Our Services

Varicocele

Urology

Varicocele is an abnormal enlargement and twisting of the veins within the scrotum, similar to varicose veins in the legs. It most commonly affects the left testicle but can also occur on the right or both sides. Varicocele is a common cause of male infertility as it can negatively impact sperm quality and testicular function.

Symptoms

The symptoms of varicocele vary; some men may experience no discomfort, while others may have noticeable signs, including:

Swelling or a feeling of heaviness in the scrotum, worsening after prolonged standing or physical activity
Palpable enlarged veins in the scrotum, resembling a "bag of worms"
Dull pain or discomfort in the testicle, especially after exercise or standing for long periods
Decreased sperm quality, potentially leading to infertility
Testicular shrinkage (atrophy), where the affected testicle becomes smaller than the other

Causes and Risk Factors

Possible Causes

Venous valve dysfunction	Usually, small valves in the veins prevent blood from flowing backward. If these valves fail, blood pools in the veins, leading to enlargement.
Increased pressure in the left renal vein	Due to anatomical differences, the left testicular vein is more prone to pressure buildup, making left-side varicoceles more common. Tumors in left kidney may also increase the venous pressure leading to the development of varicocele.
Nutcracker Syndrome	A condition where the left renal vein is compressed between the superior mesenteric artery and the aorta, leading to increased venous pressure and varicocele formation.

Risk Factors

Most common in adolescents and young men (ages 15-25)
Prolonged standing or heavy physical activity
Genetic predisposition
Abnormal vein structure in the testicular area

Diagnosis

Valsalva Maneuver: The doctor asks the patient to hold their breath and strain to detect the enlarged veins while standing.
Scrotal Doppler Ultrasound: The most common and accurate diagnostic tool used to measure vein enlargement and abnormal blood flow.
Semen Analysis: If infertility is a concern, a sperm test can evaluate sperm count, motility, and morphology.
Advanced Imaging (CT Scan or Venography): It is used when an underlying condition, such as a kidney tumor, is suspected.

Treatments

Conservative Treatment
(For mild or asymptomatic patients)

Observation and regular follow-ups
Avoid prolonged standing or heavy physical labor
Wear a supportive scrotal suspensory to relieve scrotal pressure
Pain relievers to alleviate discomfort

Surgical Treatment
(For severe symptoms or infertility-related cases)

When varicocele causes significant discomfort or affects fertility, doctors may recommend surgical treatment.

Microsurgical Subinguinal Varicocelectomy

The most standard and effective method currently available
Uses a microscope to ligate veins while preserving the testicular artery and lymphatic vessels
Advantages: Low recurrence rate (1-4%), small incision, fewer complications, and fast recovery
Disadvantages: Requires microscope to operate; surgeons should have related experience

Laparoscopic Varicocelectomy

Small incisions are made in the abdomen to perform vein ligation using a laparoscope
Advantages: Suitable for patients with bilateral varicoceles
Disadvantages: Higher surgical risks (e.g., potential organ injury), higher recurrence rate

Percutaneous Embolization

A catheter is used to inject embolic agents (such as coils or sclerosing agents) into abnormal veins to close them
Advantages: Minimally invasive with a fast recovery
Disadvantages: Lower success rate and higher recurrence rate

Microsurgical Subinguinal Varicocelectomy

Microsurgical sub-inguinal varicocelectomy is a minimally invasive procedure designed to treat varicocele. This surgery utilizes microsurgical techniques and a high-powered microscope, allowing surgeons to precisely identify and ligate abnormal veins while preserving essential structures such as the testicular artery and lymphatic vessels.

Surgical Steps

Anesthesia & Preparation: The patient typically undergoes general anesthesia. A urinary catheter may be placed before the procedure to assist with urination.
Incision Placement: A small incision (about 3 cm) is made below the inguinal area (subinguinal approach).
Microscope Assistance: Using a high-powered microscope (10-12x magnification), the surgeon can visualize swollen veins, delicate testicular arteries (approximately 1 mm in diameter), and lymphatic vessels.
Vein Ligation: Abnormal veins are carefully ligated while preserving the testicular artery to maintain proper blood supply and prevent testicular atrophy.
Wound Closure: The incision is closed with sutures or staples and covered with a sterile dressing.

Advantages of the Surgery

Low Recurrence Rate
Medical studies indicate that microsurgical varicocelectomy has the lowest recurrence rate, ranging from 0.8% to 4%.
Fewer Complications
Microsurgical precision helps protect the testicular artery and lymphatic vessels, reducing the risks of testicular atrophy and scrotal hydrocele.
Minimally Invasive & Faster Recovery
Smaller incisions lead to less postoperative pain, and most patients can be discharged the next day and resume normal activities quickly.

Indications for Surgery

Male Infertility
Varicocele is strongly linked to male infertility, and surgery can improve sperm quality and increase the chances of conception.
Testicular Pain or Discomfort
For patients experiencing scrotal or testicular discomfort due to varicocele, surgery provides effective symptom relief.
Testicular Atrophy
If testicular shrinkage is detected in adolescents, surgery can help prevent further atrophy and support normal testicular development.

Postoperative Care

Activity Restrictions
Avoid strenuous exercise or heavy lifting for one-month post-surgery.
Wound Care
Keep the incision clean and dry, follow medical instructions for proper wound care, and attend scheduled follow-up appointments.

It generally does not directly impact erectile function, but if left untreated for a long time, it may lower testosterone (male hormone) levels, indirectly affecting libido.

No, once varicocele develops, it will not resolve on its own. If symptoms are severe, medical treatment may be necessary.

If there are no significant symptoms or fertility issues, observation is an option. However, if there is pain, infertility, or testicular atrophy, doctor may recommend surgical treatment after evaluation.

Most patients can resume light activities within 1-2 days. Strenuous exercise should be avoided for 2 weeks. Regular physical activities and sexual function can typically resume after about 1 month.

Semen quality usually improves within 3-6 months, as the sperm production cycle takes approximately 72-90 days.

Microsurgical varicocelectomy has a low recurrence rate (about 1-4%). Other methods (such as laparoscopic surgery or embolization) have a higher recurrence rate.