Background Information:

What are the other Names for the Procedure?

• Microscopic Sub-Inguinal Varicocelectomy
• Varicocelectomy

What is the Varicocele Removal surgical procedure?

• Varicocele Removal (or Varicocelectomy) is a procedure that involves the removal of the varicocele, in males
• The varicocele is a group of veins in the scrotum (spermatic cord veins) that are dilated, distended, and twisted

What part of the Body does the Procedure involve?

The Varicocele Removal procedure involves the scrotum and its contents (usually the left testis), and the varicocele.

Why is the Varicocele Removal surgical procedure Performed?

The Varicocelectomy procedure is performed to:

• Relieve the patient from discomfort
• Reduce the congestion
• And sometimes, help improve the sperm quality and quantity

What are some Alternative Choices for the Procedure?

A few alternate choices to this procedure are:

• Laparoscopic surgery
• Percutaneous transvenous embolization

What are the Recent Advances in the Procedure?

Various non-invasive procedures are being developed to carry out the procedure, with as little pain as possible and to ensure a quicker recovery.

What is the Cost of performing the Varicocele Removal surgical procedure?

The cost of Varicocele Removal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Varicocele Removal procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.healthcommunities.com/varicocele/patient-information/questions-to-ask-doctor.shtml

http://www.maleinfertility.org/new-varicocelectomy.html

Prior to Varicocele Removal surgical procedure:

How is the Varicocele Removal surgical procedure Performed?

Microscopic Sub-Inguinal Varicocelectomy is one of the efficient methods for performing this surgery.

• Sub-inguinal refers to the location, where the incision is made. A single incision is made, about 1 inch above the penis and 1 inch, to either side
• The spermatic cord is then identified and the affected veins are cut and removed carefully, ensuring that the other veins are not harmed
• The surgeon performs the delicate part of the surgery by looking through a large microscope. It gives a much clearer view to the surgeon, reducing the chances of damage to other veins and arteries
• The spermatic cord is then placed back; the tissues are closed carefully, layer by layer. The skin is then closed with sutures; sutures that are later absorbed by the body

Where is the Procedure Performed?

A Varicocele Removal procedure can be performed in a surgical facility at a hospital, or at an out-patient surgical facility.

Who Performs the Procedure?

An urologist or a general surgeon performs the Varicocele Removal surgery.

How long will the Procedure take?

The procedure to remove a varicocele, usually takes between 1-2 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform your physician, if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Varicocele Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Varicocele Removal surgical procedure?

Prior to a Varicocele Removal procedure, the patient may need to undergo certain tests, such as:

• Routine blood test
• Routine urine examination
• Ultrasound of the scrotum

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Varicocele Removal procedure?
• Why is this procedure necessary?  How will it help?
• What does the procedure involve?
• Will I need adjunct treatments after the surgery?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed? 
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• How many such procedures have you (the physician) performed?
• What are the costs involved?

During the Varicocele Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Anesthesia is injected either in the spine (spinal anesthesia), or administered locally (local anesthesia). In some cases, general anesthesia may need to be administered.

How much Blood will you lose, during the Procedure?

The blood loss is very minimal and no transfusion is generally required, unless any complications arise.

What are the possible Risks and Complications during the Varicocele Removal surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Inadvertent injury to the spermatic cord
• Excessive bleeding
• Infection
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Varicocele Removal surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. However, sperm examinations are to be carried out regularly post-operation.

After the Varicocele Removal surgical procedure:

What are the possible Risks and Complications after the Varicocele Removal surgical procedure?

Post Varicocele Removal procedure, the following complications may arise:

• Surgical wound infection
• Difficulty with urination
• Development of a hydrocele (a fluid-filled cyst formed around the testicle)
• Atrophy (shrinkage of the affected testicle)
• Sperm quantity may be affected

What is the Prognosis after the Surgery?

• The Varicocele Removal surgery is normally successful and no complications are seen, most of the time
• About 5-20% of the cases experience a recurrence
• 50% of those individuals, who undergo the procedure to correct infertility, regain fertility in about a year’s time

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Infection at the surgical site
• Fever, dizziness, or nausea
• Pain, swelling, or redness
• Formation of cysts

What Post-Operative Care is needed at Home after the Varicocele Removal surgical procedure?

At home, the following post-operative care is recommended, after a Varicocele Removal procedure:

• Take the painkillers and antibiotics, prescribed by the physician
• Avoid all activities that are physically strenuous for about 2-3 weeks after surgery
• Wear a jockstrap (athletic supporter) for a period of 2 months

How long does it normally take to fully recover, from the Procedure?

It takes about 1 week, to fully recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Varicocele Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The surgical facility
• A surgeon
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Varicocele Removal procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA