Varicocele is more common than what you might think, affecting around 15-20% of men (about 1 in every 5 men). While it is generally asymptomatic and often doesn't require treatment, in some cases, however, it might be painful or cause infertility, making surgical removal necessary.  

What is Varicocelectomy?

Varicocele surgery, or varicocelectomy, involves closing off the blood flow to the enlarged vein by tying, cutting, and sealing it. This redirects the blood to other normal veins in the testicle. (1)

There are two common techniques to perform varicocelectomy: open microsurgery and laparoscopy. Both are typically done under general anesthesia and are same-day procedures. (1)

Indications

The most common indication for varicocelectomy is to treat infertility related to varicocele and improve the chances of conception.  A doctor can also proceed with surgery if: (2)(3)

• Severe testicular pain.
• Testicular atrophy.
• Very low sperm quality.
• Bilateral varicocele.
• Severe tenderness or swelling in the varicocele.
• Low testosterone levels.

Only surgery can actually correct varicoceles, but that may not be necessary if none of these things are happening.

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Results

Gradually, sperm quality and count improve, and the chances of pregnancy increase to about 40-60% at least 3 to 4 months post-varicocele surgery. (4)

Risks

Varicocelectomy is relatively safe, but as with other procedures, there might be some rare complications, which include: (3)

• Risks of general anesthesia.
• Infection around the incision site.
• Blood clot or hematoma around the surgical site.
• Accumulation of fluid around the testicle (hydrocele).
• Injury to the testicular artery.
• Rare cases of testicular weakness or recurrence of the varicocele.

Preparations

Follow all the instructions regarding preoperative procedures, which often include: (5)

• Stopping certain medications that increase the risk of bleeding.
• Fasting the night before the surgery.
• Informing any allergies that you have to the medical team, whether to medications or substances.

Surgery steps

Varicocelectomy is a simple procedure and typically includes these steps: (3)

1. Anesthesia.
2. A small incision is made in the groin or abdomen to reach the varicocele, after which the vein is tied or cut to redirect blood flow toward healthy veins. The procedure can also be done laparoscopically using smaller incisions.
3. The incision is closed with small stitches.

The surgery can take anywhere from 30 minutes to 3 hours, depending on the method used. Most patients can go home the same day.

Recovery

You can return to work and other simple daily activities about two days after varicocele surgery, pain and swelling will reduce significantly within the first few days, but it might take a few weeks  to fully subside.

Adhere to your doctor’s instructions after surgery, which may include: (2)(3)

• Apply ice packs on the surgical site in 10-minute intervals to reduce swelling, several times a day.
• Use the painkillers and other drugs that have been prescribed.
• Keep the surgical site clean and dry as much as possible. Change dressings as directed, and ensure that you wash your hands thoroughly before doing so.
• Avoid lifting heavy objects or engaging in strenuous physical activity for at least two weeks, or as recommended by your physician.
• Increase your fiber intake and drink plenty of water to prevent constipation, which may exert pressure on the incision area.

References

1. NIH NLM - Varicocele
2. European Association of Urology - Varicocele
3. Cleveland Clinic - Varicocelectomy
4. Medscape - Varicocele Treatment & Management‍
5. Saint Luke's - Laparoscopic Varicocelectomy