Varicocelectomy Microsurgical

[Bulah Landaker]

Varicocelesenlarged scrotal veins, can be a source of male infertility, pain, and may even impair testosterone production. Learn more about varicoceles. If your surgeon believes your are a candidate for microsurgical varicocele repair, here is what to expect:

A microsurgical varicocelectomy is performed under a high-powered operating microscope to achieve the highest success rates with the lowest side effect risks. There are two approaches to microsurgical varicocelectomy, inguinal or subinguinal. If the procedure is being performed for pain, the inguinal approach is often used to allow access to the ilio-inguinal nerve which can be cut to provide permanent pain relief. The incision site for inguinal is a little higher in the groin than subinguinal (anatomy art insert). Once the surgeon incises the skin, he or she dissects down to the spermatic cord where the abnormal veins are encountered.

Each vein is meticulously dissected circumferentially and then tied off to disrupt flow and provide drainage of blood away from the testicle into the inner thigh and pelvis. Keys to a good operation are to interrupt every vein, leave every artery intact, leave the vas deferens intact and leave lymphatic drainage intact. If an artery is cut, damage to the testicle can occur. If the vas deferens is injured, sperm can be blocked. If lymphatics are cut, the scrotum can feel with fluid and require additional surgery to drain the fluid. The microsurgical approach has been statistically shown to reduce all of these risks.

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

Please note that although we strive to protect and secure our online communications, and use the security measures detailed in our Privacy Policy to protect your information, no data transmitted over the Internet can be guaranteed to be completely secure and no security measures are perfect or impenetrable. If you would like to transmit sensitive information to us, please contact us, without including the sensitive information, to arrange a more secure means of communication.

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.

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.

Defined as a dilatation or tortuosity of the venous plexus that drains the testicle, a thorough understanding of testicular physiology and relevant anatomy provides the foundation upon which varicocele treatment is based.

Other vital structures that are contained within the spermatic cord include the cremasteric muscle fibers, the genital branch of the genitofemoral nerve, and the vas deferens. The cremasteric muscle fibers and the genital branch of the genitofemoral nerve travel alongside the cremasteric vessels between the external and internal layers of spermatic fascia while the vas deferens travels within the internal spermatic fascia and is intimately associated with its own named vessels.

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