Varicoceles are enlarged veins in the scrotum which cause the testicle to appear larger. This condition causes pain and can also lead to male infertility. Therefore, it’s prudent to get treatment.1
Microsurgical varicocelectomy is one of two surgical approaches to treating varicoceles. Unlike open laparoscopy this surgery involves using a smaller incision and an operating microscope, which decreases risks of complications and improves recovery time.
Why Microsurgical Varicocelectomy
Microsurgical varicocelectomy is the procedure of choice over open laparoscopy for most patients and urologists attempting to correct the blood flow in the veins surrounding the testes.2
This is mainly because this form of varicocelectomy is a bit less invasive and offers fewer complications than open surgery. Additionally, a patient requires significantly less post-surgical pain medication and recovery time.3
Types of Microsurgical Varicocelectomy
Depending on the varicocele a patient presents with, surgeons can opt for either inguinal or sub-inguinal microsurgical varicocelectomy procedures.
Here is what each procedure entails:
A. Inguinal Microsurgical Varicocelectomy
This surgery involves making an incision of 3 – 5 cm along the right or left groin, about the length of a lime. This allows the surgeon to access the spermatic cord, which contains the nerves, arteries and veins that support the testicle. Once the cord is identified it is pulled outside the body through the abdominal muscle.4 The surgeon can then start dissecting apart the structures within the cord to identify and separate the abnormal veins. The abnormal veins are either burned or closed using sutures or clips. Missed veins can cause a recurrence.
B. Sub-inguinal Microsurgical Varicocelectomy
Sub-inguinal approach is a lower incision than the inguinal approach, ie closer to the scrotum. This surgical approach takes a longer time to perform because the incision is made in the groin area where the spermatic vein has already branched into several vessels. This technique allows the surgeon more opportunity to identify various vessels and lymphatic channels.4
The process otherwise is the same. The vein has to be safely dissected apart from the other important structures. The enlarged veins are then cut and sealed off, allowing the testicular circulation to drain out more efficiently. Missed veins can cause a recurrence.
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Risks of Microsurgical Varicocelectomy
Compared to laparoscopic surgery, microsurgical varicocelectomy has a lower rate of complication and recurrence, but it is still invasive surgery with potential complications.5
Surgical complications can occur, and they include:6
- Injury to the lymphatic vessels. This will cause development of a hydrocele, which is fluid build-up within the scrotum. This can cause one testicle to be larger than the other. Treatment is either surgery or sclerotherapy. (Read more here)
- Injury to the testicular artery. If the blood flow to the testicle is disrupted, this would cause the testicle to decrease in size and affect its function causing infertility or hormone loss.
- Recurrence. If an abnormal vein is left behind there will be recurrence of symptoms. This will require repeat surgery.
- Injury to testicular nerve. This will cause numbness of the scrotum.
Best Candidate for Microsurgical Varicocelectomy
Microsurgical varicocelectomy is ideal for infertile men with visible or palpable varicoceles during a physical examination of the scrotum.7
It is also a viable solution if a couple is trying to conceive but has infertility issues. However, this varicocelectomy approach only applies if the female partner is fertile or has a treatable infertility condition.8
The procedure is also indicated for men with pain, testicular atrophy or abnormal semen profiles.
Microsurgical Varicocelectomy Recovery
Due to the incision there will be some pain at the suture site. Patients recovering from inguinal microsurgical varicocelectomy might feel more pain since the incisions involve the abdominal muscles, requiring narcotic pain relievers.9
Complete recovery is expected by two weeks. Typical time to return to work and light activities is 2 days. However, work should be as light and non-strenuous as possible to allow the incisions to heal. Recovering patients shouldn’t engage in sexual intercourse for at least one to two weeks.
Microsurgical Varicocelectomy Results
This surgery has a success rate of 80% in improving fertility demonstrated by improved sperm count and sperm function.10 There is a similar rate of success in improving pain symptoms.
Surgery vs Non-Surgical Varicocele Embolization
Microsurgical varicocelectomy is still surgery involving anesthesia, with risks of bleeding, injury and infection. Because of its invasive nature, varicocelectomy may compromise the blood and lymphatic flow if there is a complication during surgery. Is non-surgical embolization treatment a better option? Non-surgical embolization does not require creating a surgical opening in your groin or dissection of the spermatic cord, as such there is no risk to the testicular artery or lymphatics. There are no major incisions or sutures. Lastly, varicocele embolization has a 90% success rate.
What is Varicocele Embolization?
Varicocele can be treated by an embolization procedure or surgery. Embolization is a non-surgical, outpatient, minimally invasive technique that uses x-ray guidance to place tiny coils and embolic fluid in the abnormal blood vessels causing them to close down.
Am I a candidate for Varicocele Embolization?
Treatment is offered for males who have:
- Fertility problems (problems fathering a child)
- Boys with a smaller testicle; at a higher risk for fertility problems when they are older
How Is Non-Surgical Embolization Performed?
- You will receive twilight sedation to help you relax
- Our specialist numbs the skin on the neck or upper thigh
- A tiny tube called a sheath is placed through a pinhole incision
- Foam and small coil plugs are placed into the abnormal vein
- The tube is removed
- Band-Aid is applied
Contact Us Today
Request a consultation to meet with our varicocele specialist who will review your imaging, labs and history to determine if you are candidate for the procedure, and the outcomes you can expect. Each person is an individual and should discuss the potential risks and benefits of embolization and other treatments with our doctor to decide which option is best.
Consultations are available via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego. Why should you choose us? Read here
1.) Cho, K. S., & Seo, J. T. (2014). Effect of varicocelectomy on male infertility. Korean journal of urology, 55(11), 703.
2.) Mehta, A., & Goldstein, M. (2013). Microsurgical varicocelectomy: a review. Asian Journal of Andrology, 15(1), 56.
3.) Pajovic, B., Radojevic, N., Dimitrovski, A., Radovic, M., Rolovic, R., & Vukovic, M. (2015). Advantages of microsurgical varicocelectomy over conventional techniques. Eur Rev Med Pharmacol Sci, 19(4), 532-8.
4.) Binsaleh, S., & Lo, K. C. (2007). Varicocelectomy: microsurgical inguinal varicocelectomy is the treatment of choice. Canadian Urological Association Journal, 1(3), 277.
5.) Wang, J., Xia, S. J., Liu, Z. H., Tao, L., Ge, J. F., Xu, C. M., & Qiu, J. X. (2015). Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis. Asian journal of andrology, 17(1), 74.
6.) Tatem, A. J., & Brannigan, R. E. (2017). The role of microsurgical varicocelectomy in treating male infertility. Translational andrology and urology, 6(4), 722.
7.) Lomboy, J. R., & Coward, R. M. (2016, September). Men’s Health: The Varicocele: Clinical Presentation, Evaluation, and Surgical Management. In Seminars in interventional radiology (Vol. 33, No. 3, p. 163). Thieme Medical Publishers.
8.) Chiba, K., Ramasamy, R., Lamb, D. J., & Lipshultz, L. I. (2016). The varicocele: diagnostic dilemmas, therapeutic challenges and future perspectives. Asian journal of andrology, 18(2), 276.
9.) Pan, F., Pan, L., Zhang, A., Liu, Y., Zhang, F., & Dai, Y. (2013). Comparison of two approaches in microsurgical varicocelectomy in Chinese infertile males. Urologia internationalis, 90(4), 443-448.
10.) Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril2007;88:639-48. 10.1016/j.fertnstert.2006.12.008
The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor but can act as a starting point for such a discussion.