The testicular veins are blood vessels which carry blood away from your testicle (towards your heart).
A varicocoele occurs when blood in flows the wrong way in the testicular veins (towards your testicle, away from your heart). This causes blood to pool in the testicular veins which becomes swollen. The swollen veins are known as a ‘varicocoele’.
A varicocoele is more common on the left side, but can occur on the right side, or both sides at the same time.
WHY IS VARICOCOELE REPAIR REQUIRED?
Varicocoeles are common, not dangerous, and often don’t require any treatment.
Sometimes varicocoeles can cause:
A visible mass/lump in the scrotum, which is often described as feeling like a ‘bag of worms’.
Pain in the scrotum.
Reduced fertility, due to impaired sperm production (Oligospermia).
Slow growth of the testicle during puberty (Testicular hypoplasia).
A varicocoele repair may be considered if a varicocoele is causing one or more of these issues.
WHAT DOES VARICOCOELE REPAIR INVOLVE?
A varicocoele repair (also called a varicocoele ligation or a varicocoelectomy) is an operation to ligate (tie off) the testicular veins where they enter your abdomen. This stops blood from flowing the wrong way and pooling in the testicular veins.
Varicocoele repair is performed in hospital under a general anaesthetic (completely asleep). It is performed as a minimally invasive ‘keyhole’ procedure using laparoscopic or robotic surgical equipment.
We inflated your abdominal cavity with carbon dioxide gas to create space to perform the operation. We make 3 – 5 keyhole incisions in your abdomen through which we insert the laparoscopic/robotic surgical instruments.
The testicular veins are located and clipped or cauterised.
After a varicocoele repair, your body will divert blood away from your testicle via an alternative vein, so the blood supply to your testicle will not be affected.
The operation is usually performed as day surgery – you can go home on the same day if you are accompanied by a responsible adult. Sometimes a one-night hospital stay is required.
WHAT IS THE RECOVERY AFTER VARICOCOELE REPAIR?
It is common to have a few days of mild to moderate pain in the wounds, your scrotum, and your shoulder/neck (from the gas in your abdomen) after the operation. This can usually be well controlled with tablet pain relief.
You will need to rest for the first day or two after the operation.
You will need to wear tight fitting scrotal support (such as speedos, a jock strap, or two pairs of tight underwear) for at least one week after the operation.
You can usually return to sedentary work two to four days after the operation.
You can usually return to gentle exercise approximately four days after the operation.
You will need to avoid strenuous exercise, cycling, and heavy lifting for at least three-four weeks after the operation.
You will not be able to swim for two weeks after the operation.
You can usually start driving two to four days after the operation.
You can resume sexual activity when you feel comfortable doing so. For most men this will be approximately two weeks after the operation.
WHAT IS THE CHANCE OF A SUCESSFUL OUTCOME WITH A VARICOCOELE REPAIR?
Varicocoele repair successfully stops blood pooling in the testicular veins in 90-95% of cases. Occasionally the varicocoele can recur in the future.
After varicocoele repair, the size of the mass in your scrotum should reduce, but it usually won’t go away completely.
If the operation is performed for pain, varicocoele repair should improve or resolve your pain. However, there are many different causes for scrotal pain. If the varicocoele isn’t the cause of your pain, it may not improve after the operation.
If the operation is performed to improve fertility, it can take 3 – 12 months for your sperm quality to improve. 50-70% of men who have a varicocoele repair will have improvement in sperm quality on testing. However, infertility is often due to multiple factors, so improved sperm quality doesn’t always increase your chance of having a pregnancy.
If you have a small testicle due to a varicocoele, varicocoele repair can lead to ‘catch up’ growth of the testicle in teenagers, but usually doesn’t result in increased testicular size in adult men.
WHAT ARE THE RISKS OF VARICOCOELE REPAIR?
Occasional risks (1/10 – 1/50)
- Problems with the wounds, including infection, the wounds splitting open, or developing a hernia.
- Developing a collection of fluid around your testicle (a hydrocoele), which may require further surgery to correct.
Rare risks (1/50 – 1/250)
- Bleeding in the abdomen, requiring a blood transfusion or another operation to correct.
- Infection in the abdomen, requiring antibiotics or another operation to correct.
- Damage to the blood supply to your testicle, causing your testicle to shrink or die.
Very rare risks (<1/250)
- Damage to another organ inside the abdomen, such as the bowel, requiring another operation to correct.
- Needing to convert from a keyhole operation to an open operation via a bigger incision.
The risks of anaesthesia have not been listed here.
WHAT ARE THE ALTERNATIVE TREATMENT OPTIONS?
- No treatment.
- Conservative management – tight fitting scrotal support, pain relief.
- Radiological embolisation of the varicocoele – inserting metal coils into the testicular vein by accessing it through a vein in your leg.
Open repair of the varicocoele – ligating the testicular vein through a single larger incision.