What Are the Surgical Options for Varicocele? Doctor Explains Treatment and Postoperative Care

Varicocele is a common male urological issue characterized by the abnormal enlargement of veins within the scrotum. While some mild cases may not cause significant discomfort and might not require special treatment, the condition typically doesn't resolve on its own. When symptoms like a feeling of heaviness or discomfort in the scrotum, pain, or testicular atrophy appear, it is recommended to get a medical check-up. In severe cases, varicocele surgery may be necessary.

Understanding Varicocele Before Surgery: Causes and Symptoms

Varicocele refers to the abnormal enlargement and twisting of the veins in the male scrotum that are responsible for returning blood from the testes. It is similar to varicose veins in the legs. This condition most commonly affects males between the ages of 15 and 35, particularly adolescents and young adults. Studies show that approximately 10% to 15% of men experience varicocele to varying degrees, with the left side being more frequently affected.

In females, the corresponding veins are the ovarian veins. Degeneration or reflux in the ovarian veins can cause discomfort and may be associated with venous degeneration in the legs. When treating venous disorders in the legs, reproductive veins—male testicular veins and female ovarian veins—should also be considered.

Causes of Varicocele

The primary cause of varicocele is related to dysfunctional venous valves. When blood cannot flow smoothly back to the heart, it pools in the veins, increasing pressure and causing the vessels to enlarge. Contributing factors can include prolonged standing, increased abdominal pressure (such as from chronic coughing or constipation), or an inherent structural abnormality of the veins.

Symptoms of Varicocele

While some individuals may not experience any obvious symptoms, others might feel a dull ache, a heavy or dragging sensation in the scrotum, or general discomfort. This is often more noticeable after standing for a long time or after physical activity. In severe cases, a varicocele can lead to testicular atrophy or affect sperm quality, which can impair fertility.

Q: Is Varicocele Graded?

Clinically, varicoceles are typically graded based on the results of a physical exam, which includes both palpation and visual inspection. The classification is as follows:

What Are the Interventional Surgical Options for Varicocele?

When a varicocele causes discomfort, affects testicular function, or impairs fertility, a doctor may recommend surgical treatment. The common surgical options for varicocele include the following:

1. Minimally Invasive Varicocele Embolization

This procedure involves making a small incision in the groin to access the problematic veins. A catheter is then guided to the varicocele, where the vein is blocked to reduce or eliminate the varicose veins. This method is often guided by non-toxic magnetic resonance venography to assess its feasibility and effectiveness before treatment in a hybrid operating room or catheterization lab.

Advantages:

• Almost no incision.
• Allows for precise localization of the gonadal veins and assessment of collateral circulation to determine the scope of intervention.
• Does not affect the testicular artery or lymphatic vessels, eliminating the risk of testicular atrophy.
• Can evaluate other potential pelvic conditions before the procedure to reduce complications.

Disadvantages:

• It may take 1-2 months for the varicocele to fully resolve after the procedure.
• Multiple interventions may be required to achieve the best results.

2. Microsurgical Subinguinal or Inguinal Ligation

This procedure involves a small 1-2 cm incision above the scrotum. Using a microscope with 10-12x magnification, the surgeon precisely separates the veins, preserving the testicular artery and lymphatic vessels, and then ligates the varicose veins. The advantage of this surgery is its ability to clearly identify and preserve tiny structures, which lowers the risk of testicular atrophy and postoperative scrotal swelling.

• Risks: Surgical infection, bleeding, postoperative pain, scrotal swelling, testicular artery injury, varicocele recurrence
• Side Effects: Scar formation, temporary scrotal swelling or discomfort in some patients. Overall, microsurgery has lower complication and recurrence rates compared to other techniques.

3. High Ligation (Retroperitoneal) Surgery

A 2–3 cm incision is made above the inguinal region to ligate the swollen veins.

• Risks: Highest recurrence rate
• Side Effects: Larger incision, more pronounced postoperative pain

4. Laparoscopic Surgery

Three to four small abdominal incisions (0.5–1 cm) are made to insert a laparoscope and surgical instruments. The veins are ligated in the abdominal cavity or retroperitoneal high position under image guidance.

• Risks: Requires general anesthesia, about 3 days of hospitalization
• Side Effects: Possible injury to intestines, blood vessels, or nerves; may cause peritonitis or pulmonary embolism

5. Traditional Inguinal Surgery

A roughly 5 cm incision is made in the inguinal region to isolate and ligate the enlarged veins. Magnification may be used, but not as high as in microsurgery.

• Risks: Difficult to ensure complete removal of varicose veins
• Side Effects: Noticeable postoperative pain, higher rates of severe complications and recurrence

Are Varicocele Surgery Costs High?

