Varicocelectomy

What is a varicocelectomy?

A varicocelectomy (vair-ick-oh-seel-eck-toh-mee) is a surgical procedure that repairs varicoceles.

Varicoceles (vair-ick-oh-seels) are a common disorder of the veins inside your scrotum. The scrotum is the pouch of skin behind the penis. It typically contains the testes (testicles). If you have varicoceles, the veins inside your scrotum are larger than they should be.

Who is a good candidate for a varicocelectomy?

Varicoceles affect about 1 in 5 men and people assigned male at birth (AMAB) in the United States. They can happen at any age. However, it’s more common for people to notice a varicocele during or shortly after puberty.

Almost half of men and people AMAB who have male infertility choose to get a varicocelectomy to improve their chances of achieving pregnancy. Your healthcare provider may also recommend a varicocelectomy if you have a lot of testicular pain or decreased testosterone production.

Does removing varicoceles improve fertility?

Yes, removing varicoceles improves fertility. Pregnancy rates may increase to nearly 70% after a varicocelectomy.

How common are varicocelectomies?

Varicocelectomies are very common. They’re the most common procedure for treating male infertility.

How painful is a varicocelectomy?

A varicocelectomy is moderately painful. The pain should start to improve after several days. You can manage your pain with over-the-counter pain relievers. Your healthcare provider may prescribe pain relievers for severe pain.

What happens if a varicocele is left untreated?

A varicocele won’t go away on its own. It may get larger or more noticeable. Varicoceles may cause male infertility. They can also cause your testicles to shrink (testicular atrophy).

How will my healthcare provider diagnose a varicocele?

Your healthcare provider will ask you about your symptoms. They’ll also perform a physical examination of your testicles. They may ask you to stand up, sit down or bear down like you’re pooping (Valsalva maneuver). Up to 90% of varicoceles are only in the left testicle (unilateral varicocele). However, varicoceles may occur in the left and right testicles (bilateral varicoceles).

Your healthcare provider may order an ultrasound, semen analysis and blood test. These help confirm their diagnosis. An ultrasound offers a more detailed view of the veins in your testicles. A semen analysis and a blood test can help determine whether a varicocele affects your fertility.

After confirming their varicocele diagnosis, your healthcare provider will determine its severity. There are four different grades of varicocele:

• Grade 0. This is the smallest type of varicocele. Your healthcare provider can’t detect it during a physical exam, but they can see it on an ultrasound. Another name for a grade 0 varicocele is a subclinical varicocele.
• Grade I. Your healthcare provider can only feel the varicocele when you perform the Valsalva maneuver.
• Grade II. The varicocele is bigger. Your healthcare provider can feel it, but it’s not visible.
• Grade III. The largest varicocele. Your healthcare provider can clearly see it.

Your healthcare provider will recommend one of many different types of varicocelectomy. The different types include:

Open surgery

During open surgery, your healthcare provider will cut your skin and tissues. This provides a clear view of your affected area. Open surgery varicocelectomy approaches include:

• Inguinal ligation. Your healthcare provider will access your varicocele through your inguinal canal. Your inguinal canal is in your groin, near the lowest part of your stomach (abdomen).
• Subinguinal ligation. Your healthcare provider will access your varicocele from your groin, below your inguinal ligament (Poupart’s ligament).
• Retroperitoneal high ligation. Your healthcare provider will access your varicocele from behind your peritoneum. Your peritoneum (pare-uh-tuh-nee-um) is a transparent, watery membrane that lines your abdomen.

Minimally invasive surgery

During minimally invasive surgery, your healthcare provider uses techniques that are less damaging to your skin and tissues. Minimally invasive varicocelectomy procedures include:

• Laparoscopic varicocelectomy. Your healthcare provider will make several tiny cuts (incisions) in your lower abdomen. Then, they’ll insert a laparoscope (a thin rod with a camera attached to it) into the incisions to help them see your varicocele on a computer screen. They use small, precise instruments to operate on your varicocele.
• Microsurgical varicocelectomy. Your healthcare provider will make several tiny incisions in a slightly higher area of your groin. They then use a powerful operating microscope to look at your varicocele and tiny instruments to operate on your varicocele.

What happens before a varicocelectomy?

Before a varicocelectomy, your healthcare provider will evaluate your general health and take your vitals (temperature, pulse and blood pressure).

Tell them about any prescription or over-the-counter (OTC) medications you’re taking, including herbal supplements. Aspirin, anti-inflammatory drugs and certain herbal supplements can increase your risk of bleeding.

Detail your allergies to your provider as well. Include every allergy, even if it seems unrelated to the procedure, such as medications, skin cleaners like iodine or isopropyl alcohol, latex and foods.

