Varicocele surgery: causes, symptoms, complications and surgical treatment

Varicocele is a condition affecting the testicular veins, called spermatic ducts, which are located within the scrotum. These veins have the important task of draining blood from the testes. In the presence of varicocele there is a dilatation of them causing a situation similar to varicose veins on the legs.
The normal diameter of the spermatic veins is about 0.5-1.5 cm, while in individuals with varicocele they reach and exceed 2 cm.

Which are the symptoms of varicocele?

This alteration in the diameter of the testicular veins usually causes swelling at the affected testicle. Normally this is the only “alarm bell” that can be noticed. In some cases pain may appear in addition to the swelling and is more likely to occur :

  • After an intense exercise session
  • After particularly long sexual intercourse
  • After spending a long time in an upright station
  • If one has been in excessively hot environments, such as a sauna

 Which individuals are most affected?

Varicocele particularly affects young people between 18 and 25 years of age. More cases occur on the left side of the reproductive system, this is because of the location of the left testicular vein. However, it can also occur on the right side.

How is the diagnosis of varicocele made?

This problem can be diagnosed with an initial objective examination performed by inspection and palpation of the scrotum: the doctor is able to feel under the fingers the presence of a soft swelling.  The specialist can also use the transillumination test, that consists in placing a light source on one side: in case of varicocele this will appear opaque, not allowing light to pass through.

If this abnormal swelling is found, an ultrasound examination is performed.

The specialist must be able to assess the grade of the varicocele, which can be:

  • Grade I: presenting only with abdominal pressure
  • Grade II: a palpable but not visible swelling
  • Grade III: the varicocele is both palpable and visible.

Once the diagnosis of varicocele is made, the patient should do a Spermyogram to understand the status of the seminal fluid (sperm count and assessment of sperm viability).

What happens if varicocele surgery is not performed?

The Failure in treating this issue can lead to:

  • Testicular atrophy: that is, a reduction in the size of one or both testicles, caused by stagnation of venous blood at the level of the scrotum
  • Infertility: this is a reversible problem, caused by azoospermia, or reduced production and presence of spermatozoa in the ejaculate.

 How is varicocele surgery performed?

It is possible to undergo surgery for anterograde sclerotization: an outpatient treatment that is performed through radiological guidance (C-arm) under local anesthesia and light pharmacological sedation, in the presence of the anesthesiologist.

Following the surgical incision of the testicle, the urologist identifies the dilated vein, isolates it and inserts a radio-opaque cannula needle (visible by radiologic instrument).  The varicocele is then repaired by injecting a sclerosing drug that can close the affected vein. The wound is then sutured with resorbable stitches and a protective dressing is applied.

There is no hospital stay, and it is a minimally invasive, painless procedure with rapid postoperative recovery. The patient will be checked after one week.

How long does the surgery take?

The patient must present fasting, accompanied, and the affected area must be shaved.

The operation is performed in an outpatient surgical clinic, with a sterile field, in the presence of both the urology specialist and the anesthesiologist. Taking into account pre- and post-operative the total duration of the surgery is approximately sixty to ninety minutes.


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