Varicocele treatment may not be necessary. However, if your varicocele causes pain, testicular atrophy or infertility, you may want to undergo varicocele repair. The purpose of surgery is to seal off the affected vein to redirect the blood flow into normal veins. However, the effect of varicocele repair on fertility is unclear.
Although varicoceles typically develop in adolescence, it’s less clear whether you should have varicocele repair at that time. Indications for repairing a varicocele in adolescence include progressive testicular atrophy, pain or abnormal semen analysis results.
Varicocele repair presents relatively few risks, which may include:
- Buildup of fluid around the testicles (hydrocele)
- Recurrence of varicoceles
- Damage to an artery
Repair methods include:
• Open surgery. This treatment usually is done on an outpatient basis, using general anesthetic or local anesthetic. Commonly, your surgeon will approach the vein through your groin (transinguinal), but it’s also possible to make an incision in your abdomen or below your groin.
Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.
You may be able to return to normal, nonstrenous activities after two days. As long as you’re not uncomfortable, you may return to more strenuous activity, such as exercising, after two weeks.
Pain from this surgery generally is mild. Your doctor may prescribe pain medication for the first two days after surgery. After that, your doctor may advise you to take over-the-counter (OTC) painkillers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to relieve discomfort.
Your doctor may advise you not to have sex for one to two weeks. You’ll have to wait three or four months after surgery to get a semen analysis to determine whether the varicocele repair was successful in restoring your fertility.
• Laparoscopic surgery. Your surgeon makes a small incision in your abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. This procedure requires general anesthesia.
• Percutaneous embolization. A radiologist inserts a tube into a vein in your groin or neck through which instruments can be passed. Viewing your enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure is done with local anesthesia on an outpatient basis. This procedure isn’t as widely used as surgery.