Varicocelectomy is a surgery that removes swollen veins inside the scrotum, called varicoceles. There aren’t any medications that treat or get rid of varicoceles, so your doctor may recommend surgery to remove them if they cause symptoms such as pain or infertility.
What Are Varicoceles?
Varicoceles are veins in the scrotum, the pouch of skin where the testicles are held, that have become swollen or enlarged. They’re a fairly common problem; it’s estimated that 1 in 6 men have a varicocele.
“Fifteen percent of men have varicoceles, but not all of these men have fertility problems or have pain,” says Jesse Mills, MD, a urologist and director of the Men’s Clinic at UCLA in Los Angeles.
Varicoceles are similar to the varicose veins you might get in your legs in that the veins become swollen and twisted. Varicoceles are visible through your skin. As they are larger than they should be, these veins can cause blood to build up in your scrotum or even flow backward into the testicles.
Varicoceles typically start to form during puberty. In most cases, varicoceles don’t cause any problems or symptoms, but there can be complications such as:
- Dull, aching, or throbbing pain in the scrotum that may ease when you lie down
- Male infertility
- Reduced or trouble with testosterone production
- A heavy feeling in the scrotum
- Shrunken testicles (testicular atrophy)
- Swelling in your scrotum or testicles
- A soft lump above one or both testicles that feels like a “bag of worms”
Studies show that varicoceles can be the cause of infertility in about 40% of men who are trying to have their first child. That number goes up to about 80% when it comes to having the second child.
During puberty and the teenage years, varicoceles can prevent the testicles from growing normally.
“Teenagers may have a size discrepancy between their testicles, where the side that has the varicocele is not growing at the same rate as the side that does not,” says urologist Boback Berookhim, MD, director of the male fertility and microsurgery program at Northwell Lenox Hill Hospital in New York City.
How common are varicocelectomies?
Surgeons perform an estimated 70,000-80,000 varicocelectomies every year, more than any other procedure to correct male infertility.
How Are Varicoceles Diagnosed?
You and your doctor will discuss your medical history and any symptoms you may be having, such as pain in your scrotum. You then will undergo a physical exam. Your doctor will ask you to take a deep breath, then hold it and push as if you were straining to poop. This breathing method, called the Valsalva maneuver, will help make your varicocele easier to feel while your doctor examines you.
You may undergo more tests, including:
- Pelvic ultrasound, an imaging test that will provide pictures of the inside of your scrotum
- Semen analysis, in which you provide a semen sample to check your sperm count and the health of your sperm (usually done to identify a fertility problem if you have been trying without success to start a pregnancy)
- Blood test, to measure the levels of hormones such as follicle-stimulating hormone (FSH) and testosterone
Who should undergo varicocele surgery?
Not everyone who has a varicocele will need surgery. It is typically recommended in three circumstances:
- Your varicocele causes you pain
- Your varicocele makes you infertile
- You are a teenager whose varicocele prevents your testicles from growing normally
If you have a varicocele that does not give you any trouble, you won’t need surgery.
“The surgery, in expert hands, is minimally risky, but if there is no clear indication to fix, I would leave it alone,” Mills says.
How to Prepare for a Varicocelectomy
You’ll undergo a thorough physical exam to check your overall health to get cleared for surgery. An important part of this exam will be a review of the medications that you take, as some medications can cause problems during surgery, and you will need to stop taking them temporarily before your procedure. For example, blood thinners such as aspirin can boost your risk of bleeding. Other common medications that also make you more likely to bleed include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Follow your doctor’s instructions on how long before surgery you should pause taking these drugs. Expect a week to 10 days.
The list you give your doctor should include everything you take, not just your prescription drugs. “Disclose every drug, recreational, prescribed, and over-the-counter, including supplements, to the surgeon and anesthesiologist so they can tell you what to stop ahead of the procedure,” Mills says.
You’ll also likely discuss the following topics with your doctor in order to prepare for your surgery:
Allergies. You will discuss any allergies that you have, as they can complicate your surgery.
