Varicocele surgery: duration, cost and step by step

• Testicular varicocele results in a drop in sperm count and reduced sperm motility, which can lead to infertility.
• The definitive treatment for testicular varicocele is varicocelectomy, i.e. the reappearance and removal of the varicocele. This intervention involves a series of improvements in the patient's semen quality and testicular function.
• If the main reason for varicocele surgery is infertility, a spermiogram is necessary to evaluate the improvements after the operation.

Before explaining what varicocele surgery, i.e. varicocelectomy, consists of, it is important to define what a testicular varicocele is. It is a dilatation of the veins of the spermatic cord that drain the testicles, i.e. the veins inside the scrotum that hold a man's testicles. 

Testicular varicocele is usually unilateral, in only one testicle. In fact, the vast majority of cases affect the left testicle. There are also cases where it occurs in both testicles, but this is a much smaller percentage, and only in rare cases does it occur in the right testicle.

Although the exact cause of testicular varicocele is not known, it is considered to be a multifactorial disease, i.e. with several causes. However, one of the main causes is a disturbance in the veins, i.e. poor blood regulation of the testicular veins. When the reflux of blood from the renal vein to the testicle causes blood to pool, the veins swell, thus affecting testicular function.

Some of the symptoms that occur with testicular varicocele are widening of the veins, pain or discomfort in the area, swelling of the scrotum, infertility problems, etc.

The definitive treatment for testicular varicocele is varicocelectomy. This surgery can be performed in several ways but the most commonly used are inguinal and subinguinal.

Varicocelectomy

Varicocelectomy is a surgical procedure that solves the problems caused by varicocele. This intervention is recommended when the affected patient presents some of the following symptoms:

• Pain in the testicles, although this does not always occur.
• Loss of sperm quality. As the quantity of sperm is reduced, testicular function is affected.
• Testicular malformation. Due to the circulatory problem, the testicle is reduced in size.

This operation consists of locating, ligating and sectioning the testicular veins that have become abnormally dilated. It is performed inguinally, under general or regional anaesthesia.

The importance and seriousness of testicular varicocele is related to infertility. In a large number of cases, infertility in men is determined by the presence of testicular varicocele. Similarly, one fifth of the adolescent and young adult population is at high risk of testicular varicocele.

As mentioned above, testicular varicocele can be asymptomatic. However, when there are symptoms, the most common are testicular pain and a feeling of scrotal heaviness, a sensation that is more uncomfortable when standing up than when lying down. 

When lying down, blood does not need to overcome gravity to return to the heart.

However, pain is not the main problem. Testicular varicocele is usually related, in most cases, to infertility. Normally, the scrotal sac, i.e. the testicles, have a lower temperature than the rest of the body, as they function better at lower temperatures compared to our body. 

Testicular varicocele involves a collapse of blood that increases the temperature in both testicles and, as a consequence, there is a drop in the spermatozoa rate, as well as a reduction in their mobility, which can lead to infertility.

It is important to know that infertility does not occur in this way alone; it is a multifactorial disease. However, men who have a testicular varicocele have a higher risk of infertility. However, it is also possible to have a testicular varicocele and have normal sperm.

It should be added that erectile dysfunction is not common after testicular varicocele. Only in some cases, when the testicular varicocele is bilateral, i.e. in both testicles, can this problem of impotence occur. In these cases, if left untreated, testicular atrophy may occur with reduced testosterone production, a known cause of erectile dysfunction. However, as mentioned above, impotence does not occur in most patients with varicocele.

Varicocele affects fertility

In most cases, infertility is related to testicular varicocele, due to several factors:

• The testicles always have a lower temperature than the rest of the body because they function better this way. With varicocele there is an increase in testicular temperature and this can be detrimental to sperm production and maturation.
• When left untreated, testicular atrophy can develop, leading to a decrease in testosterone production.
• Varicocele causes germ cell damage.
• The damming of blood in the testicles caused by varicocele causes stress on both testicles, leading to increased sperm DNA fragmentation.

