WHAT IS VARICOCELE?
VARICOCELE is a varicosis disease which appears as a result of advanced dilatation and curve increase of veins carrying the venous blood of testicles into the heart (pampiniform plexus veins).
WHAT DISORDERS DOES VARICOCELE CAUSE IN MEN?
In general, varicocele does not cause any physical complaints until it becomes serious. Sometimes, patients with advanced varicocele may have testicle pain, shrinking, fullness sense. Varicocele may cause a blunt pain sensed on groins and retraction feeling on the testicle. Pain increases if the individual stands for a long time, lying decreases the pain.
However, varicocele causes INFERTILITY without any physical disorder in some men. Approximately 40 to 50% of men with infertility complaint have varicocele.
WHAT IS THE MOST COMMON LOCALIZATION OF VARICOCELE?
Varicocele is more frequent at left. Occurrence on the right side solely is very rare and this should be investigated for right renal tumors. Varicocele may be bilateral in 10% of the patients.
WHICH TESTS SHOULD BE APPLIED FOR THE DIAGNOSIS OF VARICOCELE?
Varicocele may be detected by examination of testicles and scrotal color Doppler ultrasonographic examination. SPERMIOGRAM test must ne ordered for every patient whose varicocele was detected (if the patient is not before puberty) to examine a possible testicle damage. Details of spermiogram have been presented in infertility page. If the patient is in childhood, testicle sizes should be followed closely by volume measurement devices.
HOW IS THE TREATMENT PLANNED FOR VARICOCELE ?
Treatment is not required for varicoceles without pain, shrinkage in testicles and /or of men who had married and have children. If varicocele causes pain, testicle shrinkage and infertility, surgical treatment is necessary.
Sooner the surgery is applied, sooner the testicle cell damage will be prevented.
HOW IS VARICOCELE OPERATION APPLIED?
Varicocelectomy may be performed easily by local anesthesia that will be applied onto the inguinal area or spinal anesthesia from the back or general anesthesia. The surgery is performed with a small cut from the inguinal area. Varicosed veins are ligated and cut. It is a simple surgery and does not require hospitalization in general, however it should be performed carefully and with an optical loop. The surgery lasts about 20 to 30 minutes. During the procedure, it should be cared that other formations related with testicle should not be damaged.
WHAT ARE POSSIBLE COMPLICATIONS OF VARICOCELE SURGERY?
If varicocele surgery is not performed carefully and lymphatic vessels are ligated, hydrocele (fluid accumulation around testes), if the artery is ligated, testicle atrophy may be observed. Experience of the urologist is important for this procedure.
WHEN SHOULD SPERMIOGRAM BE DONE AT THE EARLIEST AFTER VARICOCELE OPERATION ON INFERTILE MEN ?
As 90 days are required for a sperm cell between initiation of the production and storing after maturation roughly, disorders of sperm cells start to recover at 3 months after varicocelectomy. Therefore, first sperm analysis should be performed at 6th month after the surgery.
HOW MUCH IS VARICOCELE SURGERY EFFECTIVE ON RECOVERY OF SPERM FUNCTIONS ON AN INFERTILE MEN?
Recovery n sperm production is seen 70% of the patients operated. The studies conducted have indicated that those who have undergone the varicocelectomy surgery have babies. careful surgery increases this ratio.
WHAT IS HYDROCELE?
Hydrocele is a condition of advanced swelling of the scrotum with excessive fluid accumulation between the membranes covering the testicle. Normally, there is 0.5 to 1.0 ml fluid is present within this space to provide lubrication of the testicle. This fluid amount is 200 to 300 ml or more in hydrocele.
HOW IS HYDROCELE DIAGNOSED?
Because the appearance and patient history are very typical, diagnosis is quite easy. Scrotum seems swelled excessively unilaterally or bilaterally and tense. There is fluid in it.
A typical elasticity sense is obtained when scrotum is hit by the finger during the examination. When scrotum is looked at by a light in a dark room, it seems pink. This simple examination called TRANSILLUMINATION finding proves that this swelling includes fluid and this is typical for HYDROCELE.
WHAT IS SPERMATOCELE7 EPIDIDYMIS CYST? HOW SHOULD THE TREATMENT BE ARRANGED?
They are small and painless masses located on and behind the testicle. It is a cystic formation including dead sperms. Treatment is not necessary unless it reaches to large volumes. It is removed by an operation if grows much.
WHAT ARE FINDINGS OF TESTICULAR TORSION? HOW DOES IT OCCUR?
Torsion of testis is a very important disease of the testicle. In this disease, spermatic cord including veins that carry blood around the testicle is twisted around itself, spermatic veins cannot carry blood and if this situation is not corrected at an early time, this situation becomes testicular necrosis (gangrene). The risk of torsion is quite high in undescended testes. Torsion is greater than ever seen during puberty.
Testicular torsion is a table being very urgent. Usually, these occur sudden onset (especially awakening from sleep), testicular and groin pain, nausea and vomiting. Testicle and epididymis are sensitive; children would not want the scrotums to be touched. Hydrocele and edema are often seen with torsion.
