Testes and andrology

The main surgical methods are laparoscopic varicocelectomy (through small openings in the abdominal wall) and microsurgical varicocelectomy (through a small incision in the groin, under an operating microscope); embolization, performed from inside the blood vessel, is another option.

Each method has its own advantages and limitations. The laparoscopic approach requires general anesthesia. The microsurgical approach requires specific experience with the operating microscope and usually takes longer. Embolization is performed without a skin incision, through a puncture of a blood vessel under X-ray guidance, but it may not be possible in every anatomy. After any of these methods, the varicocele can recur or fluid can collect around the testicle (hydrocele).

No method is equally suitable for every patient, and an improvement in sperm parameters after surgery is not guaranteed — the choice is made individually based on the grade of the varicocele, whether it is a recurrence, whether it is on both sides, and the patient’s goals.

A varicocele most often means dilation of the veins of the left testicle. There is no single definite answer here. If it is grade 1 and causes no symptoms, there is no need for any surgery. If it is grade 2 or 3, there still has to be an indication: if the couple cannot have a child, or if it causes discomfort or pain, that is an indication for surgery.

Some men are older, already have children and a family, and have a grade 4 varicocele. If it causes no symptoms, there is no need to operate on it. But if it is a young man and there are also changes in the semen, such as weak sperm, it does need to be treated.

If the patient himself wants the operation as a preventive measure, to be rid of it, that is also possible, because this condition is not going to go away on its own.

A preventive operation done at the patient’s own request is still a surgical procedure, and the general risks of surgery apply to it as well; the decision is made jointly with the doctor after an individual examination. There are several methods of varicocele surgery; which one is chosen is determined individually based on the patient’s condition.

No, not necessarily. There are two main types of azoospermia: obstructive (a blockage) and non-obstructive (impaired sperm production). In both, it may be possible to retrieve sperm directly from the testis.

Retrieving sperm from the testis is a surgical procedure and carries risks; it cannot be promised in advance that sperm will be found. The indication is determined after an individual examination.

A sperm count of zero does not necessarily mean there are truly no sperm. That zero is the count in the semen that comes out of the seminal vesicles. There may be a problem in the pathways before that point: the testicles may well be producing sperm, and there is simply an obstruction somewhere along those pathways.

In such cases, sperm must be taken directly from the testicles and, through examination under a microscope, either found or ruled out. If the count there is also zero, there is no chance of becoming a father. But if even one or two sperm are found there, there is a chance of becoming a father — and later, based on the examination results, those pathways can also be treated; if they are opened, there is a chance of becoming a father the natural way.

This refers to the possibility of fathering a child with the patient’s own sperm. Outcomes differ from patient to patient and cannot be promised in advance at any stage. If no sperm are found in the testis, other paths to building a family are discussed together with a reproductive medicine specialist. Retrieving sperm from the testis is a surgical procedure and carries risks; the next steps are discussed in an individual consultation.

TESE is the search for sperm in a tissue sample taken from the testis. Micro-TESE is the selective removal, under an operating microscope, of the sperm-producing tubules — compared with conventional TESE, this method may increase the chance of finding sperm and cause less damage to the testicular tissue.

This method is used in certain cases of male infertility: when there are no sperm at all in the semen (azoospermia), or when all of the sperm present are immotile. In other words, TESE is not chosen for every case of infertility — only when there is a specific indication.

Both methods are surgical procedures, and the general risks of surgery (bleeding, infection, effects on the testicular tissue) apply to them as well; it cannot be promised in advance that sperm will be found. The indication is determined after an individual examination.

In men who have no sperm at all in their semen (azoospermia), micro-TESE may make it possible to retrieve sperm from the testis and thus to have a child through in vitro fertilization (assisted reproduction).

In rare cases, micro-TESE may also be used in men with poor semen quality — the aim is to obtain healthy sperm this way. This decision is made individually based on the semen analysis and other test results.

Micro-TESE is a surgical procedure and, like any operation, carries risks. Sperm may not be found after the operation; even when sperm are found, whether a child is born also depends on the reproductive (IVF/ICSI) stage and on the female factor. No outcome is promised at any stage.

Infertility means that a couple is unable to have a child despite a year of unprotected intercourse. A treatment path is chosen after the causes have been investigated in detail.

Factors that can cause infertility in men: a low sperm count; an age-related decline in the production of good-quality sperm; hormonal problems; blockage of the seminal ducts; genetic disorders; infections and diseases such as cancer; erection problems; varicocele; smoking and alcohol; stress and panic attacks.

Many of these causes can be identified through testing, and in many cases treatment is possible — but the outcome depends on the cause and on the health of both partners.

Ureaplasma and Gardnerella that cause no symptoms in the urethra are not considered a cause of male infertility on their own; an infertility workup should look for the real cause, and the decision to treat should be made individually based on the examination results.

It is often related to benign causes, but if it keeps recurring or appears after the age of 40, the prostate and seminal vesicles need to be examined.

Prostate diseases, infections and injuries are among the factors that can cause blood in the semen. Although visible blood in the semen frightens patients, in most cases the cause is not malignant.

If the necessary examinations and tests reveal a problem such as an infection or a blockage (obstruction), it should be treated. In every case, if this sign appears, you should see a specialist — do not simply wait, assuming “it will go away on its own.”

If blood in the semen occurs together with blood in the urine, that is a different situation — visible blood in the urine always requires a thorough workup, even without pain (cystoscopy and imaging may be needed). See the “Bladder” page.

A hydrocele is a collection of fluid around the testicle, and if it causes symptoms it can be treated surgically. Like any surgical procedure, this operation carries risks — swelling, hematoma, infection and, in rare cases, recurrence are possible; the method is chosen individually after an examination.

Testicular torsion, by contrast, is an EMERGENCY — with sudden, severe testicular pain, hours are critical, and you must seek emergency care immediately.

A small hydrocele that causes no symptoms does not necessarily require surgery; the decision is made after an individual examination.

Patients with this condition often say they have testicular pain, but the examination shows an infection of the epididymis — a hardening. The infection passes from the urethra to the prostate, and from the prostate it travels back along the ducts leading to the seminal vesicles, settles in the epididymis and causes chronic symptoms.

In such cases, treatment often has to be prescribed for the infection of both the prostate and the epididymis — this is called combined treatment. Here, too, the approach is individual: which antibiotics and other medications should be used is decided for each patient.

Chronic testicular pain wears people down a great deal and affects daily life. Even though it is chronic, there is treatment for it. In the most difficult cases, the epididymis can be removed — but that is not done in a young person.

Sexually transmitted infections (e.g., trichomoniasis, gonorrhea) are one of the causes of this inflammation, but not the only one; the diagnosis is made through an examination guided by the symptoms. Removal of the epididymis is a last-resort surgical procedure; like any operation, it carries risks and is not suitable for everyone.