Varicose vein surgery of the testicle for varicocele

A varicocele usually exists since birth and is located on the left side. This is due to the special venous drainage conditions on the left side. Acquired varicoceles are possible, though rarely, and can also occur on the right side. Tumours can cause varicoceles.

Occasionally, varicoceles can cause discomfort in adolescents and young adults, accompanied by pain or a feeling of heaviness in the affected testicle. Most of the time, however, a varicocele does not cause any discomfort. Non-symptomatic varicoceles are often noticed when determining the cause for difficulties having children. In this case, abnormalities are often found when microscopically examining the ejaculate (spermiogram or semen analysis).

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

A varicocele surgery should only be performed if certain factors are present. These include, in particular, a conspicuous spermiogram in case of difficulties having children, pain, or reduced testicular volume in adolescents.

An ultrasound examination is sufficient to diagnose a varicocele. However, the mere presence of a varicocele does not necessarily mean that treatment is required. For further diagnosis, a microscopic evaluation of ejaculate is necessary (spermiogram or semen analysis).

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

Surgical procedure:
The testicular vein, which runs upwards to the renal vein and opens there, is accessed, cut off, and severed via a lower abdominal or inguinal incision. A laparoscopic procedure is also possible. The procedure is performed under general anaesthesia.

Sclerosing procedure (sclerotherapy):
In antegrade sclerotherapy, the testicular vein is accessed through a small incision in the scrotum and sclerosed by injecting medication.
In retrograde sclerotherapy, the principle is the same as in antegrade sclerotherapy, but here a leg vein is punctured, and a thin catheter is advanced into the testicular vein under X-ray control. The scleroscant is then injected through this catheter. The sclerotherapy procedures can be performed under local anaesthesia. However, the likelihood of recurrence is increase and pain syndromes may occur.

Admission for the procedure takes place on the day of the surgery. After the operation, inpatient treatment is recommended for 1-2 days. During this time, the testicle should be elevated and cooled. It is recommended not to work for 1 week after being discharged and avoid physical exertion.

In addition to the general risks of any surgical procedure, such as bleeding, inflammation, and interruption of wound healing, there are risks unique to varicocele surgery. For example, the testicle may shrink, and in rare cases there may be recurrence. All possible risks of the surgical intervention are discussed in a detailed consultation before the procedure.

If the surgery was performed because the patient was experiencing pain, the chance that this will no longer occur after the procedure is very good. Sperm quality can improve and increase fertility. This is an important treatment in cases where the patient is having difficulty having children.