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Illustration-of-Varicocele

A varicocele is an enlarged vein that's similar to a varicose vein.

In this case, the vein is in the scrotum, the sac of loose skin that contains the testicles. However, varicoceles can be more than just cosmetic. These enlarged veins sometimes contribute to a reduction in sperm count and issues with male infertility. Enlarged scrotal veins may also cause problems with testicle development and size.

  • Some varicoceles are harmless and require no treatment.
  • But if testosterone production is affected, a urologist might recommend microscopic varicocele surgery.

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What Is Microscopic Varicocele Surgery?

A varicocelectomy is the most common procedure performed to correct issues with varicoceles. With microscopic varicocele surgery, a high-powered surgical microscope is used to perform the operation. This type of surgery allows for a better view of the affected area. Microscopic surgical techniques have also been linked to fewer complications and lower risks for patients. Such procedures are often done with local anesthesia.

What Are Inguinal and Subinguinal Surgical Approaches?

Microscopic varicocele surgery can be done with an inguinal or subinguinal approach, referring to the location where the incision is made. An inguinal approach is typically used if the purpose for the procedure is to ease pain caused by varicoceles. Doing so allows for direct access to the ilioinguinal nerve, which can be cut to relieve pain caused by enlarged veins. With a subinguinal approach, the incision is made just above the top of the penis. It's sometimes necessary to make two incisions in the same area, which is where the spermatic cord leaves the abdominal wall.

Surgeon-Performing-Microscopic-Varicocele-Surgery
Happy-Surgeon-After-Successful-Microscopic-Varicocele-Surgery

What Happens During Surgery?

Both surgical approaches involve a cut that's made to access the spermatic cord to reach the abnormal veins. The problem veins are then cut and tied to take accumulated blood away from the testicles. During microscopic surgery, the special microscope is above the patient. The surgeon or urologist is then able to view all veins that need to be severed. Other structures, including the vas deferens and arteries, can also be viewed and avoided. Lymphatic drainage also remains intact. Unintentional damage to the vas deferens or arteries can affect sperm flow and cause issues with the testicles. Lymphatic damage can cause the scrotum to fill with fluid. With microscopic varicocele surgery, these risks are significantly reduced.

What Happens After Surgery?

Microscopic varicocele surgery is usually an outpatient procedure. Most patients recover fairly quickly and experience little discomfort while healing. There may be some minor swelling and bruises in the scrotum, although it's usually minor and manageable with medication. Most men resume normal activities within a few weeks. Men with sedentary occupations can usually get back to work in a day or so. The procedure normally takes about an hour to perform.

It's believed varicoceles may be caused by a reduced blood flow in the spermatic cord, the tiny tube that transports blood to and from the testicles. This reduction in blood flow results in wider veins. The condition often develops during puberty. However, it's usually not until later in life that varicoceles require attention if sperm quality and fertility are affected. For times when issues related to varicoceles are mild, men may benefit from over-the-counter pain medications or wearing athletic supporters to ease pressure on the scrotum.

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faculty_gelman
Joel Gelman, M.D.
Male Urology
HS Clinical Professor-VCF
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Faysal A. Yafi, M.D., F.R.C.S.C.
Male Urology
HS Assistant Clinical Professor, Medical Director Men’s Health Program

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