Treatment for Varicocele

There are several treatment options for varicocele, depending on symptoms and seriousness of the condition.
If the varicocele is not causing any symptoms of pain and infertility is not an issue, no treatment is warranted. In cases of mild discomfort, the condition usually can be managed by wearing an athletic supporter or snug-fitting underwear during strenuous activity or exercise.

Treatment for varicocele is indicated in the following conditions:

a) Adolescent (age 12-18 years) with large varicocele and evidence of decreased testicular size.
    The size of testes on the side where varicocele is present, is smaller than the opposite side.
    Treatment is advised although the varicocele is not causing pain or other symptoms as it would improve function of the affected testes.

b) Any person with varicocele induced testicular pain.
    Pain is usually described as 'dragging' and worse with prolonged exercise or standing.

c) Varicocele that is men who are subfertile or infertile
    Correction of varicocele would result in 50%-70% improvement in men with low or poor sperm
    count
    

S H HO UROLOGY AND LAPAROSCOPY CENTRE

Treatment Options

Our centre offers the following treatment options for correction of varicocele:

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Open surgery (microsurgical)

Our centre practises the transinguinal approach where a small incision is made over the groin. The distended varicocele veins are identified with the aid of an operative microscope and surgically ligated and divided. The use of an operative microscope, which offers upto 6 X magnification, is necessary to identify clearly the dilated veins and avoiding injury to artery and lymphatics. Blood flow is re-routed to normal veins.

Laparoscopic Varicocelectomy

This the preferred technique in our centre. Dr Ho is a well-trained laparoscopic urology surgery who has extensive experience with laparoscopic varicocelectomy.

Under general anaesthesia, three small incisions (5mm each) are made in the abdomen. Varicoceles on the right or left or both can be approached. The abnormal veins are identified and clipped and divided.

Complications are uncommon and include wound infection (5%), bleeding leading to hematoma (5%), testicular artery injury (1%) and hydrocele formation (1-5%). Improvement in sperm counts of between 50-70% can be seen after 3 months. Pregnancy rates are between 10-20%.

Laparoscopic varicocelectomy incisions

Open varicocelectomy incision

Embolization of Varicocele

We have arrangements with an interventional radiologist to perform embolization of varicocele. Under mild sedation and local anaesthesia, a small puncture is made at the groin skin. A fine catheter is passed into the underlying vein and followed into the testicular vein.

An x-ray dye is injected to map out where the problem is and where to embolize or block. By using coils or balloons, blood flow to the varicosed veins is blocked and is re-directed to other healthy pathways. The entire procedure can be completed within 2 hours.

Results of embolization are comparable to other treatment modalities.
Our centre prefers to reserve the embolization option for cases of varicocele recurrence after a surgical ligation.

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Varicocele veins identified

Varicocele veins ligated with metal clips

Updated 21 June 09

pain

Adolescent

subfertile

Laparoscopic varicocele surgery (minimally invasive)

Open microsurgical surgery

Embolization

This procedure is done as a day surgery. Pain from the surgical wound is minimal and can usually be controlled with tablet painkillers. Return to work is expected within 2-3 days.

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Advantages of laparoscopic varicocele surgery over other techniques include:

 

1. Accurate identification of all the veins and avoiding injury to the artery and lymphatic vessels as the surgery is done under magnification during laparoscopy

 

2. Varicoceles from both sides of the body can be corrected at the same time without needs for further surgical incisions

 

3. Rapid recovery from surgery with minimal pain as the small 5mm wounds causes minimal trauma to tissue

 

Surgery is completed within 45 minutes, even in the case of varicoceles occurring on both sides. Patient can be discharged a few hours after surgery and return to work is within 48 to 72 hours.

 

Complications are rare. Injury to abdominal organs can occur in less than 1% of cases. Testicular artery injury (1%) and hydrocele formation (1-5%) is not common. Improvement in sperm counts can be expected in 50%-70% of patients within 3 months. Overall pregnancy rates are between 10-20%.