Your healthcare provider will give you specific directions on when to eat and drink before the procedure. It’s important to follow these directions. If you have fluids or food in your stomach, there’s a chance you could vomit (throw up) while under anesthesia. If you throw up, you may inhale food or fluid into your lungs (pulmonary aspiration). Pulmonary aspiration can cause serious conditions, including pneumonia and asphyxiation.

What happens during a varicocelectomy?

A team of healthcare providers who specialize in urinary tract conditions and reproductive system conditions will perform a varicocelectomy. The team includes:

• A urologist.
• An anesthesiologist.
• Nurses.

Your anesthesiologist will sedate you (put you under) with general anesthesia. You won’t be awake and won’t feel any pain during the procedure.

Once you’re asleep, your urologist will use a sharp, sterile knife (scalpel) to make incisions in your skin and access your varicocele. They’ll then cut the veins and seal off the ends. Sealing the ends causes blood to flow into other healthy veins in your scrotum.

Once your urologist has treated the varicocele, they may place small silicone tubes in your affected area to drain blood or fluid. They’ll stitch the tubes into place.

Finally, they’ll stitch the incisions closed.

How long does a varicocelectomy take?

The length of a varicocelectomy depends on the type of technique that your healthcare provider uses.

Microsurgical varicocelectomy may take between one and three hours.

Laparoscopic varicocelectomy usually takes 30 to 40 minutes.

A bilateral laparoscopic varicocelectomy or a bilateral microsurgical varicocelectomy will take twice as long.

What happens after a varicocelectomy?

After a varicocelectomy, a healthcare provider will cover your stitches with bandages. The anesthesiologist will also stop putting anesthesia into your body.

You’ll move to a recovery room. Healthcare providers will wait for you to wake up and monitor your overall health.

Once you wake up, you may feel dazed. Your groin or abdominal area may feel sore. Once your healthcare providers determine that it’s safe, they’ll discharge you (let you go home). In most cases, you can go home a few hours after your procedure. However, you must have a family member or friend drive you home. A friend or family member should also help take care of you for the first day or two after the procedure.

What are the advantages of a varicocelectomy?

Advantages of a varicocelectomy:

• Varicocelectomy surgery is a relatively safe procedure. There’s a low risk of complications or side effects.
• Your fertility may increase as a result of increased sperm and testosterone production.
• Testicular pain will decrease.
• Increased self-esteem. Varicoceles often look or feel like a bag of worms or spaghetti. The procedure will improve the appearance and feel of your scrotum.

What are the risks of a varicocelectomy?

All surgical procedures carry some risks. Some risks of a varicocelectomy 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 lose its ability to function or the varicocele may come back.

What is the recovery time?

It’s important to remember that your body is unique, so recovery times may vary. In general, swelling and bruising in your groin and scrotum should go away in three to four weeks. You may have tenderness in your groin for up to six weeks.

To manage pain, some people take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Bayer®), ibuprofen (Advil®) or naproxen (Aleve®). Not everyone can take NSAIDs, so be sure to ask your healthcare provider for other medications, if needed.

Your healthcare provider may prescribe antibiotics or other medications. Take them as directed.

To help reduce pain and swelling, apply an ice pack to your affected areas for up to 10 minutes. You may do this repeatedly throughout the day.

To help your body heal as you recover, keep your affected areas as clean as possible to prevent infection. Wash your hands with soap and water before changing your bandages.

It’s best to avoid taking a bath as you heal. Take showers and clean your affected areas gently. You should also avoid swimming.

Strenuous exercise can put pressure on your incisions. Avoid lifting anything over 10 pounds for at least two weeks.

Constipation and straining while having a bowel movement (pooping) can also put pressure on your incisions. Add fruits, vegetables, whole grains and other high-fiber foods to your diet. It’s also a good idea to drink more water. You can also take stool softeners or magnesium hydroxide (milk of magnesia) to make pooping easier.

Can I masturbate after a varicocelectomy?

Masturbation and sex can put pressure on your incisions. Avoid masturbating and having sex for at least one week after your varicocelectomy.

When can I go back to school or work?

Most people can go back to school or work within three days.

When should I see my healthcare provider?

Schedule a follow-up with your healthcare provider. They’ll want to check your incisions. If you have drainage tubes, they’ll remove those.

Call your healthcare provider right away if you have any complications after a varicocelectomy. These may include:

• Heavy bleeding at your incision sites.
• A fever of 100 degrees F (38 degrees C) or higher.
• Infection.
• Increased pain.

A note from Cleveland Clinic

A varicocelectomy treats a varicocele. It can reduce pain, improve your quality of life and improve fertility. Surgery can be scary, but a varicocelectomy is a relatively safe procedure. The results are usually permanent. Talk to your healthcare provider about your questions and concerns. They can go into greater detail about the outcomes and risks.