Lakes Area Urology

Dr. Brad Qualey Dr. David Paul

1903 S. 6th St. , Brainerd, MN 56401

A varicocele is a bundle of dilated veins (varicose vein) of the testicle. It first appears at the time of puberty and persists throughout life. It is caused by a poorly developed valve in the testicular vein resulting in incompetence of the vein. Generally the varicocele is found on the left side, however occasionally a varicocele can affect both testicles. A varicocele can affect sperm production, motility (the way sperm move), morphology (microscopic appearance), and function. The most common reason that a varicocele is operated upon is for low sperm production. A small number of men will have varicoceles operated upon because the size of the vein causes pain with lifting or straining. Varicoceles have been implicated in the formation of antibodies to sperm. They may also produce chemicals or cause increased heat in the scrotum resulting in poor sperm quality. This inturn can prevent pregnancies.

TREATMENT of a varicocele can be by one of four methods:

1. Cooling
2. Transvenous occlusion
3. Laparoscopic vein ligation
4. Surgery

Cooling with ice (Four hours per night) or cooling with a hypothermia device can improve sperm production somewhat but is cumbersome and time consuming. Most men prefer other treatments.

Transvenous occlusion is done by puncturing a leg vein or a neck vein. A small tube is threaded into the testicle vein. Blockage is accomplished by chemicals or internal coils, etc. The effectiveness of this method is extremely variable.

Laparoscopic vein ligation has been performed at some major medical centers. Although the procedure appears to be as effective as convention surgery there are potential serious or life threatening complications that can occur that negate is routine use.

Varicocele surgery is generally the preferred method of treatment. The surgery which takes about an hour is performed as an outpatient. You may have either general, spinal or local anesthesia at you and your surgeons preference. The incision will be in the groin area just above the pubic bone and is only about an 1 or 2 inches in size. After surgery you will need someone to drive you home. You can return to work whenever you are comfortable usually 2-4 days after the surgery. Since no muscles are being cut, the only impairment to activity is the discomfort from the skin incision, most men have no pain in the testicle. Surgical tapes will be used to close the skin edges and all the stitch material being underneath the skin will devolve. These tapes should be left on for one week after surgery.

• Infection of the incision associated with redness, swelling, or drainage occurs in 1% of clean operations.
• An occasional man will develop a hematoma or "black and blue" area around the incision and occasionally into the scrotum.
• Occasionally swelling can occur into the testicle.
• About 5% of men might develop a recurrent varicocele.
• Up to 5% of men might develop a hydrocele (fluid collection) around the left testicle. ( I personally have never seen this complication).
• Because we are operating in the area of the vas deferens and the arterial blood supply to the testicle, either structure can be injured. I have not seen any problems from damage to the testicle after varicocele surgery but it can occur.

We will re-examine you about 2 weeks after the surgery. Because of the long time required for sperm to develop in the testis and to be transported to the ejaculation fluid, sperm counts are generally done four to six months after surgery. If the sperm count is increasing, long-term observation will continue. If the sperm count is not increasing, you be re-examination for recurrance of the varicocele and certain blood tests will be ordered.

1. A varicocele is a varicose vein of the testicle caused by high pressure developing between the junction of spermatic vein and left kidney vein.
2. Reverse flow of blood due to weak or absent valves causes dilated veins in the scrotum when in any position other than flat.
3. Excess venous blood affects function of both testicles (heat, pressure, hormones).

TREATMENT: (Results in up to 50% pregnancies within one year of surgery)

1. Ligation (tying) and cutting of the vein. A small incision is made low on the left side of the abdomen.
2. X-rays are taken to assure complete blockage of the veins.
3. Usually this is done on an in-and-out same-day surgery basis.
4. Before hospitalization, hormone tests will be done.
5. Treatment with medicines will be indicated if the sperm count does not improve within six months of surgery.