Varicocoeles are abnormally dilated veins within the scrotum. Small varicocoeles are asymptomatic but large ones can cause scrotal ache, affect sperm production and even shrink the testicle. Varicocoele surgery aims to interrupt the congestion within these veins. A small groin incision 2 cm long is made and the big veins within the spermatic cord identified. These abnormal veins are dissected and individually tied or clipped. The advantage of using the microscope is to magnify all the veins and more importantly, avoid accidental injury to the testicular arteries and lymphatic channels. The surgery takes 30 to 45 minutes to do.

If done for subfertility, there should be a 70% to 80% improvement in the semen analysis.

Complications include:

  • scrotal swelling. This is to be expected because the blood flow out of the scrotum is interrupted once the veins are tied. These veins clot to cause a cord-like swelling. The swelling should subside within a month, depending on the number of veins that have been tied.
  • damage to the testicular artery. This occurrence occurs in <1% of cases and is due to inadvertent injury of the testicular artery. Rarely, the testicle may shrink.
  • hydrocoele. This is excess fluid collection within the scrotum due to interruption of the lymphatic drainage.
  • recurrence. This occurs in < 5 % of cases and due to veins outside the spermatic cord. Late recurrence is due to opening up of small veins over time.

Desired outcomes:

  • no testicle artery injury
  • no hydrocoele
  • low recurrence rate ( < 5%> )