Selecting Optimum Combined Gel Compositions. Pharmaceutical Chemistry Journal, 51(5), 411-415.
[32] Кариева, Ё. С., & Максудова, Ф. Х. (2017). Использование методов математического планирования для выбора оптимального состава комбинированной гелевой композиции. Химико-фармацевтический журнал, 51(5), 60-64.
[33] Khadjimetova, K. R., Karieva, Е. S., & Maksudova, F. K. STUDY OF RHEOLOGICAL PROPERTIES OF DEXPANTHENOL GEL. ФАРМАЦИЯ ИШИНИ ТАШКИЛ ЭТИШ, 71.
[34] Maksudova, F. K., & Karieva, E. S. (2014). The diclofenac sodium release kinetics examination from 3% gel "in vitro" experiments. European journal of natural history, (2), 23-25.
[35] Azimov, A. A., Maksudova, F. K., Usmonova, M. K., & Yarkulova, Y. M. (2021). Marketing Research of the Pharmaceutical Market of Restorative Action Drugs of the Republic of Uzbekistan. European Journal of Life Safety and Stability (2660-9630), 12, 338-342.