Eating. You will be given instructions on when to stop eating before your surgery. You likely will have to fast starting at midnight the night before your varicocelectomy.
Eat a healthy, protein-heavy diet in the weeks prior to surgery, Mills says. “Increase protein intake by about 60 grams a day to provide lots of nutrition for wound healing.”
Diabetes. If you have diabetes, managing your blood sugar level in the weeks before and after surgery is critical to prevent infection and heal properly, Mills says.
Transportation. Finally, be sure to make arrangements for someone to take you home. You will not be able to drive yourself home.
Varicocelectomy Surgery
This is a surgery to remove the varicoceles by cutting the veins and then closing off their ends. This allows blood to flow into healthy veins inside your scrotum.
There are three main approaches to this surgery:
- Open microsurgery, in which your surgeon makes incisions, or cuts, above your scrotum in order to reach your varicoceles
- Microsurgery, in which the surgeon operates with a microscope and very tiny instruments through very small cuts in the area a little higher than your groin.
- Minimally invasive surgery, in which your surgeon reaches your varicoceles through your abdomen and uses small tools to complete the procedure.
The type of procedure that you will undergo depends on your surgeon’s preference, Berookhim says. No matter which procedure you have, you will sleep through it under general anesthesia. You can plan to go home the same day.
Open surgery
The two main types of open surgery for varicoceles are:
Inguinal ligation. During inguinal ligation, your surgeon makes a cut in your groin just below your abdomen in a spot called your inguinal canal. From there, your surgeon continues down into your scrotum to locate and tie off (ligate) the varicoceles. Your surgeon may choose this approach if your varicoceles cause pain, as it allows your surgeon access to your ilio-inguinal nerve, which can be cut to permanently relieve pain.
Subinguinal ligation. During this type of procedure, your surgeon makes a slightly lower cut than in an inguinal ligation. According to Mills, this procedure is the gold standard. “It has the fewest side effects, the lowest risk of recurrence, and the fastest recovery of any surgical approach,” he says.
Microsurgery
In a microsurgical varicocelectomy, the surgeon uses a high-powered microscope to find the right veins. This process can easily identify the veins to be removed and distinguish them from those that need to be preserved.
Your surgeon will make many very small cuts in the area a little higher than your groin. The exact spot depends on the procedure. Next, they will tie up the small veins and remove the varicoceles. This procedure can take as little as 45-60 minutes to complete if the varicoceles are found on only one side of your scrotum. Your surgeon will need about twice that amount of time if you require repairs on both sides of your scrotum.
Inguinal ligation and subinguinal ligation are approaches also used for microsurgery.
Minimally invasive surgery
In minimally invasive surgery, your surgeon makes tiny cuts and inserts surgical tools and a tiny camera that will guide the procedure. Minimally invasive surgery, in general, causes less pain and has a shorter recovery time than open surgeries.
There’s one type used to repair varicoceles.
Laparoscopic surgery is a minimally invasive surgery performed on the stomach or pelvic area in which a camera mounted on a rod and tiny tools are inserted into your abdomen. For a varicocelectomy, your surgeon will use the camera to guide those tools through the abdomen to the varicoceles that need repair and fix them. According to Berookhim, it’s possible to injure the abdominal organs as the tools and camera move through it. For that reason, he typically prefers microsurgery. Laparoscopic surgery, which typically takes 30-40 minutes, also has lower long-term success rates than open surgery.
What Happens After a Varicocelectomy?
Immediately after your procedure, you’ll be moved to a recovery room where you’ll wake up from your anesthesia. You may feel some soreness, but the pain is typically mild. Depending on the type of procedure you had, you should expect to stay in the recovery room for at least an hour before you head home. Mills says subinguinal ligation surgery offers the fastest, least painful recovery.
“Most men do not need pain medicine stronger than acetaminophen [Tylenol] or ibuprofen and are discharged within an hour of the end of surgery,” Mills says.
How to Recover From a Varicocelectomy
As you can go home after a varicocelectomy the same day, you’ll likely be able to return to work within a few days of surgery, provided you don’t have a very physically demanding job. “Most people are up and around the following day,” Berookhim says. “But do nothing strenuous for about a week afterward.”
