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Surgery is the only way to treat varicoceles, but not all patients would benefit from surgery. Surgery may be recommended if:
- The affected testicle is small
- Fertility is or could be affected
- Varicocele is present in both testicles
- The sperm is not healthy (in older adolescents)
- Pain, marked swelling, or physical discomfort is present
If none of these criteria apply, surgery is not needed. Annual visits to the doctor are needed annually until sperm can be analysed.
The surgical procedure blocks the enlarged veins from draining blood from the testicle (Figure 1). This blockage redirects the blood flow to healthy veins. This can be done:
- Through a small cut in the groin with the use of a surgical microscope
- Though multiple small cuts made with laparoscopic instruments
During surgery, the doctor will try to protect nearby structures called lymphatic vessels. These tiny structures are usually invisible to the naked eye. They carry lymph, a clear, yellowish liquid that collects in all parts of the body. If they are injured, lymph cannot flow properly, and complications can develop. This surgery, called lymphatic-sparing varicocelectomy , can lower the chance of complications.
What are the most common complications after surgery?
- Collection of fluid in the scrotum around the testicle (hydrocele formation)
- Shrinking of the testicle (testicular hypotrophy)
- Reduced function of the testicle
Less often, a procedure called angiographic occlusion is used to treat varicocele. It collapses the twisted vein with a special substance. This method does not usually require you to be asleep (general anaesthesia) and is less invasive than laparoscopic surgery. However, it uses X-ray, so you are exposed to radiation.
The patient may be able to return to normal, nonstrenuous activities after 2 days. As long as they are not uncomfortable, they may return to more strenuous activity, such as exercising, after 2–4 weeks.
Pain from this surgery is usually mild but may continue for several days or weeks. the doctor may prescribe pain medication for a limited time after surgery. After that, the doctor may advise you to take over-the-counter medication like acetaminophen or ibuprofen. Wearing briefs or a jockstrap can also help by relieving pressure in the testicles.
It will take several months after surgery before improvements in sperm quality can be seen with a semen analysis. This is because it takes approximately 3 months for new sperm to develop.
Contact the doctor if you have questions or concerns.