Varicocele surgery is recommended to correct enlarged veins in the testicle and improve problems such as infertility, pain, or changes in testicular development. It may be especially recommended when semen analysis shows abnormalities or when there are changes in testicular function or growth.
Several techniques can be used to treat a varicocele, including minimally invasive and endovascular procedures such as embolization and sclerotherapy. Surgical approaches using microscopes, cameras, or robotic systems may also be used.
After varicocele surgery, the urologist may recommend certain measures to support recovery and reduce discomfort. These may include resting, applying cold compresses during the first 24 hours, taking pain relievers, and using scrotal support or supportive underwear.
Types and how they are performed
The different types of varicocele surgery that may be used include:
1. Microsurgical varicocelectomy
Microsurgical varicocelectomy is currently considered the standard surgical technique for treating varicocele because it is associated with a lower risk of complications and recurrence, as well as better outcomes for semen quality.
This surgery is mainly recommended for men with infertility who have a palpable varicocele and abnormalities on semen analysis.
It may also be recommended for adolescents when a varicocele affects testicular growth or when changes in semen quality are already present. Other possible indications include persistent testicular pain that does not improve with treatment and, in some cases, varicocele associated with low testosterone levels.
How it is performed: a small incision is made in the lower groin area. Using a surgical microscope, the surgeon identifies and ties off the affected veins while preserving important structures such as the testicular artery and lymphatic vessels.
This technique helps reduce the risk of complications such as hydrocele, which is a buildup of fluid within the scrotum, while also lowering the risk of recurrence.
The surgery usually takes between 2 and 3 hours and, in most cases, is performed as an outpatient procedure, allowing the person to return home the same day.
This technique is not recommended for subclinical varicocele, meaning a varicocele that is detected only by ultrasound and cannot be felt during a physical examination, or when semen analysis results are normal.
2. Embolization
Embolization is a minimally invasive procedure used to treat varicocele by blocking abnormal blood flow within the affected veins.
This procedure is mainly performed in men with varicocele associated with infertility, an abnormal sperm count, or chronic testicular pain.
Embolization may be especially appropriate when a less invasive treatment is preferred or when a varicocele has returned after a previous procedure.
How it is performed: local anesthesia is administered and a small incision is made in the groin. A very thin catheter is then inserted through a vein in the groin or neck and, using X-ray imaging for guidance, advanced to the veins affected by the varicocele.
Once the catheter reaches the affected veins, small metal coils are placed or a substance is injected to block the vein and redirect blood flow to healthy veins.
The procedure usually takes about 1 hour and is performed on an outpatient basis, allowing the person to return home the same day.
Embolization is an effective option with a relatively quick recovery, although it may have a slightly higher recurrence rate and some rare risks related to catheter use or radiation exposure.
3. Sclerotherapy
Sclerotherapy is a minimally invasive procedure used to treat varicocele by injecting a substance into the affected veins to make them close.
This procedure is mainly performed in men with infertility and abnormalities on semen analysis, as well as in adolescents or young adults with delayed testicular development.
It may also be performed in men with chronic testicular pain that does not improve with pain relievers or when a less invasive alternative to conventional surgery is preferred.
How it is performed: a small catheter is inserted through a vein in the groin or neck and, using imaging for guidance, advanced to the veins affected by the varicocele.
A sclerosing solution is then injected, causing the affected veins to close and redirecting blood flow to healthy veins.
The procedure takes about 1 hour and is performed on an outpatient basis. Recovery is usually quick, and the person may be able to resume normal activities within a few days.
Sclerotherapy and embolization are often combined in a single procedure known as scleroembolization to treat varicocele.
In these cases, the specialist may use metal coils together with a sclerosing agent to completely close the affected veins.
4. Laparoscopic varicocelectomy
Laparoscopic varicocelectomy is a minimally invasive surgery used to treat varicocele.
This surgery is mainly recommended for male infertility associated with abnormal semen analysis results, when a varicocele is identified during the evaluation of an infertile couple, or when semen quality is reduced.
It may also be recommended for adolescents or young adults with delayed testicular development or signs of testicular atrophy, as well as for men with chronic testicular pain that does not improve with pain relievers.
In some cases, this technique can be especially useful for bilateral varicocele because both sides can be treated during the same procedure.
How it is performed: small incisions are made in the lower abdomen, and a camera and surgical instruments are inserted.
The surgeon identifies the affected veins and ties them off to redirect blood flow to healthy veins. The instruments are then removed and the incisions are closed.
This surgery is performed as an outpatient procedure under general anesthesia and, in most cases, the person can return home the same day.
The procedure usually takes between 30 and 40 minutes, making it a faster technique than some other types of varicocele surgery.
5. Open surgery
Open surgery is a procedure used to treat varicocele through an incision in the lower abdomen or just above the groin, providing access to the internal spermatic veins.
It is mainly recommended for male infertility associated with a palpable varicocele and abnormalities on semen analysis, as well as for adolescents with delayed testicular growth or differences in testicular size.
This surgery may also be recommended for men with persistent testicular pain or associated problems such as poor semen quality or low testosterone levels.
How it is performed: the surgeon makes an incision just above the groin or in the lower abdomen to access the internal spermatic vein and tie it off, interrupting abnormal blood flow.
This type of surgery is generally performed under general anesthesia and may be associated with a higher risk of hydrocele and recurrence compared with more modern techniques.
6. Robotic surgery
Robotic surgery is a modern technique for treating varicocele in which the surgeon uses a robotic system that provides three-dimensional visualization and greater precision, reducing hand tremor and improving control during the procedure.
This surgery is generally used for the same reasons as other varicocele procedures, including male infertility with abnormal semen analysis results, persistent testicular pain, or problems with testicular development in adolescents.
However, robotic surgery does not have specific indications that distinguish it from other techniques, and its use is more limited because of its complexity and high cost.
Although some studies have reported good outcomes, robotic surgery has not been shown to be superior to other techniques. Its use therefore remains limited because conclusive evidence of an additional benefit is lacking.
Recovery and care
After varicocele surgery, the doctor may recommend applying cold compresses to the affected area during the first 24 hours to help reduce swelling and inflammation.
The doctor may also prescribe pain relievers to control pain and recommend scrotal support or supportive underwear to provide support and reduce discomfort.
It is also important to rest and gradually return to normal activities according to recovery progress and the doctor's recommendations.
Possible complications
Although varicocele surgery is safe in most cases, some complications may occur:
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Hydrocele, which is a buildup of fluid around the testicle that can cause swelling or enlargement;
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Recurrence of the varicocele, meaning that it returns after treatment;
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Infection or bruising in the surgical area;
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Blood clotting problems, such as small blood clots;
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Injury to nearby structures, such as blood vessels, in rare cases;
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Testicular atrophy, which is a decrease in the size of the testicle;
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Chronic or persistent pain after surgery;
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Epididymitis, which is inflammation of the epididymis.
In some cases, when surgery is performed mainly to treat pain, the pain may not improve or may change in character.
The risk of complications varies depending on the type of procedure and how precisely it is performed. For this reason, treatment is selected individually for each case.