Microsurgical Varicocelectomy

A varicocelectomy procedure is the surgical removal of swollen veins in the scrotum called varicoceles. Varicoceles are more common on the left side, but they usually have no signs or symptoms. Occasionally a varicocele may cause pain (although it’s rare), which may:

• Switch from sharp pain to a dull discomfort
• Increase when you stand or physically exert yourself
• Worsen over the course of a day
• Get better when you lie down

How Common Are Varicoceles?

Approximately 15% of males in the general population have varicoceles, while it’s extremely rare in pre-pubescent boys. The percentage jumps to 35% in men with primary infertility, and 75-80% in men with secondary infertility.

Primary infertility refers to couples who have been able to get pregnant after a year of trying (having sex without birth control). Secondary infertility refers to couples who have had at least one pregnancy but are now unable to become pregnant. Varicocele and infertility commonly occur together.

What Causes Varicoceles?

Varicocelectomy doctors aren’t entirely sure what causes varicoceles to develop. They may be caused by a problem with blood flow in the cord that carries blood to and from the testicles (the spermatic cord).

It’s also possible that, much like varicose veins in the legs, the valves of the veins in the testicles don’t function properly. This can cause the blood to back up, leading to enlarged veins.

How Are Varicoceles Diagnosed?

Doctors will first perform a physical exam to detect a varicocele. Your doctor may be able to easily feel the mass. If not, he or she will likely perform the Valsalva maneuver, during which you will stand up, take a deep breath, and bear down, which helps the doctor feel any enlarged veins.

If a physical exam isn’t enough or is inconclusive, your doctor may order an ultrasound of your scrotum, which uses sound waves to create images of your internal organs and tissues.

Microsurgical Varicocelectomy: A Safe and Effective Varicocele Treatment

There are no medications to treat varicoceles. In cases where varicoceles cause pain or infertility, surgery is required to remove them.

The expert varicocele surgeons at Weill Cornell Medicine recommend microsurgical varicocelectomy to repair varicoceles. The procedure involves using a microscope to the surgically repair the enlarged veins through tiny incisions (one inch or less).

The Microsurgery Advantage: The blood vessels going to and from the testicles are very small. Using a microscope during varicocelectomy procedure helps the surgeon find the veins that need to be removed while preserving the tiny arteries that bring blood to the testicles.

Magnification also helps the surgeon identify and preserve the vessels that drain fluid around the testicles (called lymphocytes). This is important for preventing swelling due to fluid build-up (hydrocele) around the testicles after surgery.

Microsurgical varicocelectomy is usually done as an outpatient procedure, which means you go home the same day.

Why Treat Varicoceles?

Varicoceles don’t usually cause pain, and most men with varicoceles are able to father children. So, why treat them at all? There are several reasons:

• There is abundant evidence that varicoceles are detrimental to male fertility. For example, a study by the World Health Organization (WHO) on over 9,000 men showed a connection between varicoceles and decreased testicular volume, impaired sperm quality, and a decline in Leydig cell (the cells that manufacture the male hormone testosterone) function.

• Another report (by Johnson and colleagues) showed that 70% of healthy military recruits who had visible varicoceles but no symptoms had abnormal test results when their semen was analyzed.

• Studies in animals and humans also suggest that varicoceles cause progressive testicular damage over time. There is evidence that surgically repairing varicoceles not only stops decline in testicular function, but often reverses it.

• Finally, recent controlled studies indicate that varicocelectomy improves pregnancy rates. [AR1] 

The microsurgical varicocelectomy specialists at Weill Cornell Medicine recommend varicocele surgery using microsurgical techniques as a safe, effective male infertility treatment.

Please contact us today to schedule an appointment with one of our world-class varicocelectomy specialists in New York City.

Further Reading

Diagnosis

Surgical Treatment

Results

Click here for pre-operative instructions

varicocele_post-op_instructions.pdf

 varicocelectomy_packet.pdf