Varicocelectomy

Overview

Varicoceles are a common condition characterized by the enlargement of veins in the scrotum, which is the skin pouch located behind the penis and houses the testes (testicles). In individuals with varicoceles, the veins within the scrotum become larger than they should be. To address this issue, a surgical procedure known as varicocelectomy is employed. The primary objective of varicocelectomy is to restore normal blood flow to the reproductive organs.

Reasons for undergoing the procedure

Any age can experience varicocele. On the other hand, varicoceles are more frequently noticed during or soon after puberty.

For better odds of becoming pregnant, over half of men and people Assigned Male at Birth (AMAB) with male infertility opt for a varicocelectomy. If you have low testosterone production or severe testicular pain, your doctor might also suggest a varicocelectomy.

Fertility is increased by varicoceles removal. Almost 70% of women become pregnant following a varicocelectomy.

Risks

Surgical procedures come with inherent risks, and varicocelectomy is no exception. Some potential hazards associated with varicocelectomy include:

• Infection
• Bruising
• Swelling
• Scarring
• Mass of clotted blood (hematoma)
• Nausea or vomiting
• Anesthesia side effects
• Healing issue
• Tenderness in your testicles
• Testicular artery damage
• Hydrocele

In rare instances, the varicocele may reappear or your testicle may lose its function.

Before the procedure

When you consult with your doctor, they will inquire about your symptoms and conduct a physical examination of your testicles. During the examination, you may be requested to execute the Valsalva maneuver, which may entail either standing up, sitting down, or exerting pressure as if you were having a bowel movement. It’s important to note that varicoceles are often found predominantly in the left testicle , accounting for up to 90% of cases (known as unilateral varicocele), although bilateral varicoceles, affecting both testicles, are also possible.

To support their diagnosis, your doctor may recommend additional tests such as a blood test, semen analysis, and ultrasound. These tests provide valuable information and can offer a more comprehensive understanding of your testicular veins. Furthermore, a blood test and semen analysis can help determine whether the presence of a varicocele has an impact on your fertility.

When the varicocele diagnosis is confirmed, your doctor will assess the severity of the condition. Varicocele comes in four different grades:

• Grade 0. The smallest variety of varicocele is this one. During a physical examination, your doctor cannot see it; however, an ultrasound can reveal it. A subclinical varicocele is another term for a grade 0 varicocele.
• Grade I. The varicocele can only be felt by your doctor during the Valsalva maneuver.
• Grade II. There is a larger varicocele. It’s not apparent, but your doctor can feel it.
• Grade III. The biggest varicocele. It is readily visible to your doctor.

Your doctor will suggest one of the numerous varieties of varicocelectomy. Among the several kinds are:

Open surgery

Your doctor will make cuts to your skin and tissues during open surgery. This gives you a good perspective of the area that is impacted. Approaches to varicocelectomy by open surgery include:

• Inguinal ligation. Your healthcare provider will reach your varicocele via the inguinal canal. The inguinal canal is located in your groin, near the lower part of your abdomen.
• Subinguinal ligation. The varicocele will be accessed by your doctor from below your inguinal ligament (Poupart’s ligament), in your groin.
• Retroperitoneal high ligation. Your varicocele will be accessed by your doctor from behind your peritoneum. Your abdomen is lined with a translucent membrane called the peritoneum.

Minimally invasive surgery

Your doctor use less invasive surgical techniques to perform minimally invasive procedures, protecting your skin and surrounding tissues. Procedures for minimally invasive varicocelectomy consist of:

• Laparoscopic varicocelectomy. Your doctor will create multiple small incisions in your lower abdomen. Then, they will insert a laparoscope—a thin rod with a camera attached in order to view your varicocele on a computer screen. They work on your varicocele with tiny, accurate equipment.
• Microsurgical varicocelectomy. A few tiny incisions will be made by your doctor in a slightly elevated area of your groin. They next examine your varicocele under an operating microscope and perform surgery on it using small equipment.

Before the procedure

Before undergoing a varicocelectomy, your doctor will conduct a thorough assessment of your overall health, which includes measuring your vital signs such as blood pressure, pulse, and temperature.

It’s essential to provide your healthcare provider with a complete list of all medications you are taking, both over-the-counter (OTC) and prescription, as well as any herbal supplements. Some medications, including anti-inflammatory drugs, aspirin, and certain herbal supplements, can increase the risk of bleeding during surgery.

Additionally, make sure to disclose all allergies you may have, including allergies to foods, latex, medications, and skin cleansers like iodine or isopropyl alcohol, even if they may not appear to be directly related to the procedure.

Your doctor will provide you with specific instructions regarding when to stop eating and drinking before the surgery. It is crucial to follow these instructions diligently because having food or fluids in your stomach while under anesthesia poses a risk of vomiting, which could lead to pulmonary aspiration. Pulmonary aspiration can result in serious health complications, including hypoxia and pneumonia.

During the procedure

A varicocelectomy will be carried out by a group of medical professionals with expertise in reproductive system and urinary tract disorders. The group consists of a nurse, an anesthesiologist, and a urologist.

• General anesthetic will be used by your anesthesiologist to put you to sleep. Throughout the process, you won’t be conscious or experience any pain.
• Your urologist will access your varicocele by making incisions in your skin with a sharp, sterile knife (scalpel) once you are unconscious. After that, they’ll cut the veins and seal the ends. Blood flows into other healthy veins in your scrotum when the ends are sealed.
• Your urologist may insert tiny silicone tubes to drain fluid or blood in the afflicted area after treating your varicocele. The tubes will be sewn into position.
• Ultimately, the wounds will be sewn shut.

After the procedure

Your surgeon will place bandages over your stitches following a varicocelectomy. Additionally, the anesthesiologist will stop administering anesthesia to you.

You’ll proceed to a room for recovery. Doctors will watch your general health as they wait for you to wake up.

When you awaken, you can feel disoriented. You can have soreness in your abdomen or groin. When your doctors decide it’s safe, they will release you and allow you to return home. You can typically return home a few hours following your operation. But you have to have a friend or family member drive you home. During the first day or two following the procedure, you should have assistance from a friend or family member.

Outcome

It’s crucial to keep in mind that recuperation timeframes can differ because everybody is different. Generally, it takes three to four weeks for groin and scrotal swelling and bruises to go gone. Your groin may feel sore for a maximum of six weeks.

Some use Non-Steroidal Anti-inflammatory medicines (NSAIDs) available over-the-counter to treat pain, like aspirin, ibuprofen, or naproxen. Since not everyone is able to take NSAIDs, make sure to ask your doctor about other medications if necessary.

Antibiotics and other medications may be prescribed by your doctor. Follow the directions and take them.

Use an ice pack for up to ten minutes on the afflicted regions to aid with pain and swelling. This is something you may do several times a day.

Maintaining the cleanest possible hygiene in the afflicted regions will help your body mend and avoid infection as you recuperate. Before replacing your bandages, wash your hands with soap and water.

When you are healing, it is better to avoid taking a bath. Shower and gently clean the regions that are afflicted. Additionally, you ought to refrain from swimming.

Exercise that is too vigorous may push on your incisions. Don’t lift more than ten pounds for a minimum of two weeks.

Straining during bowel movements or dealing with constipation can exert pressure on your incisions. To alleviate this issue, consider enhancing your diet by incorporating more whole grains, fruits, vegetables, and other high-fiber foods. It’s also advisable to increase your water intake. Additionally, you can facilitate easier bowel movements by using magnesium hydroxide, commonly known as milk of magnesia, or opting for stool softeners.