Varicocelectomy is a surgical procedure that is mainly used to treat male infertility. This infertility in men is always as a result of varicocele. The aim of treating varicocele is to obstruct or hinder venous drainage to the testicles while maintaining the lymphatic drainage and arterial inflow. To understand varicocelectomy better, it is important to understand what a varicocele is.
A varicocele is an abnormality of the scrotum which is characterized with dilated, elongated, and torturous veins that drain the testicle. This condition is common and is observed in more than 15% of the male population around the globe. Varicoceles can occur on one or both sides of your testicles. The condition develops during puberty.
Repair for Varicocele
The primary repair or treatment for varicoceles is a surgical therapy known as varicocelectomy surgery. The presence of varicoceles on your scrotal sac doesn’t necessarily mean that you need surgery. The doctor will have a physical examination to see if your varicocele has a potential of causing testicular damage before performing the surgery.
As for the major aim of varicocelectomy, it should include occlusion of the offending varicosity by use of high success preservation of your arterial flow to the testis to minimize discomfort and morbidity.
Reasons Why You Need Varicocelectomy
Varicoceles have been found to raise the temperature of the testicles. This causes blood to get back into the veins supplying the testicles.
Although scientists still do not fully understand the mechanism in which varicoceles cause infertility, varicoceles have been found to destroy or damage sperm. The major reason why varicocelectomy is performed is to improve fertility.
Other reasons you should have varicocelectomy include:
- To improve or raise low testosterone levels
- To correct male factor infertility
- To reduce varicocele-induced scrotal pain
- Adults with a varicocele tend to have smaller testis. Varicocelectomy is necessary to correct this.
During varicocelectomy surgery, the varicocele veins are blocked by use of a tie or clip that holds the outside of the veins tightly. This is aimed to block venous drainage. This surgery is an outpatient procedure, meaning that you can go home the same day of the operation.
Recovery After Varicocelectomy
After varicocelectomy surgery, the patient should have someone to drive him home or stay for one night after the operation.
You should at least walk around to exercise your calf muscles and make sure you are able to eat or bath.
In case you are lying down most of the time, you should exercise your calf muscles to prevent formation of blood clots in the leg veins. After varicocelectomy, you should also expect pain and some discomfort. However, a large number of patients report experiencing only a mild pain or no pain at all. The following are some steps you should take to reduce postoperative pains:
- Application of ice packs to your scrotum or area of surgery can help reduce pain. This can be done in 15-20 minute intervals. Use of ice packs can be helpful for a few days after the operation.
- Speak to your doctor to see if you can use some of the over-the-counter pain relievers such as NSAIDs. NSAIDs such as ibuprofen are very effective in reduction of preoperative pains.
- You should also wear a scrotal support in your first weeks after the operation. This will help you reduce discomfort while standing, exercising, or walking.
- Narcotic pain relievers can also help in pain reduction. Narcotics are only used if your pain level is high or greater than 5 on a 0-10 scale.
- Elevation of the scrotum by use of a small towel or pillow can also reduce postoperative pain. This can be done while sitting or lying down to help reduce discomfort and minimizes swelling as well. The scrotum is raised enough so that the testicles are at the same level with the front of your thighs. This procedure can be helpful in the first few days after surgery.
You will also have sutures or gauze dressing covering the surgical site. You can remove the dressing two days after the operation and take a shower. You should leave your stitches in place until they fall off on their own.
Other tips you can apply to quicken your recovery include:
- Watch your recovery before returning to your normal activities. Returning to work after varicocelectomy should not take more than four days.
- You are able to return to your normal sexual activity after 1-2 weeks of surgery.
- After one week, you can return to your normal physical exercises.
- Avoid standing for long periods or lifting heavy loads after varicocelectomy surgery. Strenuous activities should be avoided for at least 2 weeks after the operation.
- You should not go for swimming or bath before your wound heals. Otherwise, your sutures will fall off before the wound heals which can prolong the healing period.
Risks and Side Effects of Varicocelectomy
Some of the common complications you can have after varicocelectomy surgery include:
- Blood clots- Blood clots are mainly found on the legs and known as deep venous thrombosis (DVT). These clots can also move to the lungs, a condition known as pulmonary embolus (PE).
- Infection- Infection is also another complication you can rarely miss with open or closed wounds. Infection after varicocelectomy has been reported in less than 1% of the patients who had the operation.
- Shrinking of the testicle- Shrinking of testicles on the side of surgery has also been reported. This has occurred in less than 1% patients.
- Hydrocele- Hydrocele is a condition characterized by fluid buildup around the testicles. this condition has been reported in less than 1% of patients.
- Recurrence of Varicocele- Recurrence of varicocele has been reported in about 5% of patients.
- Persistent pain- Failure to relieve pain after varicocelectomy has been reported in up to 15% of patients.
- Continued infertility- Not all couples benefit from the surgery. Some couples will not get pregnant more rapidly as expected after varicocelectomy.
While varicocelectomy surgery is aimed to reduce infertility in adult men, some of them do not fully benefit from the operation. Some research has shown that the surgery produces favorable pregnancy rates, while others have shown pregnancy rates as the same with those who do not choose to undergo the operation.