Pfizer COVID-19 vaccine appointments are available to our patients. Sign up for Connect today to schedule your vaccination. Continue your routine care with us by scheduling an in-person appointment or Video Visit.


Varicoceles are common. They may be detected in 15% of the male population, 35% of men with primary infertility and up to 80% of men with secondary infertility. Studies have shown that varicocele causes progressive duration-dependent injury to testicular function over time. The most likely pathophysiologic mechanism is an elevation of testicular temperature due to impaired scrotal thermoregulation. Varicocele repair will halt and often reverse this duration-dependent process.

The most common complications from non-microsurgical varicocelectomy are hydrocele formation, varicocele recurrence, and testicular artery injury. 

Use of the operating microscope allows for reliable identification of spermatic cord lymphatics, internal spermatic veins and venous collaterals, and the testicular artery or arteries so that the incidence of these complications can be virtually eliminated. Delivery of the testis through a small subinguinal incision provides direct visual access to all possible avenues of testicular drainage. Although some controversy continues to surround varicocelectomy as a treatment of male factor infertility, a great deal of data does exist to support this form of therapy.


1. Gorelick J, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993;59:613-616.

2. Kass E, Belman A. Reversal of testicular growth failure by varicocele ligation. J Urol. 1987;137(3):475-476.

3. Hadziselimovic F, Herzog B, Liebundgut B, Jenny P, Buser M. Testicular and vascular changes in children and adults with varicocele. J Urol. 1989;142(2 ):583-585.

4. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol. 1992;148:1808-1811.

5. Goldstein M, Young GHP, Einer-Jenson N. Testicular artery damage due to infiltration with fine gauge needle: experimental evidence suggesting that blind cord block should be abandoned. Surgical Forum. 1983;24:653-656.

6. Hopps CV, Lemer ML, Schlegel PN, Goldstein M. Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol. 2003;170:2366-2370.

7. Beck EM, Schlegel PN, Goldstein M. Intraoperative varicocele anatomy: a macro- and microscopic study. J Urol. 1992;148:1190-1194.

8. Wysock J, Goldstein M. Hydroceles associated with varicoceles: incidence and mathematical model of their insulating effects. Annual Meeting of the American Urological Association. Chicago, IL2009.

9. Dabaja A, Goldstein M. Microsurgical hydrocelectomy: rationale and technique. Urol Practice. 2014;In Press.

10. Goldstein M, Eid JF. Elevation of intratesticular and scrotal skin surface temperature in men with varicocele. J Urol. 1989;142:743-745.

11. Harrison R, Lewis R, Roberts J. Pathophysiology of varicocele in nunhuman primates: long-term seminal and testicular changes. Fertil Steril. 1986;46(3):500-510.

12. Dubin L, Amelar R. Varicocelectomy: 986 cases in a twelve year study. Urol. 1977;10(5):446-449.

13. Schlegel P, Goldstein M. Anatomical approach to varicocelectomy. Semin Urol. 1992;10(4):242-247.

14. Marmar J, Agarwal A, Prabakaran S. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007;88(3):639-646.

15. Tanrikut C, Goldstein M, Rosoff J, Lee R, Nelson C, Mulhall J. Varicocele as a risk factor for androgen deficiency and effect of repair. BJU Int. 2011;108:1480-1484.

16. Su L, Goldstein M, Schlegel P. The effect of varicocelectomy on serum testosterone levels in infertile men with varicoceles. J Urol. 1995;154(5):1752-1755.

17. Howards S. Subclinical varicocele. Fertil Steril. 1992;57:725.

18. Lemack GE, Uzzo RG, Schlegel PN, Goldstein M. Microsurgical repair of the adolescent varicocele. J Urol. 1998;160:179-181.

19. Goldstein M, Tanrikut C. Microsurgical management of male infertility. Nature Clin Pract Urol. 2006;3:381-391.

20. Matthews GJ, Matthews ED, Goldstein M. Induction of spermatogenesis and pregnancies following microsurgical varicocelectomy in azoospermic and severely oligoasthenospermic men. Fertil Steril. 1998;70:71-75.

21. Kim E, Liebman B, Grinblat D, Lipshultz L. Varicoclee repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol. 1999;162(3):737-740.

22. Lee R, Li PS, Schlegel PS. Cost effectiveness of male infertility treatments. Surgery of Male Infertility, Second Edition. Ed. Goldstein M and Schlegel PN. New York: Cambridge University Press; in press. 2011

23. Lee R, Li PS, Schlegel PN, Goldstein M. Reassessing reconstruction in the management of obstructive azoospermia: reconstruction or sperm acquisition? Urol Clin North Am. 2008 May;35(2):289-301, x. Review.

24. Schlegel PN: Is assisted reproduction the optimal treatment for varicocele-associated male infertility? A cost-effectiveness analysis. Urol 49:83, 1997.

