Varicocoelectomy

Varicocoelectomy

Varicocoeles are abnormally dilated veins found in the scrotum. Varicocoele surgery is normally performed to improve fertility, but it can also help to relieve varicocoele-related pain and discomfort in the scrotum. A small groin incision 2 cm long is made and the big veins within the spermatic cord identified. With the help of an operating microscope, these abnormal veins are dissected out and tied to stop the excess blood flow into the scrotum. The advantage of using the microscope is it allows the surgeon to easily identify all the veins and avoid injury to the testicular arteries and lymphatic channels. The surgery takes up to 1½ hours to do. If done for subfertility, some 70% of men should find an improvement in their semen analysis and 50-60% of couples can achieve a pregnancy (assuming no problems with the female partner) within 12 to18 months.

Complications include:

  • scrotal swelling. This is expected because the surgery itself interrupts blood flow out of the scrotum. These ligated veins then clot up 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 should be <<1% and due to inadvertent injury of the testicular artery. Rarely, the testicle may shrink because of the interrupted blood supply.
  • 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 extra veins going into the scrotum. These veins lie outside the spermatic cord and hence, are not easily seen. Recurrence may also be due to opening up of small veins over time.