A varicocele is an enlargement of the veins in your scrotum. Varicocelectomy is a surgery performed to remove those enlarged veins. The procedure is done to restore proper blood flow to your reproductive organs.
When a varicocele develops in your scrotum, it can block blood flow to the rest of your reproductive system. The scrotum is the sac that contains your testicles. Because blood can’t return to your heart through these veins, blood pools in the scrotum and the veins become abnormally large. This can decrease your sperm count.
Varicoceles occur in about 15 percent of adult men and 20 percent of teen males. They don’t usually cause any discomfort or symptoms. If the varicocele doesn’t cause pain or discomfort, your doctor may suggest leaving it as is to avoid the risks of surgery.
Varicoceles often appear on the left side of your scrotum. Varicoceles on the right side are more likely to be caused by growths or tumors. If you develop a varicocele on the right side, your doctor may want to perform a varicocelectomy, as well as remove the growth.
Infertility is a common complication of a varicocele. Your doctor may recommend this procedure if you want to have a child but are having trouble conceiving. You may also want to undergo this procedure if you’re experiencing any side effects of decreased testosterone production, such as weight gain and reduced sex drive.
Varicocelectomy is an outpatient procedure. You’ll be able to go home the same day.
Before the surgery:
- Let your doctor know if you’re taking medications or supplements. Stop taking any blood thinners, such as warfarin (Coumadin) or aspirin, to lower your risk of bleeding during the surgery.
- Follow your doctor’s fasting instructions. You may not be able to eat or drink for 8 to 12 hours before the surgery.
- Have someone take you to and from the surgery. Try to take the day off work or other responsibilities.
When you arrive for surgery:
- You’ll be asked to remove your clothes and change into a hospital gown.
- You’ll lie down on a surgical table and be given general anesthesia through an intravenous (IV) line to keep you asleep.
- Your surgeon will insert a bladder catheter to remove urine while you’re asleep.
The most common procedure is a laparoscopic varicocelectomy. Your surgeon performs this surgery using several small incisions, and a laparoscope with a light and camera to see inside your body. Your surgeon might perform an open surgery, which uses one large incision to allow your surgeon to see inside your body without a camera.
To perform a laparoscopic varicocelectomy, your surgeon will:
- make several small cuts in your lower abdomen
- insert the laparoscope through one of the cuts, allowing them to see inside your body using a screen that projects the camera view
- introduce gas into your abdomen to allow more space for the procedure
- insert surgical tools through other small cuts
- use tools to cut any enlarged veins that are blocking blood flow
- seal off the ends of the veins using small clamps or by cauterizing them with heat
- remove the tools and laparoscope once the cut veins are sealed
Surgery takes about one to two hours.
Afterward, you’ll be placed in a recovery room until you wake up. You’ll spend about one to two hours recovering before your doctor clears you to go home.
During your recovery at home, you’ll need to:
- take any medications or antibiotics that your doctor prescribes
- take pain medications, such as ibuprofen (Advil, Motrin), to manage your pain after surgery
- follow your doctor’s instructions for cleaning your incisions
- apply an ice pack to your scrotum for 10 minutes several times a day to keep swelling down
Avoid the following activities until your doctor says you can resume them:
- Don’t have sex for up to two weeks.
- Don’t do strenuous exercise or lift anything heavier than 10 pounds.
- Don’t swim, take a bath, or otherwise immerse your scrotum in water.
- Don’t drive or operate machinery.
- Don’t strain yourself when you poop. Consider taking a stool softener to make bowel movements pass more easily following your procedure.
See your doctor right away if you notice any of the following:
- fluid buildup around your testicle (hydrocele)
- difficulty peeing or fully emptying your bladder
- redness, inflammation, or drainage from your incisions
- abnormal swelling that doesn’t respond to cold application
- high fever (101°F or higher)
- feeling nauseous
- throwing up
- leg pain or swelling
This procedure can help increase fertility by restoring blood flow to your scrotum, which can result in increased sperm and testosterone production.
Your doctor will perform a semen analysis to see how much your fertility improves. Varicocelectomy often results in a 60–80 percent improvement in semen analysis results. Instances of pregnancy after varicocelectomy often rise anywhere from 20 to 60 percent.
Varicocelectomy is a safe procedure that has a high chance of improving your fertility and reducing complications of blocked blood flow into your reproductive organs.
As with any surgery, there are some risks, and this procedure may not be able to fully restore your fertility. Talk to your doctor about whether this surgery is necessary, and whether it will have any impact on your sperm count or sperm quality.