Varicocelectomy: Varicocele Repair Procedure, Risks and Recovery

Doctor in lab wearing lab coat and stethoscope with the words "varicocelectomy" varicocele repair.

What Is A Varicocelectomy?

A varicocelectomy is an surgical procedure used to repair a varicocele, which is a swelling of the veins in the scrotum that transport blood from the testicles. It is an outpatient procedure performed by a urologist who specializes in the male reproductive system. During the surgery, doctors remove the varicocele, tie off the ends, and redirect blood flow to normal, healthy veins.

Surgery can be done under general or local anesthesia, and most patients are back to work and/or sexual activity within a week or two after the procedure. This procedure is relatively safe and has a success rate of over 90%. The patient will likely go home the same day.

After the procedure, you can expect to have some pain and swelling. You should avoid strenuous activities and taking baths for at least four weeks.

A varicocelectomy is not always necessary, however, and the condition may only cause mild symptoms, if any. If the varicocele is causing significant pain and affecting your life, surgery may be necessary.

While it is rare for this condition to produce symptoms, a varicocele can affect fertility. The blood pooling in a varicocele causes the scrotum to heat up, which reduces sperm production.

If the varicocele is causing significant pain, fertility problems, or affecting your life in other ways, surgery may be necessary. If your doctor recommends varicocele surgery, you should discuss the risks and benefits with him or her.

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Is Varicocele Surgery Necessary?

Very often, no treatment for varicoceles is necessary. Men experiencing certain symptoms may opt to have treatment, however. These symptoms can include:

  • Pain or discomfort
  • Infertility
  • Testicular atrophy
  • Poor semen analysis results

Currently, varicoceles are not able to be prevented or cured with any known medication. However, there may be some relief from symptoms using over-the-counter painkillers like acetaminophen or ibuprofen.

When necessary, surgery is an option. An alternative to surgery is a procedure known as varicocele embolization, which is a less invasive method of blocking off the enlarged veins.

A varicocelectomy involves closing off the affected vein and redirecting blood flow back to healthy veins. In cases where there are problems with infertility, varicocele surgery can be used to improve or reverse the condition.

Additionally, the odds of success when using assisted reproductive methods (such as IVF) may be improved by having a varicocelectomy, since it will likely improve sperm quality.

During adolescence, symptoms of pain, impaired testicular growth, or an abnormal semen analysis all indicate that the varicocele needs to be treated. Teens who have had surgery to fix a varicocele to treat impaired testicular development may be able to resume growth following treatment.

Although a varicocelectomy can improve sperm parameters, the effects of untreated varicoceles on sperm quality are not known.

Surgical Procedures

There are a number of ways to perform a varicocelectomy. They all involve blocking blood flow to the affected testicular veins. Varicocele surgery usually requires a general anesthetic to be administered, meaning you will be unconscious during the procedure.

Two of the most popular surgical options include laparoscopic surgery and microsurgical varicocelectomy.

Microsurgical Varicocelectomy

Microsurgical varicocelectomy is performed by using a microscope to find the right veins. This enables the doctor to easily to distinguish between the healthy veins and the veins that will need to be removed.

The surgeon will then make a small 1 cm incision above the scrotum. Next, he or she will tie off the healthy veins and remove the varicoceles. This procedure typically takes between 2 to 3 hours, and you are able to go home the same day.

Compared to other surgical procedures to treat varicoceles, the microsurgical subinguinal varicoclectomy has the highest success rate.

Laparoscopic Varicocelectomy

Another option is laparoscopic surgery. This type of varicocelectomy involves using a thin tube with a light, known as a laparoscope. The surgeon only needs to make a few small incisions when using this procedure.

The scope is first inserted through one of the incisions where it sends live imaging of the inside of the abdomen to a video monitor. The abdomen is then filled with gas, which provides space for the surgeon to see and work.

Next, instruments are inserted through the other incisions and the swollen veins are severed. The ends may be cauterized or sealed off with tiny clips.

When the surgery is complete, the instruments are removed and the incisions are closed with stitches or staples. This procedure only takes about 30-40 minutes to perform and you can also return home the same day.

Risks And Complications From Varicocelectomy

There are risks and complications associated with varicocelectomy, so it’s best to discuss the procedure with a physician before making an appointment.

The surgery itself is fairly safe, and there are very few risks associated with having varicocele surgery, Even so, there are some situations in which complications can occur, however. including those associated with the anesthesia. Varicoceles may recur, and approximately 15 percent of men experience them again. The procedure may also decrease sperm count.

These include:

  • Recurrence of a varicocele
  • Fluid accumulating in the scrotum (hydrocele)
  • Infection
  • Accidental testicular artery damage
  • Accidental injury to the intestines or major blood vessels of the abdomen

Recovery After Treatment

Recovery time following a varicocelectomy is typically fairly short with only minor discomfort. You can return to work within 5-7 days. However, you should refrain from exercising or engaging in strenuous activity for up to two weeks. Additionally, your physician might recommend that you avoid having sex for a certain period of time.

An ice pack may help reduce the pain and swelling after the procedure. While pain resulting from the surgery is typically mild, it could potentially persist for several days or even weeks.

After the surgery, your doctor may prescribe you pain medication. Your doctor may also recommend that you use over-the-counter medications to alleviate any discomfort such as acetaminophen or ibuprofen.

You will be scheduled for a follow up appointment by your urologist, and a semen analysis will be performed 3-4 months after surgery if the varicocelectomy was done because of fertility issues. It takes sperm around 90 days for them to mature fully, so any improvements in sperm quality will not be noticed until then.

Does A Varicocelectomy Improve Fertility?

Following varicocele surgery, a couple may be able to conceive more easily than before. In fact, some couples have reported increased conception rates after the procedure.

Although the surgery does not cure male infertility, it will improve a man’s chances of conceiving, and a majority of men who undergo varicocelectomy will see an improvement in semen quality.

A number of studies have assessed the effects of varicocelectomy on fertility parameters, and the majority showed significant improvement in semen quality and pregnancy rates. While many of these studies were poorly designed or uncontrolled, they do suggest that varicocelectomy can increase the likelihood of conceiving naturally.

Varicocele repair may have a beneficial effect on fertility, but for couples trying to conceive, the procedure should be considered in conjunction with other fertility treatment options.

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