Varicocelectomy

A varicocelectomy is surgery to repair swollen veins in your scrotum.

Swollen scrotal veins (varicoceles) may cause testicular pain and male infertility. Medications can’t treat or get rid of the swelling. But your healthcare provider may recommend a varicocelectomy (pronounced “var-i-koh-si-LEK-tuh-mee”) if varicoceles cause problems.

Varicocelectomies are very common. This is the most common procedure for treating male infertility.

Who is a good candidate?

Varicoceles affect between 15 and 20 out of every 100 males in the U.S. Many males choose to get a varicocelectomy to improve their chances of having a biological baby. Your provider may also recommend the procedure if swollen scrotal veins cause a lot of pain or low testosterone.

What are the benefits and risks?

Varicocelectomy benefits include:

• It’s a relatively safe procedure with a low risk of complications or side effects.
• Your fertility may increase because of increased sperm and testosterone production.
• Testicular pain will go away.
• Over time, the veins may shrink. This may boost your self-esteem.

All surgeries carry risks. Some varicocelectomy risks include:

• Anesthesia risks
• Healing problems
• Infection
• Mass of clotted blood (hematoma)
• Swelling
• Bruising
• Scarring
• Tenderness in your testicles
• Hydrocele
• Injury to a testicular artery

In rare cases, your testicle may no longer work or your varicocele may come back (recur).

How successful is it?

The varicocelectomy success rate is good:

• About 8 out of 10 people have less pain.
• Many also have a higher sperm count in follow-up semen analyses. About 3 out of 10 can get their partner pregnant.

What are the different types of varicocelectomy?

The different types of varicocelectomy include:

• Open surgery
• Minimally invasive surgery

Open surgery

During open surgery, your surgeon cuts your skin and tissues. This gives them a clear view of the affected area. Open varicocelectomy approaches include:

• Inguinal ligation: The surgeon accesses the varicocele through your inguinal canal. Your inguinal canal is in your groin, near the lowest part of your abdomen.
• Retroperitoneal high ligation: The surgeon accesses the varicocele from behind your peritoneum.

Minimally invasive surgery

Minimally invasive surgery is less damaging than open surgery. Minimally invasive approaches to varicocelectomy include:

• Microsurgical varicocelectomy: The surgeon makes a few tiny incisions in a slightly higher area of your groin. Then, they use a powerful operating microscope to look at the varicocele. They use tiny instruments to operate. This is the gold standard approach and the most common.
• Laparoscopic varicocelectomy: The surgeon makes a few tiny cuts (incisions) in your lower abdomen. Then, they insert a thin rod with a camera attached to it (laparoscope) into the incisions. This helps them see the varicocele on a computer screen. They insert small, precise instruments into other incisions to operate. This approach isn’t common because varicoceles have a high chance of coming back and there’s a higher risk of injury.

How should I prepare?

Before a varicocelectomy, you’ll meet with your care team. They’ll:

• Discuss what type of varicocelectomy is best for you
• Check your general health
• Take your vitals, including your temperature, pulse and blood pressure
• Ask about any medications you’re taking that may increase your risk of bleeding
• Ask about any allergies you have

A member of your care team will also give you directions on eating and drinking. You shouldn’t eat or drink anything after midnight the night before your surgery. If you must take medications, you should take them with a small sip of water.

Who makes up my care team?

Your varicocelectomy care team usually includes:

• A urologist
• An anesthesiologist
• Nurses and surgical techs

What is done in a varicocelectomy?

Your anesthesiologist will give you general anesthesia. You won’t be awake, won’t move and won’t feel any pain during the procedure.

Once you’re under anesthesia, your urologist will:

1. Make incisions in your abdomen or groin to access the varicocele
2. Cut the veins and seal off the ends, which causes blood to flow into other healthy veins in your scrotum
3. Stitch the incisions closed

How long does it take?

It depends on the technique your surgeon uses:

• Open varicocelectomy usually takes at least one hour.
• Microsurgical varicocelectomy usually takes between one and three hours.
• Laparoscopic varicocelectomy usually takes 30 to 40 minutes.

Sometimes, varicoceles affect both testicles (bilateral varicoceles). In that case, the procedure takes twice as long.

What happens after?

After a varicocelectomy, healthcare providers will:

• Move you to a recovery room
• Monitor your overall health
• Treat your pain
• Give you recovery instructions

Anesthesia makes some people feel like they may throw up after surgery. If you have nausea, providers will give you medication to treat it. They may also prescribe:

• Pain medications
• Stool softeners
• Antibiotics
• Blood thinners

Once you’re stable, you can go home. In most cases, you can go home a few hours after the procedure. You must have a family member or friend drive you home. Consider arranging for someone to help take care of you the first day or two after the procedure.

What is the recovery time?

Your body is unique, and recovery times may vary from person to person. But in general, bruising in your groin and scrotum should go away in three to four weeks. Swelling may last between six and eight weeks. You may have tenderness in your groin for up to six weeks.

As you recover, it’s a good idea to:

• Take NSAIDs to manage pain. Not everyone can take NSAIDs, so be sure to check with your healthcare provider first.
• Take any prescription antibiotics or other medications as your provider tells you to.
• Apply an ice pack wrapped in a towel over the affected areas for up to 10 minutes. You may do this repeatedly throughout the day.
• Keep the affected areas as clean as possible. Wash your hands with clean water and soap before changing your bandages.
• Avoid baths and swimming. Gently clean the affected areas in the shower.
• Avoid strenuous activities, which can put pressure on your incisions. Avoid lifting anything over 10 pounds for at least two weeks.
• Drink extra water and eat extra fruits, veggies and other high-fiber foods. This helps prevent constipation, which may cause you to strain when you poop. Stool softeners and milk of magnesia can also help.

Can I have sex after a varicocelectomy?

You should avoid sexual intercourse and masturbation for at least one week. Sexual activity puts pressure on your stitches, which can interfere with healing.

When can I go back to work/school?

Most people can go back to work or school within a few days after a varicocelectomy. Your healthcare provider will give you a better idea of what to expect.

When should I call my healthcare provider?

Schedule follow-up appointments as your care team advises. These visits may be with your urologist or another member of your care team. Providers will check your incisions. You may also need to schedule a follow-up visit for a semen analysis.

Call your provider if you have any complications after your varicocelectomy. These may include:

• Heavy bleeding at your incision sites
• Discolored drainage from your incisions
• Signs of infection, including a fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher, chills or a headache
• Bad odor around the surgical site
• Skin separation at your stitches
• Increased pain