Varicocelectomy is a surgery that removes swollen veins inside the scrotum, called varicoceles. There aren’t any medications that treat or get rid of varicoceles, so your doctor may recommend surgery to remove them.
What Are Varicoceles?
Varicoceles are veins in the scrotum, the pouch of skin where the testicles are held, that become swollen or enlarged. They're a fairly common problem, as it’s estimated that 10 to 15 out of every 100 men have a varicocele.
Varicoceles are similar to the varicose veins you might get in your legs in that the veins become swollen and twisted. Varicoceles are visible through your skin and carry sperm to the testicles. Since they are larger than they should be, these veins can cause blood to build up in your scrotum or even flow backward into the testicles.
In most cases, varicoceles don’t cause any problems or symptoms, but there can be complications, like:
- Pain in the scrotum
- Male infertility
- Reduced or impaired testosterone production
- A heavy feeling in the scrotum
Studies show that varicoceles can be the cause of infertility in about 40% of men who are trying to conceive their first child. That number goes up to about 80% when it comes to conceiving a second child.
If you’re experiencing infertility or pain due to varicoceles, your doctor may suggest a varicocelectomy procedure. This is a surgery to remove the varicoceles by cutting the veins and then closing off the ends.
Microsurgical varicocelectomy. In a microsurgical varicocelectomy, the surgeon uses a microscope to find the right veins. This process can easily identify the veins to be removed and distinguish them from those that need to be preserved.
Your surgeon will make a 1-centimeter incision above your scrotum. Next, they will tie up the small veins and remove the varicoceles. Typically, this procedure takes 2 to 3 hours, and you can go home the same day.
Laparoscopic surgery. Another option is laparoscopic surgery, which is a varicocelectomy procedure that uses a thin tube, called a laparoscope. This small, lighted tube allows the doctor to make just a few tiny incisions during the procedure.
Your surgeon will insert the tubes through your abdomen, where there are fewer veins to tie off. This kind of varicocelectomy surgery only takes 30 to 40 minutes. You can also go home the same day.
Recovering from Surgery
Since you can go home from a varicocelectomy procedure the same day, most men are able to return to jobs with little activity within days of surgery. It takes 2 to 3 weeks to make a full recovery.
Recovering at home. You may need help from someone at home to help you recover. It’s important that you follow your doctor’s instructions when it comes to taking medicines and caring for your incisions.
To help alleviate the pain after your surgery, apply an ice pack to your scrotum in 10-minute intervals for the first couple of days. This helps reduce the swelling, too.
Your doctor will also tell you to:
- Avoid having sex for the next week or two
- Avoid submerging your incision in water until it's fully healed
- Try not to do any heavy lifting or vigorous activity
- Try not to strain when using the bathroom, and take a stool softener if necessary
To make sure you’re healing properly, your urologist will schedule a follow-up appointment with you. In the case of infertility, your doctor will order a semen analysis 3 or 4 months after the varicocelectomy.
Risks and Complications
As with many surgeries, there are some possible risks and complications with varicocelectomy procedures.
While they are rare, serious complications include:
- Blood clots in your legs
- Injury or damage to your testicle
- Atrophy, or shrinking of your testicle
- Chronic pain
The procedure also carries with it the risks linked to using anesthesia.
While the purpose of varicocelectomy procedures is to remove the varicoceles, there's a chance they can come back. It’s estimated up to 15% of men will have their varicocele come back after surgery.
Research shows that about 60% of men see an improvement in the quality of their semen after this procedure, but varicocelectomy surgery isn’t guaranteed to cure male infertility.
When to call a doctor. If you have any of the following complications after your varicocelectomy, you should contact your doctor right away:
- Signs of infection near your incision
- A fever of more than 100.4℉
- Swelling or pain that doesn’t go away
- Pain or swelling in your legs
- Persistent nausea and vomiting