Varicocele surgery of the testicle

A varicocele usually exists from birth and is located on the left side. This is related to the special venous drainage conditions on this side. Acquired varicoceles, then also on the right side, are rarely possible. In this case, tumours can also be the cause of the varicocele.

Occasionally, varicoceles can cause symptoms in adolescents and young adults, associated with pain or a feeling of heaviness in the affected testicle. In most cases, however, a varicocele causes no symptoms. Asymptomatic varicoceles are often noticed when an unfulfilled wish to have children is investigated. Abnormalities are then frequently found in the microscopically examined ejaculate (semen analysis).

A varicocele is characterised by a dilated venous plexus in the area of the spermatic cord. This can be palpated from the outside as a swelling. In pronounced cases, it is even visible. An increase in temperature and reduced blood flow to the testicle as a result of the backflow of blood can sometimes lead to shrinkage of the affected testicle. A reliable diagnosis is possible by means of an ultrasound examination.

Varicocele surgery should only be performed if certain factors are present. These include in particular an abnormal semen analysis in the case of an unfulfilled wish to have children, pain or a reduced testicular volume in adolescents.

An ultrasound examination is sufficient to diagnose a varicocele. However, the mere presence of a varicocele does not necessarily have to be a reason for treatment. As further diagnostics, a microscopic examination of the ejaculate (semen analysis) is then usually required.

There are different procedures, all of which aim to prevent the backflow of blood into the venous plexus surrounding the spermatic cord. The ideal treatment method is selected by the experienced specialist in urology.

Surgical procedure:
Via a lower abdominal or inguinal incision, the testicular vein, which runs upwards to the renal vein and opens into it there, is located, ligated and cut. A laparoscopic approach is also possible. The procedure is performed under general anaesthesia.

Sclerotherapy procedure:
In antegrade sclerotherapy, the testicular vein is located via a small incision in the area of the scrotum and sclerosed by injecting a drug.
The principle of retrograde sclerotherapy corresponds to that of antegrade sclerotherapy, but here a leg vein is punctured and a thin catheter is advanced into the testicular vein under X-ray control. The sclerosing agent is then injected via this catheter. The sclerotherapy procedures can be performed under local anaesthesia, but the probability of recurrence is increased and pain syndromes can also occur.

Patients are admitted on the day of the operation. After the operation, inpatient treatment for 1–2 days is recommended. You should not work until one week after discharge and should take it easy physically.

In addition to the general risks of any operation, such as bleeding, inflammation and impaired wound healing, there are other special risks with varicocele surgery. For example, the testicle may shrink, and recurrence is also possible in rare cases. All possible risks of the surgical procedure are discussed in a detailed consultation before the operation.

In the case of pain, the prospects are very good that it will no longer occur after the operation. Even if there is already an abnormal semen analysis, sperm quality can improve and the man's fertility can thus be increased again. This is an important treatment for an unfulfilled wish to have children.