Microsurgical Varicocele Repair


Varicoceles have long been identified as the most common reversible cause of male infertility. 15% of men in the general population have a clinical varicocele (large dilated testicular veins in the scrotum) but the incidence in infertile men is much higher. 19%–41% of men with primary infertility and 45%–81% of men with secondary infertility having clinical varicoceles.

Signs and Symptoms

Most varicoceles are asymptomatic. However, they can be uncomfortable and cause scrotal pain. This pain is generally mild to moderate, occurs with long periods of sitting, standing or activity and is relieved by lying down. Although it can be uncomfortable before bedtime (after a long day of activity), it generally does not occur upon awakening after a night’s rest. The pain is dull, congestive‚ “tooth ache” like and generally doesn’t refer elsewhere. It is not associated with urination issues or erectile dysfunction; however, it is associated with male infertility. Lastly, when large, a varicocele can cause a clumpy “bag of worms” feel in the scrotum and can be bothersome for this reason as well.


Diagnosis and Indications for Surgery

Men with a history of infertility and varicoceles on physical exam are candidates for surgery if they have any of the following: abnormal semen analysis and/or low testosterone levels. Significant atrophy or decreased growth of the testes in adolescence is another indication. Sometimes a testicular doppler ultrasound is used to confirm the diagnosis.

Patient EDU

The Procedure:

A general anesthetic and local cord block with 1% plain lidocaine is used. A 2 cm incision in made at the bottom of the groin and the operating microscope is used to aid in the identification of the testicular arteries and veins. A microvascular doppler ultrasound is used to located and preserve the arteries. All veins are tied off. Absorbable sutures are used to close the incision.


What do expect after surgery and post-op instructions:

There may be some mild swelling and discomfort in the scrotum afterwards. Ice will help with scrotal swelling. Tylenol and ibuprofen are recommended for pain. Sometimes a stronger pain pill is prescribed if needed. Patients should wear a scrotal support or compression shorts for the first week to minimize swelling and discomfort. It is ok to shower but no tub soaking or swimming for 2 weeks. Patients may resume regular physical and sexual activity at 2 weeks.

Frequently Asked Questions

Are varicoceles dangerous?

Varicoceles are not life threatening, but rarely then can be associated with dangerous conditions. For example if a varicocele forms on the right side and not the left, it is important to make sure there is no mass or other abnormality in the abdomen that might be causing it.

Also, varicoceles should “reduce” or decrease in fullness when a patient is lying down since the gravity no longer fills the pampiniform plexus of veins. When a varicocele doesn’t reduce, it also raises concern that there is an abdominal blockage such as a mass or tumor that could be causing the mass.

Finally, it seems varicoceles almost always have effects on testosterone production. However, many men with varicoceles will maintain satisfactory levels of testosterone throughout their lives without treatment. In rare cases, however, varicocele could lead to severely low testosterone, with its associated complications including metabolic syndrome, diabetes, and osteoporosis.