The cost of varicocele surgery depends on the surgical method, whether a microscope is used, and if it is self-paid. Currently, aside from microscope-assisted inguinal varicocelectomy, which is generally self-paid, most standard varicocele surgeries are covered by Taiwan’s National Health Insurance (NHI).

However, according to NHI regulations, even with coverage, patients are required to pay 1/10 of the total cost out-of-pocket. Actual costs may vary depending on the hospital, equipment used, anesthesia type, and other factors. It is recommended to confirm the precise cost with the hospital prior to surgery.

Below is a summary of common varicocele surgery types, approximate costs, and key features:

Varicocele Surgery: Pre- and Post-Operative Care

A successful varicocele surgery relies not only on the surgeon's skill but also on the patient's preparation and post-operative care. The following is a summary of common pre- and post-op considerations to help you have a smooth recovery.

Pre-Operative Precautions

• Provide complete medical history – Inform your doctor about chronic illnesses, bleeding disorders, allergies, or current medications, especially blood thinners.
• Follow fasting instructions – If general anesthesia is required, usually no food or drink 6–8 hours before surgery to reduce the risk of vomiting or aspiration.
• Discontinue certain medications – Follow your doctor’s instructions to stop medications like aspirin, vitamin E, or fish oil a week before surgery if they affect blood clotting.
• Arrange post-op support – Have a family member or friend accompany you on the day of surgery to ensure safe transportation and care afterward.
• Stay relaxed – Maintaining a calm mindset can help the procedure and recovery go smoothly.

Post-Operative Precautions

• Wound care – Keep the incision clean and dry; avoid moisture. Return to the clinic if you notice discharge, redness, or unusual pain.
• Avoid strenuous activity – Refrain from heavy lifting, intense exercise, or excessive walking for 1–2 weeks to prevent increased abdominal pressure from affecting wound healing.
• Monitor swelling and discomfort – Mild swelling is normal. If swelling worsens significantly or is accompanied by fever, contact your doctor promptly.
• Follow medication instructions – Take prescribed painkillers or antibiotics on schedule to reduce discomfort and prevent infection.
• Follow-up appointments – Attend all scheduled check-ups to monitor wound healing and recovery progress.
• Sexual activity – Avoid sexual activity for at least one month post-surgery to allow proper healing of the surgical site.

Common FAQs About Varicocele Surgery

Q1: How long does postoperative pain from varicocele surgery last?

For most people, the pain will gradually subside within 3 to 7 days after surgery. A small number of individuals may experience mild discomfort for about 1 to 2 weeks. If your pain worsens or doesn't go away, it's best to see your doctor for an evaluation.

Q2: Does varicocele surgery require general anesthesia?

It depends on the type of surgery. Minimally invasive embolization and microsurgery/traditional surgery are often performed under local or spinal anesthesia, while laparoscopic surgery requires general anesthesia. Your doctor will assess your individual situation to determine the most suitable type of anesthesia for you.

Q3: Is there a high risk of varicocele surgery failing?

In general, the success rate for varicocele surgery is high. Microsurgery, in particular, has a recurrence rate of less than 5%. However, a small number of cases may still experience recurrence, infection, or other complications. Therefore, it is highly recommended to choose an experienced specialist to perform the surgery.

Q4: How long is the recovery period after varicocele surgery?

Daily activities can usually be resumed gradually within 1 week. Exercise is generally recommended 3–4 weeks post-surgery. For those planning to conceive, semen quality should be evaluated 3–6 months after surgery.

Q5: How long does varicocele surgery take?

The duration of the surgery depends on the method used. A minimally invasive embolization or microsurgery typically takes about 1.5 to 2 hours, while a laparoscopic procedure takes around 1 hour.

Q6: When can sexual activity be resumed after surgery?

It is generally advised to avoid sexual activity for at least 1 month after varicocele surgery to allow the surgical site to heal properly and reduce the risk of bleeding or pain.

Q7: Are post-operative complications common?

Most patients recover well. Complications after varicocele surgery are relatively rare but may include scrotal swelling, infection, or, in a few cases, recurrence.

Which Medical Department Is Recommended for Varicocele Surgery?

Varicocele is a vascular abnormality. Although it occurs in the male reproductive system, the underlying issue is impaired blood return. Therefore, besides urology, many patients choose cardiovascular surgeons with expertise in vascular surgery for treatment.

Dr. Huang Yao-Guang has extensive experience in managing peripheral vascular diseases, including varicocele surgery. If you are considering treatment for varicocele, you are welcome to consult Dr. Huang’s Cardiovascular Surgery Clinic, where a professional cardiovascular surgical team can evaluate and recommend the most appropriate treatment for you.