varicocelectomy

Varicocelectomy is a surgical procedure to ligate the dilated veins of the pampiniform plexus within the scrotum to treat a varicocele. Varicoceles are dilated veins that can impair venous drainage from the testis and may be associated with pain, testicular asymmetry, or reduced sperm quality.

Indications for varicocelectomy typically include infertility in men with a clinically evident varicocele and abnormal semen analysis, persistent scrotal pain, or testicular hypotrophy. It is not universally beneficial for all men with varicocele, and decisions are individualized. Alternatives include observation in selected cases or radiologic embolization.

Anatomy and approach: The varicocele most often involves the internal spermatic veins, usually on the left side, due to venous anatomy and valve competence. The goal of surgery is to interrupt the abnormal venous drainage while preserving arterial blood supply and lymphatics to reduce hydrocele risk and other complications.

Techniques: Varicocelectomy can be performed via open (inguinal or subinguinal), laparoscopic, or percutaneous radiologic embolization methods. The microsurgical subinguinal approach under magnification is widely favored for lower recurrence and hydrocele risk and better preservation of arteries and lymphatics. In the open approach, veins are ligated with careful attention to preserve arterial branches and lymphatics.

Outcomes and risks: Many men experience improvement in semen parameters after varicocelectomy, and some achieve spontaneous pregnancy. Recurrence rates vary by technique (roughly 1–15%), and hydrocele formation occurs in a minority (roughly 2–15%). Other complications include infection, arterial injury, and testicular atrophy.

Recovery: Most patients recover within 1–2 weeks and may resume light activity sooner. Strenuous heavy lifting should be avoided for several weeks.