All treatment options for varicocele repair are done on an outpatient basis and are generally very effective.
When treatment is recommended for varicocele, Dr. French and the Dallas Center for Pelvic Medicine recommend microsurgical subinguinal varicocele repair. This outpatient procedure allows the surgeon to visualize and avoid damage to vital structures that are intertwined with the varicocele, such as the vas deferens, testicular artery and lymph vessels. It also allows for rapid recovery and return to normal activity with minimal risk of complications.
Other treatment options include different techniques for surgical repair such as laparoscopic repair, inguinal ligation, or percutaneous embolization but these techniques can be associated with longer recovery or greater risk of complication
Inguinal or Retroperitoneal Approach – An incision is made in the low abdomen or groin region and the veins are tied off and cut. Both techniques are effective, but they also require cutting of muscle or fascia and this may increase pain during recovery.
Laparoscopic Varicocele Repair – Through several small incisions a camera and instruments are inserted into the abdomen and the dilated veins are clipped at this level. This technique is also very effective with a short recovery. Complication rate is very low but if they occur, complications can be more severe than other methods.
Percutaneous Embolization– This procedure is performed by a radiologist who threads accesses the varicocele through puncturing large veins in the leg. Coils or chemicals are used to plug the dilated varicocele veins. This procedure is also effective with minimal recovery. Though complications rare, if a complication occurs, it can be more severe than other methods.
Microsurgical Varicocele Repair– This is the preferred method of repair at the Dallas Center for Pelvic Medicine. It is done on an outpatient basis with the assistance of an operating microscope. First the patient is given anesthesia and then a small incision is made in the low groin area to access the spermatic cord. The veins are tied and cut while preserving vital structures such as lymph vessels, vas deferens (sperm duct), and testicular artery.
Recovery requires the patient to rest for the next several days but return to desk work is usually possible in 3-5 days. Strenuous activity should be avoided for a few weeks.
If the varicocele repair was done for male infertility, a semen analysis is checked about 4 months after surgery to assess improvement in sperm count.