Appearing in the scrotum of approximately 10-15 out of every 100 men, varicoceles are a fairly common occurrence.
Usually more noticeable when standing up, enlarged or swollen scrotal veins aren’t a serious problem if there is no discomfort or issues with sperm quality and production.
- If surgery does become necessary, one possibility is a microsurgical varicocelectomy.
- This is a more precise procedure performed with a surgical microscope that has a high success rate and low side effect risks.
Why Consider Microscopic Varicocelectomy?
Swollen veins in the scrotum may contribute to issues with male infertility. In some cases, testosterone production may be impaired because of the way veins are affected. Since this male hormone plays a key role in the development of reproductive tissues, muscles and bone mass, and body hair growth, lower levels could contribute to several problems, including general muscle weakness and a loss of sex drive. Surgery may also be suggested as an option if the enlarged veins are affecting testicle size.
How Is It Performed?
A high-powered operating microscope is used when a microsurgical varicocelectomy is performed with either a general or a local anesthetic. The purpose of the procedure is to seal off the affected vein and redirect blood flow to other healthy veins. There are two possible surgical approaches with microscopic surgery: inguinal or subinguinal.
With the inguinal approach, an incision is made in a way that provides access to the ilioinguinal nerve, which branches off from the first lumbar nerve in the lower back. This approach to a microsurgical varicocelectomy is usually recommended if pain is experienced because of the varicoceles. Cutting this nerve while also sealing affected veins can provide permanent pain relief. With the subinguinal approach, the incision is made lower in the groin.
Both approaches are done with small incisions that are typically less than an inch in length. The spermatic cord is dissected to access the abnormal veins, which are sealed or tied. Blood flow is then redirected away from the affected area and diverted to the pelvis or inner thigh.
It’s important to avoid cutting arteries that supply blood to the testicles. Damaging the vas deferens can affect sperm production. Lymph node damage could impact the immune system. Microsurgical techniques reduce such risks by providing a better and more detailed view. Surgery typically lasts about half an hour per side.
What Happens After Surgery
Since the procedure is normally done on an outpatient basis, most men are able to return home shortly after surgery is completed. It typically takes two to three weeks to fully recover. Patients who work in fairly sedentary jobs are usually able to return to work within a few days. If the main reason for a microscopic varicocelectomy is because of fertility issues, a semen analysis may be done during a follow-up visit to determine if sperm quality and quantity has improved.
There are no medications specifically for the treatment of varicoceles. Prior to considering a microsurgical varicocelectomy, however, men or boys with the condition may be encouraged to use over-the-counter pain relievers such as ibuprofen to manage any related discomfort. If surgery is recommended, it may be combined with less-invasive techniques that minimize scarring and post-procedure discomfort.