Varicocele, or varicose veins around the testicles, occur in 15% of the general male population, but 40-50% of the infertile male population. These dilated veins are thought to exert their effects by “heating” the testis with warm blood that pools in the veins – or more accurately by impairing the normal dissipation of heat that occurs when veins flow normally. Varicoceles are easily detected on physical exam of the testicles by an experienced urologist used to evaluating fertility issues.
There are multiple surgical approaches repairing varicoceles. While the repair can take place anywhere along the course of the spermatic cord, clear advantages have been shown (smaller incision, faster recovery time, more precise ligation of the veins, and less complications) with the microsurgical repairs. No varicocele should be repaired without the use of an operating microscope in this day and age. By precisely tying off only venous structures and not channels carrying lymph fluid away from the testis, complications such as testis atrophy and fluid collections (hydroceles) are very rare. It is critical to eliminate all of the veins contributing to a varicocele to prevent recurrence and to achieve the full benefit to fertility.
Dr. Nudell has performed over 700 varicocele repair surgeries using the operating microscope. This surgery is done through a one inch incision below the “underwear line” in the groin area. Surgery can be done in 1 hour and is done as an outpatient. Recovery time is minimal and most men are back at work a few days later. Heavy activity may resume in 1 week.