Varicocele
means dilatation of the venous network around the testes.
The dilatation is sometimes so severe that it is reminiscent
of chicken intestine upon palpation. Varicocele almost always
presents on the left side. The reason for this is that while
the right testicular vein connects with the large abdominal
vein at an acute angle the left vein empties into the renal
vein at a right angle. The left-sided occurrence of the illness
is so typical that its presentation on the right side has
to prompt the urologist to rule out other pathology. The
ultimate cause of varicocele is reversal of the blood flow.
Treatment options
The solution is surgical,
directed at the removal of the dilated veins, and also to
create an anatomical situation that prevents dilatation of
veins in the future and recurrence. The most frequently performed
Bernardi procedure involves high ligation of the testicular
vein above its entry into the abdominal cavity after an incision
in the groin area. Outcome after timely surgery is very good.
The usual recovery time is 3-4 weeks, that does not mean
that the patient is bedridden for the whole time, rather
the time it takes to be able to resume unlimited activities.
During this time physical exertion should be avoided.
One day surgery
"One day surgery" means,
that patients can leave the outpatient center on their own
feet, accompanied by a helper, within 24 hours of surgery
(usually after few hours of observation), and continue the
healing process in the familiar confines of their own
home. "One
day surgery" requires strict professional, social, and
various other preconditions that are discussed at the stage
of the consultation when the need for surgery becomes clear.
(i.e. good general health, absence of serious systemic disease,
patient must take responsibility for arrangement of transportation,
home care, must have phone to contact the clinic or the surgeon
if necessary, etc).
Preparation for surgery
Surgery is always preceded
by an examination by the urologist. Next the patient is informed
whether from a surgical standpoint he or she is candidate
for same day surgery. It is at this point that the patient
is acquainted with the concept of one day surgery. It is
also here, that the patient is informed about laboratory
and other accessory studies (Imaging, ECG, abdominal ultrasound,
medical) that might be required for surgery, options for
anesthesia, possible complications, home care-related issues,
stages of recuperation, i.e. all the information that is
relevant for the patient to make a decision on which treatment
method, or surgery to choose.
The procedure
On the day of the surgery,
the patient signs the consent form, then the necessary lab
tests are done and the surgery fee is paid. Immediately before
the operation, the patient is premedicated with an injection
containing analgesics and sedatives. The operation can be
performed under local
anesthesia, spinal
anesthesia or general
anesthesia. The majority of our surgeries are performed with
local anesthesia, which means infiltration of the surgical
field with 1% Lidocaine. During surgery the vessels of the
affected testis are exposed. About 30-60% (depending on the
extent of the illness) of the dilated venous plexus is dissected
between ligatures and removed. The wound is closed in layers
using absorbable sutures. The skin is united with cosmetic
sutures.
Possible complications
No doctor can guarantee a
complication-free surgery. Complications can arise even following
the most carefully performed procedures. The early
complications:
postoperative bleeding, inflammation are however treatable.
Therefore if you experience any sign of complications call
your doctor day or night who will make sure the problem is
resolved. At different stages of home recovery patients may
experience various changes that are not necessarily abnormal.
Wound pain, maybe low grade fever in the first days, swelling
or discoloration of the scrotum are are part of the normal
healing process and are not cause for concern. Late
complications (recurrence) can be prevented by appropriate techniques and
careful surgery.
Postoperative care
The surgery is commonly followed
by 6-8 hours of observation, during which
time the vital functions (blood pressure, urine output) stabilize,
the sedative
effects of the premedications wear off, and patients are
able to leave the center on their own feet, with the help
of an escort. During the first week the patient should
refrain from physical exertion, however constant bed rest
is not necessary.
Sutures are removed at the one week follow-up.
Full recovery takes about 3-4 weeks, meaning
that normal activities can be resumed at that time.
Fees
Charge
for examination and consultation: 10.000 HUF > Euro
Surgery performed with local
anesthesia: 120.000
- 160.000 HUF > Euro
Spinal or general anesthesia: 80. 000
HUF > Euro
Charge for overnight stay: 30.000 HUF > Euro
50% of the fee is due at the time the operation is scheduled,
as a prepayment.
These are estimated prices; the severity of the case
also influences the overall cost.
Appointments:
Monday-Friday, 8 am - 8 pm.
Telephone: + (36 1) 266-7766
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