The definitive treatment for testicular varicocele is surgical intervention, i.e. varicocelectomy. However, in order to undergo this type of surgery, you must meet some of the following criteria:

• Testicular pain due to varicocele.
• The testicle on the side of the varicocele is smaller than normal, i.e. less than 2 cm in size.
• Bilateral testicular varicocele, i.e. in both testicles
• Testicular varicocele in an adolescent with altered spermiogram.

If any of the above indications are met, it is necessary to undergo surgery to repair and remove the testicular varicocele. So, below we explain what the day of the varicocele surgery would be like:

On the day of the operation, you will have to go to the hospital a few hours before the surgery. Before going into the operating theatre, you will be given surgical clothes so that you can dress correctly for the operation. You will also be given antibiotics to prevent infection during and after the varicocelectomy.

You will then enter the operating theatre, where you will meet the surgeon, the anaesthetist and a member of the nursing team. Once there, you will lie down on the stretcher and the anaesthetic will be administered. 

When the medicine takes effect, the operation will begin:

• First of all, the area to be operated on is shaved where the incision to access the inguinal canal will be made.
• The surgeon will make an incision of about 5 centimetres and, using a suitable surgical instrument, the spermatic cord is removed.
• The spermatic cord is opened and the internal veins that cause part of the problem are ligated, preserving the artery, lymphatic vessels and vas deferens.
• The external spermatic veins are then ligated.
• To complete the varicocelectomy, the surgeon reintroduces the venous plexus into the inguinal canal, sutures and repairs the incision site.

After waking up, you will be transferred to a recovery room until all the effects of the anaesthesia have worn off. 

Normally, you will be able to go home the same day as the operation. However, if the operation has taken longer or the doctor considers it is too early to leave the hospital, you will be admitted overnight to monitor and secure the postoperative period.

Testicular varicocele surgery lasts 30 - 60 minutes, depending on whether it is a unilateral or bilateral varicocele. This procedure can be performed under regional anaesthesia and sedation, which will keep you asleep and avoid the need for intubation that general anaesthesia requires. 

To determine the type of anaesthesia you are suitable or unsuitable for varicocele surgery, the following preoperative tests will be required.

• Complete blood test. Through this test, the anaesthetist will check whether or not you are fit for surgery, if you have any type of infection and, in general, if you are in good health. If the test detects any infection, it must be treated and removed before the varicocele surgery.
• Chest x-ray. This test checks that there is no pulmonary pathology that would contraindicate surgery.
• Electrocardiogram. The anaesthetist will check that the health of the heart is adequate for varicocele surgery.

As you may already know, testicular varicocele involves a collapse of blood that increases the temperature in both testicles and, consequently, there is a drop in the rate of spermatozoa, as well as a reduction in sperm motility, which can lead to infertility. 

Therefore, it is important to note that varicocelectomy stops the degradation of testicular function and, therefore, the sperm count improves by 60-70% with varicocele surgery.

Inguinal varicocele surgery results in several improvements after surgery:

• Sperm quality increases. In most cases, after the operation there is an increase in the number of spermatozoa and their mobility.
• The pregnancy rate increases considerably. After varicocele surgery, numerous studies show that the chance of spontaneous pregnancy is 3 times higher in men who have undergone surgery than in those who have not.
• Stopping the deterioration of testicular function. In most patients, spermatogenesis and testosterone production are improved.
• Rebound testicular growth. In some cases, when the intervention is performed early, the decrease in testicular size can be reversed. As we have indicated, this is called rebound growth. In a very high percentage of cases in adolescents and young men, the testicle increases in size after varicocele surgery.

The duration of varicocele surgery is 30-60 minutes, so it does not usually exceed one hour. In fact, this procedure has been performed in as little as 20 minutes due to its minimal invasiveness, as well as the optimisation of surgical tools and manoeuvres.

