VaricoceleA Varicocele is a swelling of the veins in the scrotum. It is caused by a faliure of the valves within the scrotal or testicular veins resulting in the backflow of blood and high pressure swelling.

Varicoceles can sometimes be felt within the scrotum as a collection of worm like structures or can be small and only visible on ultrasound.

Varicoceles can cause symptoms such as scrotal pain, which may get worse over the course of the day. Rarely, a varicocele can be the first sign of a kidney problem.

Varicoceles, even when not symptomatic, are the most commonly identifiable cause of primary and secondary male infertility. A varicocele is present in 15% of the general population but up to 35% of men with primary infertility (have never fathered a child) and over 75% of men with secondary infertility (have previously fathered a child but are now infertile).

The swollen veins surrounding the testicle cause problems with testicular function and can result in poor semen quality and low testosterone levels. Surgical treatment of clinically significant varicocles can lead to a higher chance of spontaneous pregnancy, a chance to avoid the need for assisted reproduction and an increased quality of semen if assisted reproduction is eventually felt to be necessary.

The options for surgical treatment of a varicocele include:

  • Radiological embolisation
  • Laparoscopic (keyhole) ligation
  • Open repair
  • Microsurgical repair

Although the most technically challenging of the above options, a microsurgical repair carries the lowest risk of complications and recurrence of the varicocele.

Microsurgical Varicocele Repair

The procedure is performed through a tiny incision in the groin.  Through this, the spermatic cord (the ‘cable’ that connects the testicle to the rest of the body and carries the blood supply, veins, lymphatics, nerves and vas deferens) is visualised and opened using the microscope.  

With the assistance of a microscope the structures within the cord can be identified and the problematic veins can be divided with preservation of the arteries, lymphatics and nerves.  Other veins from elsewhere in the scrotum that can the varicocele to return over time are identified and divided too.

After the operation you will usually stay in hospital overnight.  You will need to take it easy and wear supportive underwear for six weeks.  The swollen veins can take some time to reduce in size and the testicle may take a number of months to recover its function.