Microsurgical correction of variocele

Testicular varicocele or varicose veins is the dilation that occurs in the veins that drain blood from the testicles. This condition implies a risk for fertility and generally tends to be progressive in time, resulting in a gradual deterioration in the sperm production and an atrophy of testicles.

In our Urology Centre, we can treat varicocele with minimally invasive microsurgical technique, through which they isolate the veins that should be linked, avoiding damage to the arteries and nodes. The patient usually does not stay entered more than 24h. Thanks to this treatment, you get increase sperm production of approximately 67% without the complications involved by other techniques.

What is a varicocele?

The spermatic cord is a structure that provides blood supply to the testicle and contains the vas deferens that carries sperm from the testicle to the penis and urethra. The spermatic cord passes through the inguinal canal and continues to the scrotum. The pampiniform plexus is a group of veins within the spermatic cord that are responsible for the blood return from the testicles. It is believed that this plexo plays an important role in the regulation of testicular temperature to keep it in the ranges suitable for the production of healthy sperm.

A varicocele is an abnormal dilation of the veins of the pampiniform plexus within the scrotum. It is more common on the left-hand side due to the characteristics of the venous drainage. Varicocele occur in 15% of the male population (from pre-teens to adults), although that can be observed in up to 40% of men with fertility problems.

What are the symptoms of a varicocele?

Most men diagnosed with varicocele are asymptomatic. When there is some discomfort, it is usually characterized by a crushing pain in the testicle. This can increase with physical exertion or when standing for long periods. Symptoms usually increase throughout the day and disappear when lying down or waking up (because this position improves venous drainage).

How are varicoceles diagnosed?

Large varicoceles may be diagnosed by examination. They look and feel like the presence of a mass in the scrotum and may even reach the appearance

“bag of worms”. Varicoceles that don’t show any symptom are usually

diagnosed during the physical examination in a routine medical examination. The patient stands and he is asked to “push” with the aim of increasing the pressure inside the abdomen and forcing blood  inside the pampiniform plexus.

This manoeuvre is known as the Valsalva Manoeuvre. Many times it is necessary to request a testicular ultrasound in order to identify minor varicoceles or document already diagnosed ones. However, this study is only a support, the definitive diagnosis is by physical examination.

There is controversy with regard to subclinical varicoceles (i.e. that are evident by ultrasound and not via physical examination). To decide whether a subclinical varicocele treatment is required will depend on the clinical context in which it is diagnosed.

What are the treatment options?

Deciding to treat a varicocele depends on each particular case. Someone with pain, atrophy or infertility should be treated in order to improve after surgery. There is still controversy in young patients with asymptomatic varicoceles.

Many authors consider surgical repair necessary for teens with an incidental in any of the following situations:  testicle atrophy, presence of pain, changes in the parameters of semen analysis, or a grade III varicocele.

The treatment can be performed through surgery that has the purpose of linking the damaged veins or by percutaneous embolisation. Several techniques are described for the surgical repair of varicocele. They all seek to bind (block) the veins of the pampiniform plexus or gonadal branch. In our Lyx Urology Centre Lyx, we perform microsurgery for repairing  varicocele.

What should I expect after surgery?

The procedure can be performed on an ambulatory basis. The recovery time is generally quick. You can return to their normal activities in 1 to 2 days. It is recommended not to perform physical effort, or sexual activity for at least 2 weeks after surgery.

What are the risks of surgery?

Although very unlikely, the risks are: formation of hydrocele, i.e. fluid around the testicle (1-15%, according to the technique); recurrence of the varicocele (1-3%); and testicular atrophy (1-3%).

The use of microsurgical techniques increases the success and decreases complications. We recommend the use of this technique for the treatment of any varicocele.

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