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Treatment of Varicocele

Regardless its size, all grades of varicocele (mild, moderate or sever) can cause infertility,

though to different extents. Pain, however, is usually a result of the larger grades of varicocele.Treatment of varicocele is essentially by surgery (varicocelectomy), which is a one-day

rocedure that does not usually re!uire hosital stay for more than a coule of hours, and doesnot usually re!uire more that one day bed rest.

"hen it comes to large grades of varicocele (#rade $), there is a consensus that it should betreated surgically, otherwise it will result in total dysfunction of the testis (atrohy). %ild and

moderate varicocele (grade & and ') may not cause atrohy of the testis but do cause infertility

that increases by time as long as the varicocele is left untreated, which is why it should besurgically eliminated.

aricocelectomy (surgical treatment of varicocele) is erformed by interruting the abnormal

veins in which blood ools, leaving behind the normal veins through which blood flows

normally. nterruting the continuity of abnormal veins is erformed by closing the vein at twoclose oints by sutures, and cutting the vein in-between the two oints.

The next figure shows the incision for *subinguinal varicocelectomy*, which is one of the most

favored surgical aroaches due to the very short convalesence. The incision is situated to one

side of the enis.

The incision is mostly '-+ cm long, oerative time ranges from $-+ minutes, and the atientmay leave the hosital in the same day and may return to light wor the next day or the day after,

with few excetions.

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This is the se!uence of stes from left to right

-ncision

-/urgical sutures are assed around the varicocele veins, while identifying and rotecting theother imortant structures (the artery and vas deferens)

-The sutures are tied

-eins are cut between the sutures

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-ncision is closed by subcuticular sutures (stitches that are underneath the sin, can be chosen

such that they dissolve on their own, not re!uiring removalr

0lternative surgical and non-surgical aroaches to the treatment of varicocele

&-1en /urgery

0s shown in the illustration, one of three incisions can be used, each having its ros and cons.

2or examle, the lowest incision is the oint of meeting of all ossible vein systems, while the

highest incision rovides access to only one system of veins (three are three systems). 1n theother hand, the highest incision rovides access to the veins and not the arteries which ees the

arteries safe, while the lowest incision rovides access to all vessels which necessitates avoiding

the arteries. The two high incision involve oening the abdominal muscles, while the lowest doesnot, leading to easier recovery and less ain.

3owever, varicocelectomy should 455R be done in the scrotum.

'-6aaroscoy

This is endoscoy of the abdomen, that is erformed through three searate incision, & cm each.The virtue of endoscoy is that it rovides access to the right and left varicocele through the

same small incisions. 3owever, it rovides access to only one system of veins, and the other two

systems cannot be accessed. t is therefore that laaroscoic varicocelectomy is reserved forlower grades of varicocele when resent on both sides.