Male fertility / infertility
- Microsurgical Vasectomy Reversal (Vasovasostomy and Vasoepididymostomy)
- Microsurgical Varicocelectomy
- No Scalpel Vasectomy
- Sperm retrieval procedures for assisted reproduction
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Varicocele repair (Varicocelectomy)
A varicocele is a collection of dilated (varicose) veins around the testicle which swell upon standing. As the veins swell, they may cause a dull achy discomfort, and they can also elevate the ambient temperature of the testicles into a range which negatively affects sperm count and function.
Varicoceles are very common, as roughly 15% of the US male population has one, and they occur mostly on the left side. Of patients seeking the advice of a urologist for infertility, 40% will have a varicocele.
Aside from testicular pain, varicoceles occasionally can cause atrophy (shrinkage) of the affected testicle.
How are varicoceles corrected?
Varicoceles are corrected through a microsurgical procedure called a subinguinal varicocelectomy. The surgery is about 1.5 hours in length. The veins of the testicle are accessed through a small groin incision and with the help of an operating microscope, the abnormal veins are dissected away and tied to prevent the reflux of blood to the testicle.
There is a tremendous microcirculation associated with the testicle so tying off these abnormal veins will not result in closing off all blood flow from the testicle.
The advantage of using the microscope is it allows the surgeon to easily identify and preserve the testicular arteries and lymph vessels, which greatly reduces both the complication and recurrence rate.
What are the risks and benefits of the procedure?
Exposure to a general anesthetic, bleeding and infection are standard surgical risks. Specific to the procedure, there is a small risk of damage to the testicular artery (<<1%), hydrocele formation (<1%), and persistence of the varicocele (<5%).
Varicocele surgery usually is performed to improve fertility, but it can also help with varicocele related pain and discomfort.
Men undergoing varicocele surgery usually have one of the following concerns:
- Deficiencies in sperm count or motility
- Discrepancy in testicular size Pain
- Anxiety or concern over the appearance of the varicocele
After a varicocele repair, 70% of men will improve their semen analysis in 6-9 months and 50-60% of couples will achieve a pregnancy (assuming no problems with the female partner) within 12-18 months.
Post-operative care instructions
After a varicocelectomy, some bruising, swelling, and oozing of the wound should be expected. It is very common to have bruising extend onto the shaft of the penis. Normally 1-2 days off work are all that is required. Please call to schedule a post-operative check about a week after surgery. Please be sure to use the words "post-op check" as this will allow you to be seen anytime that is convenient for you.
Swelling is a normal part of the healing process as well. As a general guideline, if the wrinkles of the scrotum can be seen and appreciated, then the swelling is within a reasonable level.
Activity level should be light, avoiding any heavy exercise or straining. Walking is encouraged to promote the flow of blood through the legs and to help re-expand the lungs after anesthesia.
As a general rule, stay ahead of your pain and discomfort. This is best accomplished by taking a steady dose (two tablets) of an over-the-counter pain reliever such as ibuprofen or Tylenol every six hours for the first 2-3 days after surgery. Use the stronger pain medicine if needed.
Dressings should be left in place and kept dry for two days following surgery. After that, leave the wound open to the air. There is no need to keep it covered or use antibiotic ointment as all the stitches are buried and absorbable within 4-6 weeks.
Warning signs that should merit a call to the office are fever >101, pus or an opening of the operative site, excessive bleeding that cannot be stopped by gentle pressure, shortness of breath, or asymmetric swelling in the legs.
Varicocele on physical examination.¬ÝNotice the left spermatic cord is significantly enlarged compared to the right.
An intraoperative photo of where the incision is situated for a microsurgical repair.
A picture through the microscope of the veins in a varicocele after they have been dissected free.
Photographs (c) Dr. Anthony Thomas