A varicocele occurs when veins in the scrotum become enlarged. Similar to varicose veins elsewhere in the body, faulty valves cause blood to pool in the scrotum. This condition commonly affects younger men, ages 15 to 25. About one in six will experience a varicocele.
Most men experience no symptoms at all. Symptoms, if present, include pain, a dull ache, or a feeling of heaviness.
Since most cases are asymptomatic, doctors usually discover the varicocele during a physical exam or infertility treatment.
Some varicoceles require surgery to repair. When compared to other surgical methods, microscopic varicocele surgery is recognized for producing the highest success rates as well as the lowest risk for adverse effects.
Under general anesthesia, a small incision is made in the groin. The inguinal approach uses an incision higher in the groin, while the subinguinal approach is a bit lower. Next, using a high-powered microscope, the surgeon will locate and tie off any enlarged veins. This will help divert blood flow to other areas of the body, reducing engorgement in the scrotum. The microscope greatly reduces the odds of damaging nearby anatomy such as arteries, the lymphatic system, and the vas deferens. If the varicocele is causing the patient significant pain, the ilioinguinal nerve may be severed to provide permanent pain relief.
Who is a Candidate?
Not all patients with a varicocele require surgery. However, sometimes a varicocele can cause great pain or discomfort. Additionally, it can restrict growth of the testicles, cause infertility problems, or decrease testosterone production. The goal of surgery in these instances would be to reduce pain, create space for the restricted testicle to grow, improve sperm quality, and increase the production of testosterone.
Because the scrotal area is so small and compact, inadvertent injuries to nearby tissues and blood vessels can occur. If the testicular artery is nicked or cut, damage to the testicle could result. Damage to the vas deferens may restrict the flow of sperm. An injury to the lymphatic system could produce extra fluid in the scrotum that requires additional surgery to repair. As with any surgery, infection is also a risk. By using the microscope to complete the necessary repairs, the risk of injury is much less.
What to Expect
Generally, a patient can return home on the same day following a microscopic varicocele surgery. On average, if both sides of the scrotum are operated on, the surgery will last about one hour. There may be mild pain or discomfort afterward. Prescription or over-the-counter pain medications or anti-inflammatory drugs may be needed for a short time. Normally, light activity can be resumed in 24 to 72 hours.
After two to three weeks, full activity and exercise will likely be permitted. It may be necessary to abstain from sexual intercourse for a period of time. Additionally, it may take a few months for sperm quality to improve. Approximately 50% of patients who were struggling with infertility will be able to father a child in the first year after varicocele repair.