varicocele

Bagian Urologi Departemen Bedah RSPAD GATOT SOEBROTO

varicocele is by far the most commonly performed operation for the treatment of male infertility.

is found in approximately 15% of the general population, in 35% of men with primary infertility, 70% to 81% of men with secondar infertility (Gorelick and Goldstein, 1993; Witt and Lipshultz, 1993). Animal and human studies have demonstrated that varicocele is associated with a progressive and duration-dependent decline in testicular function

grade I varicocele, an impulse can be palpated in the scrotum during a Valsalva maneuver. grade II varicocele is large enough for tortuous and dilated veins to be palpated without a Valsalva maneuver.

Grade III varicocele is visible through the scrotal skin.

VARICOCELECTOMY

Scrotal Operations
Retroperitoneal Operations Laparoscopic Varicocelectomy

Microsurgical Inguinal and Subinguinal Operations: The Preferred Approaches Radiographic Occlusion Techniques

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hypothalamo-pituitary-gonadal axis provides pulsatile secretion of GnRH and subsequently LH and FSH release from the pituitary to stimulate spermatogenesis and testosterone production. GnRH pulses are released every 90 to 120 minutes. Diurnal variation of testosterone results in higher morning levels of testosterone than that observed in the afternoon and evening hours. The testis is a specialized structure that functions optimally 2C to 4C below body temperature.

 Spermatogenesis

is less efficient in humans than in most other animals. The process of spermatogenesis and spermiogenesis takes approximately 64 days in humans and results in a haploid germ cell that acquires natural ability to fertilize oocytes during epididymal transport. Spermatogenesis is an androgendependent process that optimally occurs with very high intratesticular levels of testosterone.

Spermatozoa exiting the testis are immotile and have limited capacity to fertilize an oocyte unless assisted reproductive techniques are applied. After epididymal transit (which takes 2 to 11 days), sperm are typically motile and capable of fertilization without assistance. Immediately before emission, spermatozoa are rapidly and efficiently transported to the ejaculatory ducts from the distal epididymis. Spermatozoal function does not stop at the time of fertilization; sperm-derived spindles even drive embryo development