Urology

TREATMENT OF INFERTILITY IN MALE VARICOCELE
Varicocele is the dilation of the veins leading to the testes and the accordingly backing up of the blood flow. Varicocele occurs at the rate of 85% in the left testicle (as the left testicular vein is poured into the renal vein which is further away with high pressure) and 15% in both. If the varicocele is seen only on the right side, an additional examination is required.About 15-20% of marriages have the problem of not having children at any time and in any number they wanted. In the infertility problem of couples, only male-related factors are as high as 20%, and in 40% of the couples, the problem in men is added to the problem in women; In 50-60% of couples who have difficulty in having children, it is seen that a problem in men contributes partly to the problem of infertility. Most of the problems in men can be understood from examination and sperm analysis, but some cases may require special examinations.Evaluation of male infertility is started with an interview with Urologist- Andrologist as a first stage and with at least two spermiograms that evaluated according to WHO (World Health Organization) criteria by giving sperm examples with a proper method.If the examination or sperm test is identifying as a result of initial evaluations, detailed examinations will be carried out. These may be more detailed examinations with sperm, hormone analyzes, ultrasonography, and some other radiological and genetic tests. As a result of the tests, treatments are starting to increase the fertilization capacity by increasing the number, motility and quality of the sperm cells in the male's semen.Some of the men with infertility problems can be treated by replacing the deficient hormones or by increasing the sperm amount with medication in patients with appropriate hormonal structure. 

VARICOCELE TREATMENT
Microsurgery is the most technically successful and least complicated method of varicocele surgery. The technical success in microsurgical varicocele operation rate can increase 99%, serious complication rate can decrease to 0% and minor complication rate can decrease to 3-5%. In other operation techniques, hydrocele risk increases up to 40% and arterial damage increases up to 5%. The embolization method, which is a radiological intervention in the treatment of varicocele, is not preferred because of low success and high, serious complication rates. Microsurgical varicocele operation is not a simple surgical procedure. The microsurgical technique is successful only with the staff who have specially trained and experienced. Inadequate and incorrect application of microsurgery, like any other method, can lead to significant complications and even organ loss. After unsuccessful varicocele operations performed with microsurgery and other old techniques, many patients with varicocele persist, or those experience problems due to complications, such as loss of hydrocele and testis, are encountered. Some of these patients whose sperm quality or spermiogram results deteriorated or even decreased to zero may benefit from corrective microsurgery, but some of them cannot be helped.Varicocele can also cause pain. Although it cannot be guaranteed that the pain will go away, the pain is eliminating in many cases with the application of microsurgical methods and surgical techniques. 

TESTICULAR CANCER
Testicular cancer occurs in one or two testicles of young men. It is highly treatable and curable.The testicles are organs of the male reproductive system. In an adult man, these two organs, smaller than a golf ball, are located under the penis in a vesicle called scrotum.Testes produce the androgen hormone, testosterone. At the same time, sperm production is done here. The sperm cells produced in the testicles are transported through the vas deference (semen channel) into the seminal vesical. Here, sperm mixes with the fluid produced by the prostate gland.  During ejaculation, sperm cells, seminal vesicle secretion and prostate secretion enter the urethra, which allows the passage of urine and semen in the center of the penis.The testicles consist of many kinds of cells. Each of these can cause single or multiple types of cancer. It is essential to distinguish the types of cancer because diagnosis and treatment are different according to different cancer cells.

