Microsurgery for Varicocele Treatment
Assoc. Prof. Muhsin BALABAN
Put your health in safe hands with microsurgical varicocele surgery technology.
After graduating from Marmara University Faculty of Medicine (English programme), Assoc. Prof. Muhsin Balaban completed his urology residency at Kartal Dr. Lütfi Kırdar Training and Research Hospital.
He spent three months in the United States at the Cleveland Clinic, Albert Einstein College of Medicine and Memorial Sloan-Kettering hospitals to broaden his knowledge and experience.
Since 2014 he has worked intensively on male reproductive health: microscopic varicocele surgery, micro-TESE, sperm-enhancing treatments, azoospermia, erectile dysfunction and its treatments. In 2018 he began his academic work as a lecturer at Biruni University Faculty of Medicine and Beykent University. In 2019 he received one month of intensive training in azoospermia and varicocele surgery at the ProCrea Infertility Center in Switzerland and at the San Carlo Clinic of the University of Milan, Italy, under Prof. Dr. Giovanni Maria Colpi.
He has been performing varicocele operations successfully with the microsurgical technique for 10 years. For the last 5 years, in response to intense demand from Turkey and abroad, he has performed ONLY microscopic varicocele surgery and micro-TESE operations.
AndroFert Men's Health Centre
Founded in 2019 by Assoc. Prof. Muhsin BALABAN exclusively for the diagnosis and treatment of male reproductive health conditions. Solutions at international standards are offered with the latest technological equipment for the treatment of men after low sperm count, azoospermia or failed IVF attempts, and especially for the diagnosis and treatment of VARICOCELE.
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Using 1.5 mm intraoperative Doppler technology in addition to microscopic surgery in varicocele operations shows the arterial structure supplying the testis more clearly and makes the operation more meticulous.
Assoc. Prof. Muhsin Balaban has performed all his operations with intraoperative Doppler since 2018. He has likewise contributed to the development of the technique of excising the dilated veins in order to reduce recurrence and achieve rapid resolution of testicular swelling. He presented these innovations and his experience in varicocele surgery to his colleagues in Turkey by live video at the Andrology Congress.
A Safe and Effective Innovation in Varicocele Surgery: Intraoperative 1.5 mm Doppler
With this technology the highly delicate arteries are preserved, and the margin of error is thereby almost completely eliminated. Its success is greater than other techniques. This Doppler technology is used very widely in the United States. I have been using it in all my operations since 2018.
What is varicocele? Why does varicocele occur?
Varicocele is the abnormal enlargement of the veins around the testis.
Veins are the vessels that return blood to the heart. Normally veins contain valves that keep the blood moving in the right direction. However, when the valves in the testicular veins deteriorate and fail to work properly, gravity causes blood to pool around the testis. This clinical picture occurs mostly on the left side.
How common is varicocele?
Varicocele is common in men; in fact 15% of adult men have a varicocele. In most cases, however, it causes the patient no harm.
What problems does varicocele cause?
Varicocele can cause three different basic problems:
- It can cause infertility by impairing sperm quality
- It can affect testosterone production by the testis
- It can cause pain and a feeling of fullness in the testis
At least one of the three reasons above must be present to treat a varicocele. In some cases varicocele can cause azoospermia (no sperm at all in the semen).
Because varicocele is very common in men and is often not diagnosed, most patients never encounter a hormonal problem, testicular pain or a fertility problem.
Microsurgical subinguinal varicocelectomy
The operation can be performed under general or spinal anaesthesia. Through a 2 cm incision in the groin the spermatic cord is located and lifted. The veins are identified, ligated and divided. Meanwhile the important structures running to the testis (vas deferens, testicular artery and the lymphatic vessels of the testis) are preserved.
Because no muscles are cut in this method there is less pain after surgery and a lower risk of post-operative inguinal hernia. With the microscope the lymphatics are preserved, so the risk of fluid accumulation around the testis (hydrocele) after surgery is greatly reduced.
Potential risks after surgery are recurrence or persistence of the varicocele, testicular tenderness and infection. Although there is a risk of hydrocele (fluid accumulation around the testis), this risk is greatly reduced after varicocele surgery performed with a microscope. Very, very rarely, if the artery to the testis is injured in less experienced hands, there is a risk of losing the testis.
After at least one year of follow-up of 540 male patients who could not have children and were diagnosed with a clinically evident varicocele, following microscopic varicocele surgery:
- An increase in forward sperm motility was observed in the semen analysis of 271 (50%) patients.
- Spontaneous pregnancy occurred in 36.6% within an average of 7 months (range 1 to 19 months).
- In 31% of couples who were IVF candidates before surgery, sperm counts increased enough to allow intrauterine insemination; pregnancy occurred in 42% of these inseminated couples.
- In conclusion, after surgery for a clinical varicocele an improvement in semen analyses is usually obtained, and the need for assisted reproduction techniques is reduced.
Data from a recent study show that in patients with an advanced-grade varicocele who also developed azoospermia, spontaneous sperm appeared after varicocele surgery in about 10% of cases.
In recent years it has been shown that varicocele damages sperm DNA and is responsible for unexplained infertility or recurrent miscarriage. Therefore in such cases each case must be evaluated in detail on its own merits, and if necessary the varicocele should be corrected to improve sperm quality, even if the sperm count is normal.
Points to consider before and after varicocele surgery
- Nothing should be eaten or drunk for 6 hours before varicocele surgery.
- Either spinal anaesthesia (from the waist down) or general anaesthesia may be chosen.
- After surgery the patient is kept under observation in hospital for at least 12 hours and discharged with painkillers and antibiotics.
- A special waterproof dressing is applied; showering is possible after 1 day.
- Provided the work is not heavy, you can return to work on the 3rd day after surgery.
- Two days after surgery the dressing is renewed and the wound is checked.
- Sexual intercourse is prohibited for 3 weeks.
- If a child is desired, additional vitamin and antioxidant treatment is started after the operation, and a semen analysis in the 3rd month checks how beneficial the surgery has been.
- Once the patient's partner becomes pregnant, the patient is discharged from follow-up.
