varicocelevaricocele

Bagian Urologi Departemen BedahBagian Urologi Departemen Bedah

RSPAD GATOT SOEBROTORSPAD GATOT SOEBROTO

varicocelevaricocele is by far the most commonly performed is by far the most commonly performed

operation for the treatment of male infertility. operation for the treatment of male infertility.

is found in approximately is found in approximately 15% of the general population, in 15% of the general population, in 35% of men with primary infertility, 35% of men with primary infertility, 70% to 81% of men with secondar70% to 81% of men with secondar infertility infertility ((Gorelick and Goldstein, 1993; and Goldstein, 1993; Witt and Lipshultz, 1993). and Lipshultz, 1993).

Animal and human studies have Animal and human studies have

demonstrated demonstrated that varicocele is that varicocele is associated with a progressive and associated with a progressive and duration-dependent decline in testicular duration-dependent decline in testicular functionfunction

grade I varicocelegrade I varicocele, ,

an impulse can be palpated in the an impulse can be palpated in the scrotum during a Valsalva maneuver.scrotum during a Valsalva maneuver.

grade II varicocelegrade II varicocele is large enough for is large enough for tortuous and dilated veins to be tortuous and dilated veins to be palpated without a Valsalva palpated without a Valsalva maneuver. maneuver.

Grade III varicoceleGrade III varicocele is visible through is visible through the scrotal skin. the scrotal skin.

VARICOCELECTOMVARICOCELECTOMY Y

Scrotal Operations Scrotal Operations

Retroperitoneal Operations Retroperitoneal Operations

Laparoscopic Varicocelectomy Laparoscopic Varicocelectomy

Microsurgical Inguinal and Subinguinal Microsurgical Inguinal and Subinguinal Operations: The Preferred Approaches Operations: The Preferred Approaches

Radiographic Occlusion TechniquesRadiographic Occlusion Techniques

The hypothalamo-pituitary-gonadal The hypothalamo-pituitary-gonadal axis provides pulsatile secretion of axis provides pulsatile secretion of GnRH and subsequently LH and FSH GnRH and subsequently LH and FSH release from the pituitary to stimulate release from the pituitary to stimulate spermatogenesis and testosterone spermatogenesis and testosterone production. production.

GnRH pulses are released every 90 to GnRH pulses are released every 90 to 120 minutes. Diurnal variation of 120 minutes. Diurnal variation of testosterone results in higher morning testosterone results in higher morning levels of testosterone than that levels of testosterone than that observed in the afternoon and evening observed in the afternoon and evening hours.hours.

The testis is a specialized structure The testis is a specialized structure that functions optimally 2°C to 4°C that functions optimally 2°C to 4°C below body temperature. below body temperature.

Spermatogenesis is less efficient in Spermatogenesis is less efficient in humans than in most other animals. humans than in most other animals.

The process of spermatogenesis and The process of spermatogenesis and spermiogenesis takes approximately spermiogenesis takes approximately 64 days in humans and results in a 64 days in humans and results in a haploid germ cell that acquires haploid germ cell that acquires natural ability to fertilize oocytes natural ability to fertilize oocytes during epididymal transport.during epididymal transport.

Spermatogenesis is an androgen-Spermatogenesis is an androgen-dependent process that optimally dependent process that optimally occurs with very high intratesticular occurs with very high intratesticular levels of testosterone. levels of testosterone.

Spermatozoa exiting the testis are Spermatozoa exiting the testis are immotile and have limited capacity to immotile and have limited capacity to fertilize an oocyte unless assisted fertilize an oocyte unless assisted reproductive techniques are applied.reproductive techniques are applied.

After epididymal transit (which takes 2 to After epididymal transit (which takes 2 to 11 days), sperm are typically motile and 11 days), sperm are typically motile and capable of fertilization without assistance. capable of fertilization without assistance. Immediately before emission, Immediately before emission, spermatozoa are rapidly and efficiently spermatozoa are rapidly and efficiently transported to the ejaculatory ducts from transported to the ejaculatory ducts from the distal epididymisthe distal epididymis. .

Spermatozoal function does not stop at Spermatozoal function does not stop at the time of fertilization; sperm-derived the time of fertilization; sperm-derived spindles even drive embryo developmentspindles even drive embryo development