STROMAL TUMORS
Tumors may also develop in the supporting and hormone-producing tissues or stroma of the testis. These tumors are known as gonadal stromal tumors. They account for 4% of testicular cancers in adults, but they account for 20% of testicular cancers in childhood. They are two main types of Leydig cell tumors and Sertoli cell tumors.Leydig cell tumors: These tumors usually develop from Leydig cells that produce male sex hormones (androgens, testosterone). Leydig cell tumors occur in both adults (75% of cases) and children (25% of cases). They often produce androgens, but sometimes they produce estrogens (female sex hormones). Most Leydig cell tumors do not spread outside of the testis and are treating surgically. But sometimes they spread to other parts of the body. If metastasis occurs, Leydig cell tumors have little chance of being treated because they do not respond well to radiotherapy or chemotherapy.Sertoli cell tumors: These tumors develop from Sertoli cells that support and feed sperm-producing cells. Like Leydig cell tumors, they are mostly benign (non-invasive). However, if spread, they are resistant to chemotherapy and radiotherapy.Secondary testicular tumors: Secondary testicular tumors are tumors that begin in another organ and spread to the testis. Lymphoma is the most common secondary testicular tumor. Testicular lymphoma is more common than primary testicular tumors in men over 50 years of age. General treatment is surgical excision followed by radiotherapy and / or chemotherapy. In children with leukemia, leukemia cells can sometimes produce tumors in the testicle.Cancers of the prostate, lung, skin (melanoma), kidney, and other organs can also spread to the testicles. However, these cancers have little chance of being treated because cancer has already spread to other organs. Treatment depends on which organ had cancer.

PROSTATE CANCER
The prostate is a gland found only in men. It is the size of a walnut and is located just in front of the rectum, just below the bottom of the penis. It encompasses the inner part of the urethra, which carries urine and semen to the outside of the penis. One of the functions of the prostate is to produce a portion of the seminal fluid that keeps alive and protects the sperm. The cells generate the prostate gland tissue, grow with the effect of the basic male hormone testosterone and remain healthy. The generic name given to all male hormones is androgen.Prostate cancer cells develop from prostate gland cells. Almost all prostate cancers develop from gland tissue (adenocarcinoma). Prostate cancer generally develops very slowly within the prostate gland and eventually develops into the outer surface of the prostate gland. It can also spread directly to the tissues of neighboring organs. Ultimately, it can penetrate into distant tissues of our body, and in particular to the bones (metastasis = direct or spread to the lymphatic system and blood circulation and other tissues). If prostate cancer spreads, it first spreads from the lymphatic channels to the lymph nodes in the pelvic region. Lymphatic tissue is a colorless transparent liquid containing cells of the immune system. Lymphatic vessels carry this fluid to the lymph nodes. Cancer cells can go into the lymph ducts and pass through the lymph nodes and continue to spread from there. If prostate cancer cells reach the lymph nodes, it is possible that they can pass to other organs of our body.

KIDNEY CANCER
Many different types of cancer can develop in the kidney. We divide these types of cancer into two groups: benign and malignant. The most common mass in the kidney is simple kidney cysts. The renal cyst is a benign mass and is entirely different from cancer. Kidney cysts, which often occur incidentally, never threaten human life. Patients with renal cysts detected generally have panic needlessly and seek for treatment. In fact, renal cysts usually do not even require treatment. Only monitoring is almost always sufficient. Kidney cancer, on the other hand, is a malignant mass that, unlike kidney cysts, can be a threat to human life. Because of the purpose of this article, renal cell cancer which is the most common malignant kidney mass in adults, will be explained. Renal cell cancer originates from tissues that filter blood in the kidney and from the tissues produce urine. As kidney cancer grows, it can spread to lymph nodes, liver, large intestine and pancreas. Besides, tumor fragments detached from the main tumor may progressively settle to other distant parts of the body (Metastasis).

KIDNEY STONES
Kidney stone, known as "nephrolithiasis" or "urolithiasis" in the medicine, is the name given to hard mineral substances accumulated in the kidneys.If substances such as calcium oxalate or uric acid are found in the urine at a higher concentration than is normally expected, kidney stones are formed. These substances can precipitate in the kidney as crystals and grow over time to form a kidney stone. Stones can be removed from the body by relocating or moving down the urinary canals. However, stones that attach to any level of the urinary canal and prevent the flow of urine often cause to fearsome, severe typical kidney pain.

Risk Factors
Some diseases and habits trigger the risk of kidney stone formation in an individual. In particular, a patient with calcium stone problems in his previous medical record has a higher risk of having kidney stone disease again. The probability of second stone formation in patients with kidney stone disease in the past is 15% in one year and 80% in 10 years.Patients with gout and those with high uric acid in the urine have a higher risk of having kidney stones. Also, some medications that lead to the formation of crystals increase the risk of kidney stone disease. In case of frequent or chronic diarrhea or as a result of fluid loss, people who produce intensive, acidic urine may develop kidney stones.