Varicocele

Varicocele treatment may not be necessary. However, in some cases, if a varicocele causes pain, testicular atrophy or infertility, varicocele repair may be necessary. The purpose of surgery is to seal off the affected vein to redirect the blood flow into normal veins. The effect of varicocele repair on fertility is unclear.

Repair methods include:

  • Open surgery. This treatment usually is done on an outpatient basis, using general anesthetic or local anesthetic. Commonly, surgeons will approach the vein through the groin (transinguinal), but it's also possible to make an incision in the abdomen or below the groin. Advances in varicoceles repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.

    Patients may be able to return to normal, nonstrenuous activities after two days. As long as there is no discomfort, patients may return to more strenuous activity, such as exercising, after two weeks. Pain from this surgery generally is mild. Doctors may prescribe pain medication for the first two days after surgery. After that, the doctor may advise patients to take over-the-counter (OTC) painkillers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to relieve discomfort. Patients may be advised not to have sex for one to two weeks. Patients will have to wait three or four months after surgery to get a semen analysis to determine whether the varicoceles repair was successful in restoring fertility.
  • Laparoscopic surgery. The surgeon makes a small incision in the abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. This procedure requires general anesthesia.
  • Percutaneous embolization. A radiologist inserts a tube into a vein in the groin or neck through which instruments can be passed. Viewing the enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure, not as widely used as surgery, is done with local anesthesia on an outpatient basis.
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