The Ultimate Guide to Varicocele Repair (Varicocelectomy)

Varicocele, a condition characterised by enlarged veins within the scrotum, affects approximately 15% of men and more among those with infertility issues. For men experiencing pain, fertility challenges, or testicular atrophy, varicocelectomy offers a potential solution.

What Is Varicocelectomy?

Varicocelectomy is a surgical or minimally invasive procedure specifically designed to address varicoceles—dilated veins within the scrotum's pampiniform plexus. These enlarged veins can compromise testicular blood flow, manifesting as symptoms such as testicular pain, diminished sperm quality, or testicular atrophy.

The procedure works by ligating or blocking the affected veins to redirect blood flow to healthier veins. This intervention aims to alleviate symptoms and potentially enhance fertility. Given that medications are generally ineffective for varicoceles, varicocelectomy serves as the primary treatment when symptoms or infertility are significant.

Who Needs Varicocele Repair?

Not all men with varicoceles require treatment, as many are asymptomatic. However, varicocele repair is often recommended for:

• Chronic Testicular Pain: Persistent discomfort or a heavy feeling in the scrotum, especially during physical activity, may warrant surgery.
• Infertility: Varicoceles are a common cause of male infertility. Men with abnormal semen parameters (low sperm count, poor motility, or abnormal morphology) may benefit from this procedure.
• Testicular Atrophy: Varicoceles can cause the testicles to shrink over time, and repair may prevent further damage.
• Adolescents with Progressive Issues: In younger patients, surgery may be considered if the varicocele affects testicular growth.

A urologist will assess symptoms, perform a physical exam and may perform tests like an ultrasound or semen analysis to determine if varicocelectomy is necessary. The decision is highly individualised, as some men with varicoceles remain fertile and symptom-free.

Benefits of Varicocelectomy

A varicocelectomy is a frequently performed surgical procedure that offers several key benefits:

• Improved Semen Parameters: Varicocelectomy usually improves sperm count, motility, and morphology, which are key to fertility.
• Pain Relief: For men with chronic scrotal pain, varicocelectomy often provides relief, improving quality of life.
• Prevention of Testicular Atrophy: By restoring proper blood flow, the procedure can halt testicular shrinkage.
• Enhanced Fertility: Varicocelectomy can help increase fertility due to enhanced sperm and testosterone production.

Recovery and Post-Operative Care

Recovery from varicocelectomy varies by procedure but generally follows these guidelines:

• Pain Management: Mild to moderate pain is common, manageable with over-the-counter pain relievers like ibuprofen. Severe pain may require prescription medication.
• Activity Restrictions: Patients should avoid heavy lifting and strenuous activities for 4-6 weeks to prevent complications.
• Swelling and Bruising: Normal post-operative swelling or bruising typically resolves within weeks. Ice packs can help reduce swelling in the first 24 hours.
• Follow-Up: Regular check-ups monitor healing and semen parameters (typically assessed 3-4 months post-surgery, as spermatogenesis takes about 74 days).

Most patients return to work within 1-2 weeks, with full recovery expected within 6 weeks. Microsurgical and embolisation patients often recover faster than those undergoing laparoscopic procedures.

Risks and Complications

While varicocelectomy is generally safe, potential risks include:

• Infection: Though rare, infection can occur at the incision sites and is typically treatable with antibiotics.
• Haematoma/Seroma: This involves the collection of blood or fluid within the scrotum, which usually resolves on its own.
• Recurrence: Varicoceles may return in a few cases, particularly after laparoscopic or embolisation procedures.
• Hydrocele: A small percentage of individuals may experience fluid buildup around the testicle.
• Testicular Artery Injury: This is a rare complication, especially when microsurgical techniques are used, but it can potentially affect testicular function.
• Testicular Loss: The risk of testicular loss is exceedingly rare, occurring in less than 1% of cases.

Why Choose Dr Jonathan Teo

For individuals in Singapore seeking varicocele treatment, Dr Jonathan Teo provides in-depth experience in urology, having been a Consultant Urologist and Director of Andrology at the Singapore General Hospital.

Dr Teo is skilled in advanced microsurgical methods, which are associated with reduced complications and enhanced success rates. His approach emphasises patient-centered care, providing personalised consultations and developing treatment plans tailored to individual needs and fertility goals.

Book a consultation with Dr Teo today to get on the path towards improved reproductive health.