HOW IS TESTICULAR TORSION DIAGNOSED?
Retraction of the testicle which is below the scrotum in normal as a result of trosion and increase of testicular pain by holding it up (Prehn’s sign) supports torison.
Blood flow can be measured from the testis and epididymis with doppler ultrasound and testicular scintigraphy. Despite the existence of a serious decrease in blood flow in torsion, increased blood flow is seen in orchitis and epididymitis. These data are very important criteria for a definitive diagnosis.
HOW IS TESTICLE TROSION TREATED?
Torsion is a table being very urgent. Normally, if there isn’t a significant delay when patients the first refer to the patient (the first 4 hours is very important), the doctor should try to rotate the testicle who returned (detorsion) to the reinstates manually. The ideal approach is the fixation (stopping) of the testicles with surgery to the place in the scrotum after detorsion electively.
If they are alive, the testis and epididymis are made detorsion and are detected in the scrotum. If they are gangrene like in the picture above, are removed completely (ORŞİO EPIDIDYMECTOMY). Because of the anomaly which cause torsion can cause the other testicle, the determination of the testicle on the opposite side, into the scrotum, is made in the same session.
WHAT ARE THE FACTORS EFFECTIVE ON TESTICULAR TUMORS?
The exact cause is unclear. However, testicular tumours are seen 5-10 times more frequently in the patients with undescended testis than normal patients.
Recently, chromosomal alterations and the use of estrogen in the womb are often considered to be emphasized.
WHAT IS IMPORTANCE OF EARLY DIAGNOSIS ON TESTICULAR TUMORS?
Today’s developments in the early diagnosis of testicular cancer have very promising results and survival rate comes to 95%.
WHAT IS THE PATHOLOGY OR TESTICULAR TUMORS?
95% of testicular tumours are due the germ cell. (SEMINOMA – NON SEMINOMATOUS).
SEMINOMA (classic, anaplastic, and spermositic)
NON SEMINOMATOUS (Embryonal carcinoma, choriocarcinoma, yolk sac tumors, teratomas).
WHAT IS THE REFERRAL CAUSE OF THE PATIENT ON TESTICULAR TUMORS?
Painless swelling of the testis (rarely can be painful) is the most common symptom. Especially in young adults coming with this complaint need to think about all the cases, such as testicular cancer until proven otherwise. in 10% of cases, the first presenting symptoms can be such ashemoptysis (blood during cough), nausea; vomiting, convulsions and bone fractures rely on METASTATIC BULK, but these complaints may be rare. Hydrocele symptom may be accompanied by testicular tumor and even can mask the main disease.
WHICH RADIOLOGICAL TEST IS APPLIED FOR THE DIAGNOSIS IN TESTICULAR TUMOR?
A rapid ultrasonography should be performed in a patient like this. Ultrasonography can tell us the diagnosis largely as the bulk in the testicle. When the mass is detected by US, another test that should be applied is COMPUTED TOMOGRAPHY OF THE ABDOMEN AND LUNGS. METASTASIS may be understood if exits.
WHICH BLOOD TESTS ARE IMPORTANT TO DETERMINE TESTIS TUMORS?
(alpha feto protein – beta HCG ( human chorionic gonadotropin ) – LDH ( lactic dehidrogenaz) – plasental alkalen fosfataz ) are blood tests used to detect the tumor.
It can be distinguished the cellular source of tumor is seminomatous or non-seminomatous or Chorio carcinoma in non-seminomatous, etc. because of the structural features of these tumor markers (determinants). Pursuit of treatment is also very important.
WHAT IS THE TREATMENT FOR TESTICULAR TUMORS?
The first step of treatment is ACCURATE DIAGNOSIS and STAGING. For this, laceration from groin and other environmental elements (funiculus) point as high as is removed as possible.
HIGH INGUINAL ORCHIECTOMY:
THOSE THAT WILL BE DONE AFTER HIGH INGUINAL ORCHIECTOMY;
Early stage (I – II A seminoma); over 90% of cure is provided with radiotherapy. If there is recurrence after radiotherapy, CHEMOTHERAPY should be done. Herein, different combinations of agents (as PROTOCOL Einhorn) such as CYS – platinum, vincristine, bleomycin, ifosfamide, etoposide are used.
NON-SEMINOMAS IN LOW GRADE TUMORS
IN AMERICA: DRPLN (dissection (removal) of retroperitoneal lymph node) is the standard form of treatment; nevertheless, it is one of the alternative therapies can be selected in close monitoring and if necessary in CHEMOTHERAPY.
Cure rate is over 80%.
IN ADVANCED STAGE NON-SEMINOMATOUS TUMORS
It should be initiated to chemotherapy immediately. Cure rate is over 60%.
IS IT POSSIBLE TO APPLY PROSTHESIS FOLLOWING TESTIS REMOVAL?
Sometimes, men whose testes are taken may enter to depression. Testicular prostheses are offered in order to support the patients with esthetic and psychological. For those patients who accepted testicular prostheses inserted with orchiectomy in the same session or at another time. Prosthesis is the same as beads of silicone as female breasts implanted prostheses.