Normal veins vs varicocoele veins
External appearance of scrotal varicocoele

Varicocoeles are abnormally dilated veins found in the scrotum. Varicocoele surgery is normally performed to improve fertility, but is also indicated in varicocoele-related discomfort in the scrotum. A small incision 2 cm long is made over the groin and the big veins within the spermatic cord identified.

Varicocoelectomy surgery incision site

With the help of an operating microscope, these abnormal veins are dissected out and tied / clipped to interrupt the excess blood flow into the scrotum. Using the microscope allows the surgeon to easily identify all the blood vessels to avoid injury to the testicular arteries and lymphatic channels. The surgery takes up to 45 mins for each side.

Operative view of the surgery

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 wife).

Complications include:

  • scrotal swelling / bruising. 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.
  • testicular artery injury. This occurrence should be <<1% and due to inadvertent injury or tie of the testicular artery.
  • hydrocoele. This is excess fluid collection within the scrotum due to interruption of the lymphatic drainage.
  • recurrence. This can occur in < 5 % of cases and may be due to extra veins going into the scrotum. These veins lie outside the spermatic cord and are not easily seen through the small incisions. Recurrence may also be due to opening up of small spermatic veins over time.