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Abstract
There are many views on the causes of the varicocele. But none of them is uncontested and causes a lot of questions. During the last several years, matrix metalloproteinases (MMP) have been shown to be involved in many pathological processes. MMPs form a family of Zn-dependent endopeptidases, which have the property of destroying the main components of the extracellular matrix. The existence of a large number of methods of operative treatment of varicocele indicates not only the author's different views on the etiology and pathogenesis of the disease, but also indirectly indicates dissatisfaction with the results of treatment, where the catamnesis relapse ranges from 10 to 43%.
The aim of the study was to study the pathogenetic characteristics of the development of varicocele and its complications, namely the participation of MSM as a marker of this disease and the improvement of surgical treatment of varicocele.
Material and methods. 190 patients with varicose veins of the left spermatic cord and 25 virtually healthy men with vasectomy were examined and operated. Patients in the main group (100 patients) performed subinvaginal microsurgical varicocelectomy (SMV) according to the classic Marmara method, and patients with control (90 patients) - laparoscopic varicoselectomy (LV). During the operation, under the control of an optical increase, a part of the varicose vein of the spermatic cord was collected. The preparations were placed in liquid nitrogen and transported to the laboratory on the basis of the "Institute of Experimental Pathology, Oncology and Radiobiology. RE. Kavetsky "National Academy of Sciences of Ukraine, where they determined the level of MMP-2 and MMP-9. The evaluation of proteolytic activity was carried out by measuring the area of the lysis zone and determining the concentration of active forms of enzymes using a standard set of matrix metalloproteinases ("Sigma"). To calculate the results, the t-criterion for independent samples was used. Information was processed using the IBM SPSS Statistics 20 program.
Results. In our study, there was a significant increase in the levels of matrix metalloproteinases (MMP): MMP-2 and MMP-9 in men with varicose veins of spermatic cord compared with men without signs of this disease. The average level of matrix metalloproteinases in the wall of the spermatic vein of patients with varicocele was: MMP-2 - 2.13Ѓ}1.96 and MMP-9 - 2.7Ѓ}2.51, which exceeded the same values in men of the control group at 23 and 27 times (p<0.05). In addition, the levels of matrix metalloproteinases differed significantly, depending on the degree of the disease. Levels of MMP-2 and MMP-9 in patients with varicocele level 2 were higher in patients with varicocele 1 degree by 62% and 64% respectively (p<0.05). Indicators of patients with varicocele of 3 degrees in turn outperformed the 2nd degree by 64% and 65%. As a result of our studies, the frequency of relapses in LV and AMD groups was determined to be 8.89% and 2.0%, respectively (p<0.05). In the CMV group, no case of hydrocele was detected – 0%, whereas the hydrocele frequency in the LV group was 3.3% (p<0.05). The duration of surgical intervention was greatest at CMV (52.0 Ѓ} 1.03 min), while the duration of postoperative inpatient treatment in this group was the lowest (6.13Ѓ}0.14 hours – 0.25 days). Time of finding in the department of patients after LV was 4 times longer (1.17Ѓ}0.03 days) compared with the group of LMW.
Conclusions. The level of the content of MMP-2 and MMP-9 in the wall of the spermatic vein is significantly increased in varicocele and can be considered a marker of the disease. The increase in the content of MMP-2 and MMP-9 correlates with an increase in the degree of varicocele. The method of microsurgical subinvaginal varicoselectomy has advantages in comparison with laparoscopic varicoselectomy in terms of postoperative complications of relapse rate and postoperative stay of a patient in a hospital. The method of microsurgical subinvivalal varicoselectomy may be recommended for introduction into specialized medical institutions of Ukraine.
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