Microsurgical Varicocelectomy

Microsurgical Varicocelectomy

A varicocele is a network of abnormally dilated scrotal veins and is the most common correctable cause of male factor infertility. They are present in approximately 15% of the general male population, 35% of males with primary infertility (those who have never conceived) and 75-80% of men with secondary infertility (men who have previously conceived but subsequently present with infertility).[i] Varicoceles are graded clinically by size, depending on if they are palpable with or without Valsalva (increases in intra-abdominal pressure) or if they are visible. They are much more prevalent on the left side due to the way the left gonadal vein inserts into the left renal vein.

Do varicoceles always need to be treated?

Varicoceles are very common and can often be left untreated. However, certain situations do warrant treatment such as if the varicocele is affecting the growth of the adjacent testicle, if it is associated with abnormal semen parameters (and there are current or future fertility concerns), if it is causing pain and occasionally for cosmetic reasons. To warrant treatment, the varicocele needs to be clinically palpable or visible; those that are noted on scrotal ultrasound but are not apparent on physical exam by your treating physician will not benefit from treatment. Testicular pain (orchialgia) is very common and so are varicoceles. Thus, when they present together, one cannot always assume that there is a causative relationship. If you suffer from orchialgia and have also been diagnosed with a varicocele, you will need to have a careful workup by your urologist to determine whether repairing the varicocele might help improve your pain.

Microsurgical subinguinal varicocelectomy

Dr. Horovitz generally treats varicoceles using advanced microsurgical techniques. A small incision, about 2-3 cm is made in your groin crease and the spermatic chord is delivered through the incision as it exits its corresponding external inguinal ring. Using an operating microscope under 10-25x magnification, the external and internal spermatic fasciae are opened. A micro-doppler probe is used to identify arteries which spared by labelling them and isolating them from the rest of the spermatic chord. All spermatic veins are tied off or clipped and divided. The vas deferens, arteries, lymphatics and nerves are all preserved and the chord is redelivered into the wound. Patients generally go home the same day, pain is mild and well-controlled with oral analgesia, and light work may be resumed in 2 or 3 days.

What other options exist to treat symptomatic varicoceles?

An interventional radiologist may be able to occlude your internal spermatic veins through a small cut-down incision over your femoral vein in a procedure called angioembolization. While potential surgical complications such as post-operative hydrocele and testicular atrophy may be avoided using these techniques, failures and recurrences are more common compared to when microsurgical approaches are utilized.

[i] Goldstein, M. (2012) Surgical Management of Male Infertility. In Wein, A. Kavoussi, L., Novick A.C., Partin, A.W., Peters, C.S (Eds.), Campbell-Walsh Urology (10th ed., pp. 678).

Request an appointment