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About the Procedure

A varicocele is a disorder in which veins inside the scrotum become abnormally swollen. A varicocelectomy is a procedure used to cure varicocele. When the enlargement of the veins causes chronic pain or male infertility, surgery is usually undertaken. Although successful in reducing testicular pain, the effectiveness of varicocele surgery in restoring male fertility is still up for dispute.

Why is the procedure conducted?

There are no signs and symptoms exhibited by a varicocele. It can cause pain but this occurs very rarely. The pain can:  

• Be sharp  
• Increases with physical activity or standing for a long time  
• Be relieved when the patient lies on their back   

As time passes, varicocele tends to enlarge and becomes noticeable. It can also be described as visually resembling a bag of worms and causes a swollen testicle on the left side.  

Patients who have pain and swelling in the scrotum that does not heal on their own require medical attention. Most varicoceles do not require treatment. 

Preparing for Surgery

Before the surgery

If the patient is using any drugs or supplements, it is important for them to inform the doctor of the same. To reduce the risk of bleeding during surgery, patients will most likely be asked to stop taking any blood thinners like warfarin (Coumadin) or aspirin. Fasting will most probably be required based on the doctor's directions and will likely involve fasting 8-12 hours prior to the procedure. The patient should ideally make arrangements for someone to drive them to and back from the surgery. 

During the surgery

The procedure can be conducted in any one of the following ways: 

1.  Open surgery - Local or general anaesthesia is given to patients as required. The problematic vein is accessed through the groin or an incision is made in the abdomen to access the same. A surgical microscope is used to view the area being treated during surgery. A Doppler ultrasound can also be used to guide through the procedure. An open surgery usually has higher success rates for a varicocele when compared with other methods. The surgeon will seal and suture the wound once the blood flow has been adequately diverted.

2.  Laparoscopic surgery – This procedure requires general anaesthesia. An incision is made in the abdomen and a catheter is inserted to view and repair the varicocele. The abdomen is inflated with carbon dioxide to provide better access. The abnormal veins are exposed and ligated. It is then stitched with tissue glue. 

3.  Percutaneous embolization – A tube is inserted into the groin and an internal view of the groin is monitored on a screen. The doctor then releases a solution that forms scars to block the testicular veins in question. This solution helps to interrupt the flow of blood and thus repairs the varicocele. It is not a commonly used procedure. 

After the surgery

The patient will be taken to a recovery room after the surgery. They will likely be kept here until they are completely awake and meanwhile all their vital signs will be monitored to check for complications. Nausea, grogginess, and weariness are common side effects. Pain in and around the incision site is also possible. Once the patient is steady enough to walk, they can return home.   

At home, it is required to stay as still as possible for the first 24 hours. A cold compress can be used to relieve local pain and swelling. Avoid getting the wound moist, and change the dressing regularly as directed by the doctor. When showering, avoid soaking the wound. Check for signs of infection after changing the bandage, and contact your doctor right away if any symptoms are visible. 

Benefits

By restoring blood flow to the scrotum, this surgery can help patients become more fertile by increasing sperm and testosterone production. A semen analysis will be performed by the doctor to see how much one's fertility has improved as a result. Varicocelectomy frequently improves semen analysis results by 60–80 per cent. 

Risks or Complications

The risks involved with varicocele are:  

·    Fluid accumulation around the testicles (hydrocele)  

·    Reappearance of varicocele

·    Infection  

·    Damaged artery 

The possible complications that can arise due to a varicocele are:  

·    Atrophy – Atrophy is a shrinkage of the affected testicle. Tubules that produce sperm make up the majority of the testicle. The testicle shrinks and softens when it is damaged. It's unclear what causes the testicle to shrink. Also, faulty valves can allow blood to pool in the veins, increasing pressure and exposing the testicle to toxins in the blood, which can cause a testicular injury.  

·    Infertility – Varicoceles may cause an increase in the temperature in or around the testicle, impacting sperm production, motility, and function. 

Conclusion

Varicocelectomy is a relatively safe treatment that has a good probability of enhancing fertility and minimizing the risks of obstructed blood supply to the reproductive organs. There are risks associated with this operation as is the case with any medical procedure. The patient must consult a doctor to determine whether this procedure is essential for them and whether it will affect the sperm count or quality.