Subinguinal mikrocerrahi varikoselektomi tecrübelerimiz: Klinik çalışma

Bu çalışmada etyolojik ayrım yapılmaksızın iki ayrı klinikte uyguladığımız mikrocerrahi varikoselektomi tecrübelerimiz sunulmuştur. Çalışmaya varikosel tanısı konmuş 60 hastaya 66 mikrocerrahi subinguinal varikoselektomi uygulandı. Öykü, fizik muayene, yaş, fertilite durumu, sperm parametreleri, tele/iki taraflı olma durumu, skrotal ağrı ve/veya rahatsızlık hissi, grade, doppler çapı, reflü varlığı, bağlanan ven sayısı, operasyon süresi, postoperatif hidrosel, orşit, yara enfeksiyonu, nüks ve hospitalizasyon süresi değerlendirildi. Operasyon mikroskobu (xlO) kullanılarak testiküler arter, vazal arter, internal spermatik lenfatikler ve vaz deferens korunarak her hasraya subinguinal mikrocerrahi varikoselektomi uygulandı. Ortalama hasta yaşı 25.9 idi. 7 (%11.6) hasta infertilite, 53 (%88.4) hasta skrotal ağrı ve/veya rahatsızlık hissi nedeniyle öpere edildi. 53 hastada sol, 1 hastada sağ, 6 hastada bilateral grade 2 veya 3 klinik varikosel saptandı. Ortalama bağlanan v&n sayısı 6.9 (3-15) idi. Ortalama operasyon süresi 44 (30-110) dakika idi. 44 hastaya rejyonel, 16 hastaya lokal anestezi uygulandı. 1 (%1.6) hastada postoperatif 1.haftada orşit, 1 (%1.6) hastada yara enfeksiyonu gözlendi. Skrotal hematom hiçbir hastada saptanmadı. 6.ayda hiçbir hastada testiküler atrofi, nüks veya ağrı gözlenmedi. Mikrocerrahi subinguinal varikoselektomi, operatif mikroskobun olduğu her ameliyathanede güvenle uygulanabilecek komplikasyon oranı düşük, etkin, morbiditesi az bir cerrahi yöntemdir.

Anahtar Kelimeler:

Azoospermi, Astenozospermi, Varikosel, Oligospermi, Ultrasonografi, doppler, renkli, Kısırlık, erkek, Mikrocerrahi, Ameliyat sonrası dönem

Experiences in microsurgical subinguinal varicocelectomy: Clinical trial

In this study, we presented the experiences of microsurgical varicocelectomy, caused by various etiologic pathologies in two different urology clinics. 66 subinguinal microsurgical varicocelectomy was performed to 60 patients. History, physical examination, age, fertility pattern, sperm parameters, laterality, scrotal pain and/or discomfort, grade of varicocele, veins doppler diameter, reflux, ligated vein number, duration of surgery, postoperative hydrocele, orchitis, infection, reccurence and hospitalization period were evaluated. Operative microscope (XlO) was used to protect the testicular artery, vasal aretery, internal spermatic lymphatics and vas deferens. The mean age was 25.9. 7 (11.6%) patients of infertility and 53 (88.4%) of scrotal pain and/or discomfort were operated. In 53 patients, left, 1 patient ,right and 6 , bilateral grade 2 or 3 clinical varicocele were detected. The mean number of ligated vein was 6.9 (3-15). The operation time was 44 (30-110) minutes. In 44, regional, 16 patients, local anesthesia were applied. In 1 (1.6%) patient, wound infection at first week after the operation, in 1 (1.6%) orchitis were observed. Scrotal hematoma was not detected at the early period. At the 6. months of follow-up, testicular atrophy, hydrocele, reccurence and pain were not established. Microsurgical subinguinal varicocelectomy that could be performed confidentaly in each operating room in which the operative microscope is available, provides low complication rate and more efficient outcome with less co-morbidity.

Keywords:

Azoospermia, Asthenozoospermia, Varicocele, Oligospermia, Ultrasonography, Doppler, Color, Infertility, Male, Microsurgery, Postoperative Period,

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