What is a Varicocele?

A varicocele is an abnormal enlargement of the small veins in the scrotum that drain blood and waste products from the testicle. When functioning normally, these veins move blood in the testicles away from the scrotum and ultimately back to the heart.

When these veins do not drain well, the blood doesn’t move as it should and can begin to pool in the veins, causing them to become enlarged. Waste products do not get cleared efficiently, and the testicle becomes warmer. This can lead to reduced sperm production and quality, thus affecting fertility. In fact, varicocele is the most common identifiable cause of male infertility worldwide, being present in up to 40 percent of male patients with infertility. Varicoceles can also lower testosterone, and cause dull, achy pain.

Surgical Treatments for Varicocele Repair

If the varicocele is causing you pain or you are concerned about your fertility, your doctor may recommend one of the following surgical procedures:

• Varicocele embolization. A minimally invasive, image-guided procedure that uses a catheter to place a tiny coil into the blood vessel(s) that leads to the varicocele, which diverts the blood away from the abnormal veins.
• Varicocele Microsurgery. This is the gold standard for treatment and has lower complication rates than embolization. The procedure is done in the operating room under general anesthesia. A surgeon with advanced training in microsurgical varicocelectomy, makes a small incision in your groin through which the spermatic cord is identified and visualized through a microscope. Taking great care to avoid injury to the testicular artery, the enlarged veins are identified and permanently tied off to stop the poor blood flow. Blood can then flow around the abnormal veins to the normal ones, improving testicular function. Varicocele repair can improve pain, sperm counts, sperm motility (the ability of your sperm to move) and the quality of your sperm.

University Hospitals urologists, Nannan Thirumavalavan, MD and Aram Loeb, MD, both have advanced training in microsurgical techniques for varicocele repair, enabling them to perform this procedure with high success rates.

Recovering After a Varicocelectomy

The majority of men will go home on the same day. You will have stitches and skin glue on your incision(s). The stitches will dissolve on their own. Some discomfort and swelling around the incision is normal and should subside within one to two weeks. You will be sent home with an athletic supporter which should be worn until the swelling goes down.

Strenuous exercise (for example, climbing ladders, riding motorcycles or bicycles, playing tennis, lifting more than ten pounds, etc.) should be avoided for at least 2 weeks after your varicocelectomy. Engaging in these activities can increase your risk of complications.

You will have a follow-up appointment with your surgeon in two weeks to check how your wound is healing. Three months after varicocele microsurgery, you will have a sperm analysis done to check your sperm counts.