Microsurgical Varicocelectomy

Pooyesh Fertility Clinic

Microsurgical Varicocelectomy

 

What is Varicocele?

  • Varicocelectomy refers to the surgical removal or ligation of dilated veins within the scrotum, a condition known as varicocele.
  • Varicoceles are more common on the left side of the scrotum. They are often asymptomatic, but in some cases may cause pain that can range from sharp and severe to a dull, dragging discomfort in the testicular area. The pain usually worsens with standing or physical activity, tends to increase throughout the day, and improves when lying down.

Prevalence of Varicocele

  • About 15% of men in the general population have a varicocele, though it is uncommon in boys before puberty.
  • The prevalence is higher among infertile men: about 35% in men with primary infertility and 75–80% in men with secondary infertility.

Causes of Varicocele

  • The exact cause of varicocele formation is not fully understood.
  • It is believed to result from impaired blood flow in the veins that drain the testicles, or from malfunctioning testicular venous valves.

Diagnosis of Varicocele

  • Varicocele is usually diagnosed during a physical examination, often with the Valsalva maneuver performed in the standing position by urologist.
  • If the clinical exam is inconclusive, scrotal ultrasound may be recommended.

Treatment of Varicocele

  • There is no effective medical therapy for varicocele.
  • Surgical intervention is recommended when varicocele causes pain or infertility. The preferred approach is microsurgical varicocelectomy.
  • During this procedure, the surgeon uses an operating microscope to make a very small incision (about one inch or less) in the groin area, carefully ligating the dilated veins.
  • The microscope helps avoid injury to the testicular artery and assists in preserving lymphatic vessels, which reduces the risk of developing a postoperative hydrocele (fluid accumulation around the testicle).
  • Microsurgical varicocelectomy is typically an outpatient procedure, allowing patients to go home the same day.

Advantages of Microsurgical Varicocelectomy

  • Improved fertility potential: Studies show a significant improvement in fertility rates after surgery.
  • Reduced pain and complications: Smaller incisions and precise technique lead to less postoperative pain and fewer complications compared to traditional surgery.
  • Faster recovery: Most patients return to normal daily activities more quickly.
  • Suitable for various cases: Effective for a wide range of patients, including those with severe varicoceles.

Steps of the Procedure

  • 1 Anesthesia: General or local anesthesia is administered.
  • 2 Incision: A small incision is made in the groin to access the spermatic cord.
  • 3 Microsurgery: Using an operating microscope, the surgeon identifies and ligates the enlarged veins.
  • 4 Closure: The incision is closed with sutures.

Indications for Surgery

  • Infertility: Particularly in men with abnormal semen parameters due to varicocele.
  • Chronic testicular pain: Persistent discomfort not relieved by conservative measures.
  • Poor sperm quality: Surgery may improve sperm count, motility, and morphology.
  • Hormonal impact: Studies show varicocele may cause reduced testicular volume, impaired Leydig cell function, and decreased testosterone levels. Repair can prevent progressive testicular damage.
  • Improved pregnancy rates: Evidence suggests that varicocelectomy increases the likelihood of natural conception.

Preoperative Instructions

  1. Shower and shave the genital and abdominal area.
  2. Stop taking blood-thinning medications such as Aspirin, Warfarin, or Heparin (as directed by your doctor).
  3. Fast for at least 8 hours before surgery.
  4. Remove jewelry, watch, contact lenses, dentures, and other prosthetics before entering the operating room.
  5. Empty the bladder just before surgery.
  6. Inform your doctor or nurse if you smoke or use drugs; avoid smoking for at least 24 hours before surgery.

Postoperative Care

  1. Begin with liquids 6 hours after surgery; gradually resume a normal diet if tolerated.
  2. Take prescribed pain relievers and antibiotics as directed.
  3. Wear supportive, snug-fitting underwear.
  4. Mild swelling or firmness at the incision site is normal; apply cold compresses to reduce discomfort.
  5. Rest for 24 hours after surgery. Avoid heavy lifting for 2 weeks, and resume sports activities after about 4 weeks.
  6. Showering is allowed 48 hours after surgery; no dressing is needed afterward.
  7. Sexual activity may resume once the incision has healed and pain has resolved.
  8. Return for follow-up one week after surgery for wound assessment and suture removal.
  9. Contact your doctor immediately if you experience excessive bleeding, fever, or significant scrotal swelling.