25. Comhaire F: Economic strategies in modern male subfertility treatment. Hum Reprod 10(Suppl. 1):103, 1995.

26. Kondoh N, Meguro N, Matsumiya K. Significance of subclinical varicocele detected by scrotal sonography in male infertility: a preliminary report. J Urol. 1993;150:1158.

27. Scherr DS, Goldstein M. Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles. J Urol. 1999;162:85-88.

28. Okuno J, Shichiri Y, Onishi H. Effectiveness of subclinical varicocelectomy: a prospective randomized study. J Urol. 1998;159:206.

29. Ficarra V, Cerruto M, Liguori G. Treatment of varicocele in subfertile men: the Cochrane Review - a contrary opinion. Eur Urol. 2006;49:258-263.

30. Marmar J, BDeBenedictis T, Praiss D. The management of varicoceles by microdissection of the spermatic cord at the external inguinal ring. Fertil Steril. 1985;43:583-588.

31. Cayan S, Kadioglu T, Tefekli A. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urol. 2000;55(5):750-754.

32. Dabaja A, Mehta A, Wosnitzer M, Goldstein M. Microsurgical assisted hydrocelectomy. Paper presented at: Annual Meeting of the American Society of Reproductive Medicine 2013; Boston, MA.

33. Lima S, Castro M, Costa O. A new method for the treatment of varicocele. Andrologia. 1978;10(2):103-106.

34. Walsh P, White R, Jr. Balloon occlusion of the internal spermatic vein for the treatment of varicoceles. JAMA. 1981;246(15):1701-1702.

35. Glassberg K, Poon S, Gjertson C, DeCastro G, Misseri R. Laparoscopic lymphatic sparing varicocelectomy in adolescents. J Urol. 2008;180(1):326-330.

36. Marmar J, Kim Y. Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol. 1994;152(4):1127-1132.

37. Raman JD, Goldstein M. Intraoperative characterization of arterial vasculature in the spermatic cord. Urology. 2004;64(3):561-564.

38. Penn I, Mackie G, Halgrimson C, Starzl T. Testicular complications following renal transplantation. Ann Surg. 1972;176(6):697-699.

39. Wosnitzer M, Roth J. Optical magnification and Doppler ultrasound probe for varicocelectomy. Urol. 1983;22(1):24-26.

40. MacMahon ROB, MC, Cussen L. The use of microsurgery in the treatment of the undescended testis. J Pediatr Surg. 1976;11(4):521-526.

41. Al-Kandari A, Shabaan H, Ibrahim H, Elshebiny Y, Sohokeir A. Comparison of outcomes of different varicocelecotmy techniquesL open inguinal, laparoscopic, and subinguinal microscopic varicocelcetomy: a randomized clinical trial. Urol. 2007;69(3):417-420.

42. Lemack GE, Uzzo RG, Schlegel PN, Goldstein M. Microsurgical repair of the adolescent varicocele. J Urol. 1998;160:179-181.

43. Barbalias G, Liatsikos E, Nikiforidis G, Siablis D. Treatment of varicocele for male infertility: a comparative study evaluating currently used approaches. Eur Urol. 1998;88(3):639-648.

44. Madgar I, Weissenberg R, Lunenfeld B, Karasik AG, B. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril. 1995;63(1):120-124.

45. Pasqualotto FL, AM, Hallak J, Goes P, Saldanha L, Arap S. Induction of spermatogenesis in azoospermic men after varicocele repair. Human Reprod. 2003;18(1):108-112.

46. Ishikawa T, Kondo Y, Yamaguchi K, Sakamoto Y, Fujisawa M. Effect of varicocelectomy on patients with unobstructive azoospermic and severe oligospermia. BJU Int. 2008;101(2):216-218.

47. Lee J, Park H, Seo J. What is the indication of varicocelecotmy in men with nonobstructive azoospermia? Urol. 2007;69(2):352-355.

48. Steckel J, Dicker AP, Goldstein M. Relationship between varicocele size and response to varicocelectomy. J Urol. 1993;149:769-771.

49. Younes A. Improvement in sexual activity, pregnancy rate, and low plasma testosterone after bilateral varicocelectomy in impotence and male infertility patients. Arch Androl. 2003;49(3):219-228.

50. Cayan S, Kadioglu A, Orhan I, Kandirali E, Tefekli A, Tellaloglu S. The effect of microsurgical varicocelectomy on serum follicle stimulating hormone, testosteorne and free testosterone levels in infertile men with varicocele. BJU Int. 1999;84(9):1046-1049.

51. Rosoff J, Goldstein M, Chu D, Kattan M, Mulhall J. Prognostic nomogram for the estimation of serum testosteorne level following varicocele ligation. Annual Meeting of the American Urological Association. Chicago, IL2009. 

Center for Male Reproductive Medicine & Microsurgery Weill Cornell Medicine
525 E 68th Street
New York, NY 10065