After varicocele surgery, the anaesthesiologist will start the awakening stage in the patient since regional anaesthesia has been applied to the lower body and very light sedation has been applied. Therefore, the patient will remain in the operating theatre until he/she is able to speak and move.

The patient will then be transferred to the resuscitation room until all the anaesthetic has been cleared from the body and vital signs are stable. This usually takes 1 to 2 hours, although sometimes much less, depending on the patient's condition. After recovering the vital signs, the patient will be taken to his or her room where he or she will stay for a maximum of one day. 

As we have already mentioned, this operation is minimally invasive, so the patient can leave the hospital the same day of the operation. However, it will be the doctor who will determine the need for hospitalisation and the patient's discharge.

Finally, the nursing team will explain to the patient the care that must be taken to avoid wound infections or the stitches opening up.

Varicocele surgery involves an incision in the groyne area and, as mentioned above, the operation lasts 30-60 minutes. 

This operation is minimally invasive so you will be able to go home after the operation, although it will be the doctor and surgeon who will determine your discharge from the hospital.

As far as recovery is concerned, you will be able to return to your daily routine as normal in approximately 2 weeks. However, the patient's job will influence his or her quick return to work.

The stitches are removed around 10 days after the operation, although it will depend on the situation of each patient and other factors, such as possible infections, which may delay the removal of the stitches. Wound care is therefore key to recovery. The patient will be able to carry out the dressings at home, bearing in mind that these must be carried out at 12-hour intervals. In addition, to promote healing, it is important that the wound remains dry after each dressing.

As you already know, varicocele increases the chances of suffering a drop in sperm count and reduced sperm motility, leading to infertility. Therefore, if the cause or problem for which you went to the specialist's office was the infertility study, it is appropriate to perform a spermiogram. 

This test will be performed 4 weeks after the intervention in order to check for possible improvements after varicocele surgery.

Testicular varicocele involves a decrease in the spermatozoa rate, immobility of the sperm and, consequently, possible infertility of the patient. As mentioned above, varicocele surgery involves a series of improvements in semen quality, testosterone production, etc. However, in order to carry out this operation, it is necessary to include all the factors and resources, both human and economic, involved in it.

Operarme includes in the cost of varicocele surgery everything necessary to carry out the operation as safely and effectively as possible for the patient. The company offers an all-inclusive price of 2.290 €.

Below you will find a breakdown of what is included in the cost of varicocele surgery with Operarme:

• Booking and use of operating theatre.
• Single room with accompanying bed, food and accommodation for up to 1 day for the patient.
• Preoperative tests (blood tests, electrocardiogram, chest X-ray, according to medical indications).
• Medical fees.
• Anaesthesiologist fees.
• Surgical material necessary for the operation.
• Medical complications insurance. All of Operarme’s surgeries include an insurance policy that covers additional expenses that may occur, such as the need to stay more days in hospital. This is not usually the norm but the company offers this as a means of prevention and security for the patient.
• Free transfer service. Operarme offers the patient this transfer service for the day of admission and discharge from hospital. In this way, the patient will not have to worry about the transfer at any time. Thus, the patient will be able to be in contact with the Operarme’s customer service department to solve any questions or setbacks that may arise.

In previous sections we have mentioned a series of symptomatic requirements that the ideal patient for this surgery usually meets. Therefore, if you have a clear diagnosis of varicocele, you can request a surgical assessment consultation with our Urology team to inform them of your case.

We recommend that, for this consultation, it is advisable to submit all the tests performed previously so that the specialists can assess more accurately the need for varicocele surgery in your case.

However, the advice team at Operarme will be at your disposal to answer any questions you may have, as well as to arrange this first consultation for a free surgical assessment. 

If you would like to request this free consultation with Operarme, you can do so by calling us directly on +34 91 141 33 56, by filling in our contact form, or by clicking below: