If your partner has a varicocele, he may be considering surgery as a treatment option. While you won’t be the one having surgery, you may still have some concerns: What does varicocele surgery involve? What are the risks? Will it work? Is it the only option?
First, varicoceles are common. This dilated collection of blood vessels around the testicles and in the scrotum is present in 15% of men.[i] While a varicocele can cause pain or discomfort, the more common reason to have surgery is infertility. About 40% of couples with infertility, or difficulty getting pregnant after at least 12 months of unprotected intercourse, have a varicocele as a contributing factor.[ii] As your partner considers treating his varicoceles with surgery, here are some things you should be thinking about as you try to support him in his decision.
9 Things You Need to Know About Varicocele Surgery
1. Technique – There are several different types of varicocele surgery for the treatment of varicocele related infertility. The success rate and risks of the surgery can vary by the approach.
- Open varicocelectomy – This type of surgery involves an incision in the groin to gain access to the blood vessels causing the varicocele. Once accessed, the blood vessels are tied off.
- Microsurgical varicocelectomy – This approach involves an incision in the groin, similar to the open approach, but uses a microscope to better visualize and locate the affected blood vessels. This surgery takes more time to perform.
- Laparoscopic varicocelectomy – This approach involves several small incisions in the abdomen for the insertion of surgical equipment, including a specialized camera, or scope, to locate the blood vessels.
2. Anesthesia – Open and microsurgical varicocelectomy can be performed under local anesthesia which involves the injection of numbing medication or an injection in the spine. Laparoscopic surgery requires the use of general anesthesia, where the patient is completely unconscious; a breathing machine is needed. General anesthesia has more side effects, such as confusion or nausea with or without vomiting, than other types of anesthesia.[iii]
3. Risk of varicocele recurrence – A varicocele will return 1-15% of the time, depending upon the approach. Recurrence is less likely with the microsurgical technique.[iv]
4. Risks with varicocele surgery – Any surgery includes the risks of bleeding and/or Here are the major risks with varicocele surgery:
- A hydrocele, or a collection of fluid, can develop in the scrotum. This can occur in up to 9% of patients with the open approach and is < 1% likely with the microsurgical approach.[iv] Another surgery may be needed to correct the hydrocele.
- The artery that supplies blood to the testicle may be accidentally injured. This happens 12-24% of the time with open varicocelectomy and < 1% of the time with microsurgical varicocelectomy.[iv]
5. Improvement in sperm – The number and health of the sperm can improve after varicocele surgery. It typically takes about 3 months for this to happen.[v]
6. Pregnancy after varicocele surgery – It is possible to become pregnant following varicocele surgery. The first-time pregnancy rate is 26-43% following varicocele surgery.[iv]
7. Length of recovery – It can take up to 3 weeks to recover from varicocele surgery. Heavy lifting should be avoided for the first week.
8. Having sex after varicocele surgery – You should wait 4 weeks after surgery before resuming sexual intercourse.
9. Alternatives to varicocele surgery – There is a minimally invasive alternative to surgery, called varicocele embolization.
If you’re hoping to avoid surgery, you should ask your doctor about varicocele embolization, the minimally invasive treatment for varicocele infertility. An interventional radiologist, a specialized medical doctor, uses imaging guidance to locate and close off the blood vessels that supply the varicocele. Here’s a quick summary of the procedure:
- Through a small nick in the right groin, a catheter is placed within the femoral vein.
- Using x-rays, the catheter is guided into the blood vessels that are feeding the varicocele.
- The blood vessels feeding the varicocele are blocked off with a small coil, and/or a sclerosant (a specialized chemical that when injected into the varicose vein causes it to clot).
- Special dye, called contrast, is injected through the catheter to confirm that the blood is flowing away from the varicocele.
- The catheter is removed and a small bandage is placed over the puncture site in the groin.
This outpatient procedure is performed with only the need for a small injection of numbing medication in the skin. The risk of hydrocele and arterial injury are very low.[iv] Varicocele embolization has a 90% success rate and the chance of pregnancy after the procedure is 30-50%.[iv,vi] Most men report feeling close to normal within 1-2 days and are back to regular activities within 7-10 days. It is usually safe to have sexual intercourse after 2 weeks.
Now that you’re aware of some of the facts about varicocele surgery, you can make the best decision about what treatment to choose. If your partner is interested in avoiding surgery, encourage him to ask his doctor for more information about varicocele embolization. Look for an interventional radiologist in your area who specializes in this minimally invasive procedure and set up a consultation. You should try to attend the consultation because, in addition to supporting your partner, you can provide input about your goals in terms of having a family.
[i] Choi, W., and Kim, S., Current Issues in Varicocele Management: A Review. World J Mens Health, 2013. 31(1): p. 12-20. http://wjmh.org/DOIx.php?id=10.5534/wjmh.2013.31.1.12
[ii] American Society for Reproductive Medicine, Male Infertility. http://www.reproductivefacts.org/topics/detail.aspx?id=1331 (accessed 7/31/2016)
[iii] American Society of Anesthesiologists, Effects of Anesthesia. https://www.asahq.org/whensecondscount/patients%20home/preparing%20for%20surgery/effects%20of%20anesthesia (accessed 8/1/2016)
[iv] Kupis, L., Dobronski, P.A., Radziszewski, P., Varicocele as a source of male infertility – current treatment techniques, Cent European J Urol, 2015. 68: p. 365-370. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643713/ (last accessed 7/31/2016)
[v] Al-Adl, A.M., El-Karamany, T., Issa, H., Zaazaa, M., The influence of antisperm antibodies, intratesticular haemodynamics and the surgical approach to varicoceletomy on seminal variables. Arab Journal of Urology, 2014, 12(4): p. 309-317. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435656/ (accessed 8/18/2016)
[vi] Cantoro, U., Polito, M., Muzzonnigro, G., Reassessing the role of subclinical varicocele in infertile men with impaired semen quality: a prospective study. Urology, 2015, 85(4): p. 826-30. http://www.ncbi.nlm.nih.gov/pubmed/25817105 (accessed 8/4/2016)