What is a Varicocelectomy?

Varicocelectomy is a surgical procedure for removing a varicocele. Varicoceles are groups of enlarged veins in the scrotum, similar to varicose veins that develop in the legs. While the exact causes of varicoceles remain unknown, it is commonly believed that they result from malfunctioning valves that prevent proper flow of blood within the veins, causing them to bulge. Varicoceles can lead to mild or moderate pain that is dull, like a toothache, and the scrotal pain occurs with extended periods of standing, sitting or activity. The pain is usually relieved by lying down. Characterized by a swollen scrotum, a varicocele increases the likelihood of male infertility due to poor-quality sperm and diminished functioning of the cells responsible for producing the male hormone testosterone.

Varicocele Diagnosis

The standard diagnosis of varicoceles is physical examination by a doctor. Careful palpation of the scrotum by a skilled and experienced urologist with the patient in a standing position can reveal a varicocele. When physical examination fails to detect the condition, the urologist may order radiologic and other imaging techniques to identify a varicocele. Depending on how the disorder is detected, it can be classified as subclinical (not detected by physical exam, found by imaging techniques), grade I varicocele (only palpable on physical exam before or after Valsalva maneuver), grade II (palpable on physical exam without need for Valsalva maneuver), and grade III varicocele (visible to the eye and detected on physical exam).

Reasons for Varicocele Surgery

Urologists often recommend varicocelectomy when the size of an affected testicle is at least 20% bigger than the size of the unaffected testicle, when semen analysis shows abnormal results, or when the condition causes persistent pain and discomfort to the patient. The most common reasons for varicocele surgery are:

1. When the condition occurs in adolescents.
2. To correct male factor infertility.
3. To boost mild/low testosterone levels.
4. To relieve varicocele-induced scrotal pain.

How Varicocele Surgery Works

Varicocelectomy is aimed at stopping the backward flow of blood from the body to the scrotum in order to “cool off” the testicles. Typically, veins running from the testis to the body are interrupted or tied off as completely as possible so that only one vein (vasal vein) that is not at risk of varicose veins is left open to allow blood to leave the testicles after surgery. Therefore, varicocele repair entails sealing off affected veins to redirect blood to flow through other healthier veins, creating a kind of bypass.

The most commonly used varicocele surgery procedure is microsurgical varicocelectomy, which is considered the gold standard because of minimal morbidity and complications, operative versatility, consistency with cost-containment principles, and high success rates. Performed under general or local anesthesia and using a small upper scrotal, inguinal (groin area) or retroperitoneal (lower abdomen) incision, the procedure allows visual access to all routes of venous return to the testis. Other techniques that can be used are laparoscopic surgery (the urologist makes a tiny incision in the abdomen and directs a tiny surgical instrument) and percutaneous embolization (a surgeon inserts a tube into the body via the groin and then scars off offending veins by releasing chemicals and coils through the tube).

Risks of Varicocelectomy

Varicocele surgery is relatively safe. However, just like any other surgery, there are risks such as artery damage, testicular atrophy, infection, abdominal pain, swelling or bruising of the area, and buildup of fluids around operated area. The patient should immediately see a doctor if signs of complications such as difficulty with urinating, fever, repeated episodes of vomiting and yellow drainage from the incision site are experienced after surgery. A skilled and experienced urologist should be able to perform the procedure with minimal risks. Pain, discomfort and swelling from varicocelectomy will last only a few weeks and can be managed with painkillers and ice packs.