A varicocele occurs when there's a swelling in the vein that runs along the structural tube that supports the testicles, called the spermatic cord. Many men with a varicocele have no symptoms, and the condition does not always require treatment. But when repair is needed, surgery is the primary approach to relieve symptoms and prevent other complications, such as infertility and shrinkage of the affected testicle(s).
Deciding on Varicocele Repair
Left untreated, a varicocele can sometimes cause infertility and the atrophy of one or both testicles.
Surgical repair of a varicocele carries certain risks, however, so surgery may not always be the right choice. A urologist will weigh the following factors when deciding whether a patient should consider a repair:
- Presence of severe pain or discomfort in the testicle(s)
- One testicle smaller than the other, or both smaller than expected
- Unexplained infertility
If a varicocele is repaired during adolescence, the affected testicle(s) may grow to normal size. In adulthood, however, repairing a varicocele will not reverse atrophy. Then a urologist will use other factors in deciding whether to repair the varicocele in adults, such as the level of discomfort and infertility.
In some cases, the physician will suggest watching and waiting to see if there are signs of additional discomfort, changes in the health of the sperm, or shrinkage of the testicle(s). Wearing a jock strap or snug underwear can sometimes relieve some of the discomfort caused by a varicocele.
Surgery to Repair a Varicocele
Surgery to repair a varicocele (varicocelectomy) is an outpatient procedure and allows the patient to return home the same day. It is done under general or local anesthesia.
This surgery can be done in a few different ways, which are named by the incision's location:
- groin or "inguinal"
- below the groin or "subinguinal"
- in the belly or "abdominal"
The inguinal and subinguinal approaches—both of which are open surgeries—are the most common. Abdominal surgery can either be performed with open surgery, which requires a large cut stretching from just below the belly button to the groin, or with smaller incisions and the use of special tubes to access the area (laparoscopy).
In all three procedures, the urologist makes an incision so as to access the vein around the spermatic cord. At this point, the abnormal vein is cut and tied off so blood no longer flows through it. (Instead, the blood will pass through other, healthy veins.)
Risks of Varicocele Surgery
The risks of surgery to repair a varicocele include:
- infection around the cut
- collection of fluid around the testicles (hydrocele)
- return of the varicocele
- atrophy of the testicle
- formation of a blood clot
- injury to the scrotum or nearby blood vessels
Varicocele embolization, another procedure to treat varicocele, blocks the vein around the spermatic cord to prevent blood flow. During this procedure, a catheter is inserted into the femoral vein (a large blood vessel located in the groin) and guided to the varicocele using X-rays. The catheter is then used to guide a coil and/or other substance (such as embolic fluid) into the varicocele to block blood flow through the spermatic cord vein. This diverts blood to the other healthy veins.
While this is the least invasive method of repairing a varicocele, it is also less successful than open surgery or laparoscopy because the coil can move out of place and cause the varicocele to recur. This procedure also carries the same risks as surgery, as well as several others, including:
- allergic reaction to contrast dyes used to help see the varicocele on X-ray
- injury to the artery
- movement of the coil out of place
- swelling of the vein due to a blood clot
Recovery and Follow Up
Recovery time depends upon the procedure used. In general, patients should be able to return to their normal activities within two days and engage in more strenuous activities (like running or weightlifting) after two weeks. Patients should be able to have sex again after a week.
An ice pack can be applied to the scrotum and site of the incision to reduce swelling. Wearing a jock strap or snug underwear can also reduce scrotal discomfort, as can pain medications, such as acetaminophen or ibuprofen.
After varicocele repair, follow up visits will be scheduled for seven to 10 days after surgery, and again after eight weeks. (A doctor should be contacted if the area around the cut becomes very swollen, red, warm or painful, or if the amount of fluid leaking from it increases. Severe bruising and throbbing pain could also indicate bleeding that requires medical attention.) For men trying to conceive children or who had a varicocele repaired due to infertility, the patient's semen will be checked for quality after three or four months. Up to 70 percent of patients have improved quality (e.g sperm count and consistency) after varicocele repair.
Barthold JS. (2011). Abnormalities of the testis and scrotum and their surgical management. Campbell-Walsh Urology, 10th. ed.