Swelling and bruising in your groin should be gone within a month, but the area may feel tender for as long as six weeks. Remember, not everyone recovers at the same rate, so your recovery timeline may be longer — or shorter.
As you recover at home, you may need help from someone at home. It’s important that you follow your doctor’s instructions when it comes to taking medicines and caring for your incisions.
To help lessen the pain after your surgery, apply an ice pack to your scrotum in 10-minute intervals for the first couple of days. This helps lower the swelling. You also can take NSAIDs for pain if your doctor doesn’t tell you not to.
Your doctor will also tell you to:
- Avoid having sex for the next one or two weeks
- Avoid submerging your incision in water until it’s fully healed
- Try not to do any heavy lifting or vigorous activity
- Try not to strain when using the bathroom, and take a stool softener if necessary
- Eat high-fiber foods such as fruits, vegetables, and whole grains, and drink plenty of water to prevent constipation
To make sure you’re healing properly, your urologist will schedule a follow-up appointment with you. In the case of infertility, your doctor will order a semen analysis three or four months after the varicocelectomy.
“If a man is actively trying to initiate a pregnancy, it’s important for him and his partner to know it will take at least four months and sometimes up to a year to see maximal improvement in sperm parameters,” Mills says.
What Are the Risks of Having a Varicocelectomy?
As with many surgeries, there are some possible risks and complications with varicocelectomy procedures. The most common complication is called a hydrocele. This is a fluid-filled sac that can form around a testicle. Swelling, pain, and a feeling of heaviness are possible symptoms. About 1 in 20 people who undergo a varicocelectomy have this complication. While it may go away on its own, it may need to be drained or surgically repaired, Mills says.
While they are rare, serious complications include:
- Bleeding
- Infection
- Blood clots in your legs
- Injury or damage to your testicle
- Atrophy, or shrinking of your testicle
- Chronic pain
The procedure also carries with it the risks linked to using anesthesia.
While the purpose of varicocelectomy procedures is to remove the varicoceles, there’s a chance they can come back. It’s estimated up to 15% of men will have their varicocele come back after surgery.
Research shows that about 60% of men see an improvement in the quality of their semen after this procedure, but varicocelectomy surgery isn’t guaranteed to cure male infertility.
If you have any of the following complications after your varicocelectomy, you should contact your doctor right away:
- Signs of an infection near your incision
- A fever of more than 100.4 F
- Swelling or pain that doesn’t go away
- Pain or swelling in your legs
- Constant nausea and vomiting
Can a varicocelectomy cause infertility?
It’s possible that a surgeon could mistake your vas deferens for a vein and cut it, Mills says. The vas deferens is a tube that helps move sperm from the testicle into your semen when you ejaculate. If it’s cut, it can’t do its job. But you have two of them — one for each testicle. So, even if your surgeon cuts one vas deferens, you wouldn’t be infertile as long as the remaining vas deferens is linked to a healthy testicle. But you likely would have a lower sperm count, which could make starting a pregnancy more difficult.
Takeaways
A varicocelectomy is a very commonly performed surgery. It’s done to repair swollen veins in the scrotum called varicoceles. These can cause pain and infertility. No medications treat varicoceles, so you will require a varicocelectomy if you have symptoms that bother you.
Varicocelectomy FAQs
Can I masturbate after a varicocelectomy?
You should wait a week to allow yourself to heal, during which time you likely will feel too sore to masturbate or have sex.
How long does a varicocelectomy surgery take?
It depends on a few factors: the type of surgery, whether you have varicoceles on both sides of your scrotum, and your surgeon’s skill and experience. Laparoscopic surgery typically takes 30-40 minutes, while open surgery can take about an hour. Double the time if you have varicoceles on both sides of your scrotum.
How much does a varicocelectomy cost?
That will depend on your health insurance coverage. Most policies cover the procedure, but out-of-pocket costs vary widely. That, says Mills, makes it impossible to give a general estimate of the cost.
