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Urology/i have varicocele


QUESTION: If I choose microscopic surgery for varicocele will there actually be new veins replace it? or veins will grow from other functional veins? If it can grow back how long does it take? Do you have any idea?

ANSWER: Brian,
that is not how it works my friend. There are many vessels that drain the testes so you have no need to graft new ones. The term ectomy is a bit off in the surgical procedure of varicocelectomy , the surgery is a ligation of (tie off) vessels that are not cut. The microscope is inserted after the incision is carefully made and this helps to visualize these tiny relaxed vessels unless they are huge like a bag of worms which most are not. They are tied off and meant to cut off outflow and reverse flow of blood that is responsible for the dilation and subsequent heat. When blood vessels are tied off they will eventually shrink (atrophy) over a 3 month (approx) period to the point the scrotal temperature is reduced to fertility parameters. The healing time is for the musculature that is severed in the surgery not the vessels.  

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QUESTION: So what you actually mean is the veins that are tied up will lead to atrophy of varicocele veins. So there won't be any new veins right? Is it the same if I choose embolization surgery? If the veins are tied up, so the other veins that do not have valve malfunction are left will result in less veins that can still function? and lastly is it better and safe if I wear a athletic supporter if I lift weights in the future if I have done the surgery? and should I wear tight underwear normally? to support the scrotum?

ANSWER: Brian,
yes there are functioning veins left untied and they amongst others drain the testes. Embolization is not as effective as varicocelectomy as we can visually choose which to tie off and which not to and with emboli you are viewing this through Xray and the contrast. We used emboli along time ago with an expert interventional radiologist and still there were many complications and some needed the varicocelectomy any way with the additional expense of removing the emboli.I do not ever recommend it even though theoretically its effective for some patients. I asked Dr Lipshultz one day in regards to emboli and his opinion, he looked me in the eyes and said if a patient is paying me cash to do this I have to have it right the one and only time I am going in to repair the vessels, there is no latitude for a redo. Emboli is only easier to recover but we all know the easy softer way is usually the wrong path. Underwear with scrotal support like briefs or an athletic supporter is recommended due to the stretching of the pampinaform plexus further worsens the condition.

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QUESTION: The gubernaculum is carefully inspected and any veins encountered are either electrocoagulated or clipped and divided depending on their size. All perforating external spermatic veins and gubemacular veins are also divided (Figure 4). The gubernacular veins have been demonstrated radiographically to account for 10% of varicocele recurrences.

I found it in this web between 3 pictures

I wonder what does that mean? Can you explain in detail for me? thanks because I need to understand it before going for surgery

Brian ,
In simple terms The vessels blood flow is cut off just as the is done with an emboli the difference is one is a permanent obstruction severing the vessel but not removing it and the other is hopefully permanent if the coil successfully embolizes (blocks) the vessels. The gubernaculum vessels are an other drainage of flow from the testes and this is the area that can have a reoccurrence of enlarged vessel or varicoceles. I recommend the varicocelectomy vs the emboli even with it being less invasive.  


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Thomas A Suppe RDMS CLT


Invervential urologic radiology , urologic laser surgery, cryotherapy of the prostate and kidney, extracorporal shockwave lithotripsy, holmium laser lithotripsy, urodynamics (video-non video),male infertility, erectile dysfunction, Peyronies disease, hypogonadism ,kidney stones, prostate cancer detection, BPH, voiding dysfunction, bladder cancer and continent diversions.


For the past 20 years performing intervential and diagnostic uro-radiology for a multitude of urologic surgeons from New York, New Jersey, Lousianna and Texas. Founder of DMS medical LLC introducing the Texas Medical Center to the first high power Green Light laser for the treatment of BPH just after its release by the FDA from Laserscope and its sucessful trials at the Mayo Clinc.

American Registery of Diagnostic Medical Sonographers (ARDMS), American Urologic Assocoation (AUA), American Medical Systems (AMS) Laserscope,Oncura, Allergan and Auxilliam pharmaceuticals.

Comprehention of Urologic Ultrasonography for the Resident Physician (Journal of Urology 2012), Author of the syllabus for the uro-radiology residency course at The Scott Dept of Urology at Baylor College of Medicine Houston Texas (2010 to present). Past Clinical Studies: Principal radiology investigator Allergan Inc for "The treatment of BPH with intra-prostatic injections of Botox" with Larry I Lipshultz MD 2011-2012, principal radiology investigator for Allergan Inc for "The treatment of Peyronies disease by intra-lesional penile injections of Botox" with Mohit Khera MD MBA MPH (2011-2012). Current studies: Principal investigator of "Blood pressure risk factors of intra cavernosal injections of Trimix and PGE1 during Penile Duplex's.

BS from Ramapo College of NJ, Registered diagnostic medical sonographer with the ARDMS, 2 year fellowship of Uro-Radiology and intervential sonography at Baylor College of Medicine Houston TX, laser safty officer in state of Texas and certified in KTP, Holmium and Lithium Tri-boride laser systems from Laserscope San Jose, California and American Medical Systems Minnatonka Minnasota, trained and certified by Oncura Inc Isreal in ultrasound guided argon cryotherapy of the prostate and kidney.

Awards and Honors
Honorary instructor of GU ultrasound course 2012 international meeting of the American Urologic Association. Author of the the AUA course for "Ultrasonography of the Testes and Scrotum" 2012.

Past/Present Clients
Baylor College of Medicine (BCM) Lousianna State University (LSU), LSU Medical Center Shreeveport LA, The Methodist Hospital Houston Texas, St Lukes Episcopal Hospital Houston Texas, Memorial Herman Health Systems Houston Texas, Palestine RMC Texas, Doctors Regional Hospital Corpus Christi Texas, Valverde Regional Medical Center DelRio Texas, Current instructor/technologist for two internationally recognized urologists : Larry I Lipshultz MD and Mohit Khera MD, MBA, MPH at Baylor College of Medicine. I served as intervential sonography consultant for Oncura Inc cryotherapy systems. Former lead trainer for Urosource mobile medical services , training new surgeons in PVP or photo-selective vaporization of the prostate for BPH, BNCs and urethral stricture vaporization.

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