Varicocelectomy Microscopic

[Paula Shuffleburg]

Swollenveins 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.

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.

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.

The UC Irvine Urology - Men's Health Center is led by Dr. Faysal Yafi, a leader in male urology and innovative treatment methods. Dr. Yafi's work is focused on helping men restore performance, vitality, and confidence.

In this case, the vein is in the scrotum, the sac of loose skin that contains the testicles. However, varicoceles can be more than just cosmetic. These enlarged veins sometimes contribute to a reduction in sperm count and issues with male infertility. Enlarged scrotal veins may also cause problems with testicle development and size.

A varicocelectomy is the most common procedure performed to correct issues with varicoceles. With microscopic varicocele surgery, a high-powered surgical microscope is used to perform the operation. This type of surgery allows for a better view of the affected area. Microscopic surgical techniques have also been linked to fewer complications and lower risks for patients. Such procedures are often done with local anesthesia.

Microscopic varicocele surgery can be done with an inguinal or subinguinal approach, referring to the location where the incision is made. An inguinal approach is typically used if the purpose for the procedure is to ease pain caused by varicoceles. Doing so allows for direct access to the ilioinguinal nerve, which can be cut to relieve pain caused by enlarged veins. With a subinguinal approach, the incision is made just above the top of the penis. It's sometimes necessary to make two incisions in the same area, which is where the spermatic cord leaves the abdominal wall.

Both surgical approaches involve a cut that's made to access the spermatic cord to reach the abnormal veins. The problem veins are then cut and tied to take accumulated blood away from the testicles. During microscopic surgery, the special microscope is above the patient. The surgeon or urologist is then able to view all veins that need to be severed. Other structures, including the vas deferens and arteries, can also be viewed and avoided. Lymphatic drainage also remains intact. Unintentional damage to the vas deferens or arteries can affect sperm flow and cause issues with the testicles. Lymphatic damage can cause the scrotum to fill with fluid. With microscopic varicocele surgery, these risks are significantly reduced.

Microscopic varicocele surgery is usually an outpatient procedure. Most patients recover fairly quickly and experience little discomfort while healing. There may be some minor swelling and bruises in the scrotum, although it's usually minor and manageable with medication. Most men resume normal activities within a few weeks. Men with sedentary occupations can usually get back to work in a day or so. The procedure normally takes about an hour to perform.

It's believed varicoceles may be caused by a reduced blood flow in the spermatic cord, the tiny tube that transports blood to and from the testicles. This reduction in blood flow results in wider veins. The condition often develops during puberty. However, it's usually not until later in life that varicoceles require attention if sperm quality and fertility are affected. For times when issues related to varicoceles are mild, men may benefit from over-the-counter pain medications or wearing athletic supporters to ease pressure on the scrotum.

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Microsurgical varicocelectomy is one of two surgical approaches to treating varicoceles. Unlike open laparoscopy this surgery involves using a smaller incision and an operating microscope, which decreases risks of complications and improves recovery time.

This is mainly because this form of varicocelectomy is a bit less invasive and offers fewer complications than open surgery. Additionally, a patient requires significantly less post-surgical pain medication and recovery time.3

Sub-inguinal approach is a lower incision than the inguinal approach, ie closer to the scrotum. This surgical approach takes a longer time to perform because the incision is made in the groin area where the spermatic vein has already branched into several vessels. This technique allows the surgeon more opportunity to identify various vessels and lymphatic channels.4

The process otherwise is the same. The vein has to be safely dissected apart from the other important structures. The enlarged veins are then cut and sealed off, allowing the testicular circulation to drain out more efficiently. Missed veins can cause a recurrence.

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It is also a viable solution if a couple is trying to conceive but has infertility issues. However, this varicocelectomy approach only applies if the female partner is fertile or has a treatable infertility condition.8

Due to the incision there will be some pain at the suture site. Patients recovering from inguinal microsurgical varicocelectomy might feel more pain since the incisions involve the abdominal muscles, requiring narcotic pain relievers.9

Microsurgical varicocelectomy is still surgery involving anesthesia, with risks of bleeding, injury and infection. Because of its invasive nature, varicocelectomy may compromise the blood and lymphatic flow if there is a complication during surgery. Is non-surgical embolization treatment a better option? Non-surgical embolization does not require creating a surgical opening in your groin or dissection of the spermatic cord, as such there is no risk to the testicular artery or lymphatics. There are no major incisions or sutures. Lastly, varicocele embolization has a 90% success rate.

Varicocele can be treated by an embolization procedure or surgery. Embolization is a non-surgical, outpatient, minimally invasive technique that uses x-ray guidance to place tiny coils and embolic fluid in the abnormal blood vessels causing them to close down.

Request an Appointment to meet with our varicocele specialist who will review your imaging, labs and history to determine if you are candidate for the procedure, and the outcomes you can expect. Each person is an individual and should discuss the potential risks and benefits of embolization and other treatments with our doctor to decide which option is best.

Appointments are available via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego. Why should you choose us? Read here

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