Varicocele is a common disease among young males. It is a vascular problem. There are mainly two types of blood vessels to all organs: (i) arterial: the vessels that bring the fresh well-oxygenated blood to the tissues (ii) venous: the vessels that carry the blood from the tissues to the heart to be cleaned and oxygenated again. Varicocele refers to a dilatation of the venous vessels of the testicles. This dilatation results in the backflow of the venous flow which is low in oxygen and nutrients and carry metabolites that need to be cleaned.
Sperm production is very delicate and very much affected by the low oxygen levels, metabolites in the blood as well as the increased temperature in the testicles due to congested blood. In such cases, two major problems arise scrotal pain and sperm production problems.
The initial diagnosis of varicocele is done by our expert upon examination. The manual examination is the gold standard. It is confirmed by a color Doppler ultrasound. A semen analysis is warranted to evaluate if and how much sperm production is affected.
The treatment plan usually involves surgery since there is no medical cure for it. Some varicoceles may not need surgery. An incidental finding of varicocele which does not compromise the sperm production and does not cause any discomfort may be carefully followed-up. Sperm production and ejaculation is actually a long process. It takes about 3-6 months for a newly produced sperm to be ejaculated. Sperm spends considerable time to mature and gain strength. Therefore it should ve kept in mind that any treatment involving sperm production will only yield its results in a minimum of 3-6 months.
Microscopic varicocelectomy: This is a minimally invasive day surgery. It is performed through a 2 cm hole on one or both sides depending on the presence of varicocele. The dilated veins are visualized by a special operating microscope and each one of them is tied up, reserving the arteries and lymphatic vessels thus preventing any complications. Microscopic surgery yields the best results and the least recurrence rates. The surgery takes about 45 minutes with minimal anesthesia. After a 3-4 hour hospital, the patients can go home. They can return to their daily life immediately. The only restrictions are:
- 2-day abstinence from bathing after surgery
- 2-week sexual abstinence
- 3-week abstinence of heavy lifting or excessive exercise
Open varicocelectomy: This is an open surgery very similar to the microscopic approach. Since the microscope is not involved it is usually difficult to see tiny vessels and differentiate lymphatic as well as arterial vessels. This approach is no longer recommended due to higher complication and recurrence rates.
Laparoscopic varicocelectomy: This is a different approach than both open or microscopic varicocelectomy. Patients need to be under deeper anesthesia and the procedure itself takes a longer surgical time. Three ports are placed through holes of about 2 cm each and under direct endoscopic vision, the cord where the vessels are enclosed is found, dissected and tied. There is good magnification close to the microscope, but the surgical tools used are larger in caliber compared to micro-instruments. It is difficult to avoid arterial and lymphatic vessels. There is usually an overnight stay to monitor laparoscopy associated symptoms.
- Is surgery painful?
- Varicocelectomy is relatively a minor surgery. Especially when done microscopically minimum tissue damage is done and there is very little skin cut. Usually, we prescribe a mild pain killer, but most patients do not feel the need to use them after 24 hours. After laparoscopy except for the incision sites, patients might experience abdominal fullness and discomfort due to the use of gas to distent the belly.
- Can I have improvement of semen parameters right after surgery?
- The earliest improvement should be seen at post-operative for 3 months but the best results are obtained after 6 months.
- When can I go back to work after surgery?
- For microscopic varicocelectomy, a 2-3 day rest is recommended. However, if the work does not require physical power some patients might return to work as soon as 24 hours after the surgery. For open surgery and laparoscopy, a slightly longer time may be necessary.