Varicocoele Repair

Varicocoeles are abnormally dilated testicular veins (pampiniform plexus) in the scrotum. Varicocoele is found in approximately 15% of the general population, 35% of men with primary infertility and in 75-80% of men with secondary infertility. It is more common on the left side. In adolescents, the incidence of varicocoele is approximately 15%; the abnormality is extremely rare in pre-pubertal boys. Varicocoele repair is the most commonly performed operation for the treatment of male infertility.

Although most men with varicocoeles are able to father children, there is abundant evidence that varicocoeles are detrimental to male fertility. A study by the World Health Organization on over 9,000 men showed that varicocoeles are commonly accompanied by decreased testicular volume, impaired sperm quality, and a decline in Leydig cell (the cells that manufacture the male hormone testosterone) function.
 
Improvements in semen parameters are seen in 70 - 80% of men after varicocelectomy, and recent controlled studies clearly indicate that varicocoele treatment improves pregnancy rates. 
 

The 2 options for treatment of varicocoele offered at Wessex Andrology are embolization (depositon of coils into the veins via a puncture in the groin), or division of the veins via a small incision in the groin (microsurgical varicocoele repair). The microsurgical repair has been shown to be the procedure with the highest success rate, and a low complication rate. 

Microsurgical sub-inguinal varicocoele repair

Under a general anaesthetic, a small (1-2cm) cut in the skin at the top of the scrotum is made, to expose and deliver the spermatic cord. The contents are then inspected, and the arteries and veins identified using an operating microscope. Dilated (stretched) veins are then tied off. The magnification also allows small lymphatic drainage channels to be indentified and preserved, thus reducing the risk of post-operative fluid swelling (hydrocoele).

Due to the small incision the recovery from this procedure is fairly rapid, with return to normal activity within a week or so. The larger the varicocoele, the greater chance of success of the operation.