Are the veins in the testicles twisted? Let's learn everything about Varicocelectomy surgery!

Do you feel like you're getting a bunch of veins in your testicles? Or is there something heavy or a little painful in that area? If you're having problems conceiving a child along with these things, you may have what doctors call a 'Varicocele'. Don't worry, this is a treatable condition that affects many men. So today, let's talk about what Varicocele is and the Varicocelectomy surgery that is performed for it.

Simply put, what is Varicocele?

Varicocele is a condition where the veins inside your scrotum become swollen, enlarged, and twisted. It's similar to the way some people get varicose veins in their legs. When the valves in the veins that carry dirty blood away from the testicles become weak, blood can back up into these veins. This is when these veins become swollen and enlarged.

Although this can occur at any age, most people realize they have it during their youth, that is, after reaching puberty.

Who should have Varicocelectomy surgery?

Not everyone with a varicocele will need surgery, but there are several main reasons why your doctor may recommend this surgery.

• Male Infertility: Varicocele is a major cause of male infertility. This is because the veins fill with blood and the temperature around the testicles increases. This increased temperature negatively affects sperm production and their quality. So, if a couple trying to have a child has this problem on the male side, the doctor will recommend this surgery.
• Testicular pain: Some people may experience a constant feeling of heaviness or pulling pain in their testicles due to Varicocele. This pain may worsen when standing all day or exercising. If this pain interferes with daily activities, surgery may be a good solution.
• Testicular Atrophy: The affected testicle may become smaller and start to shrink due to a varicocele. In this case, the doctor may recommend surgery.
• Decreased Testosterone: In some cases, Varicocele can cause a decrease in the production of the male hormone testosterone. This is also a reason to resort to surgery.

How do you find this, Doctor?

When you go to see your doctor, he will ask you about your symptoms and do a physical exam. He will examine your scrotum. You may be asked to stand, sit, and hold your breath (the Valsalva maneuver). When you do this, you will be able to clearly feel these swollen veins.

Most often (about 90%) Varicocele occurs in the left testicle. However, sometimes it can occur on both sides.

The doctor will order several more tests to confirm the diagnosis and understand the severity of the condition.

• Ultrasound Scan: This allows you to clearly see the condition of the veins and blood flow inside the testicles.
• Semen Analysis: This test is important to understand the size, movement, and shape of your sperm.
• Blood Test: This helps check hormone levels, especially testosterone levels.

After these tests, a grade is made based on the severity of your Varicocele.

What are the methods of performing Varicocelectomy?

There are two main methods for performing this surgery. One is traditional open surgery. The other is minimally invasive surgery. Your doctor will decide which method is best for you.

1. Open Surgery

In this, the skin is cut and the relevant veins are treated.

• Inguinal Ligation: The veins are treated by making a small incision in the groin area.
• Subinguinal Ligation: An incision is made just below the groin.
• Retroperitoneal Ligation: A small incision is made on the side of the abdomen and the veins are treated from inside.

2. Minimally Invasive Surgery

These cause less damage to the body and require less recovery time.

• Laparoscopic Varicocelectomy: The surgery is performed by making several very small incisions in the abdomen, inserting a thin tube (laparoscope) with a camera attached, and viewing it on a monitor, using delicate instruments.
• Microsurgical Varicocelectomy: This is considered the most successful and best method available. A very small incision is made in the groin area, and the veins are treated very delicately under the guidance of a very powerful microscope (Operating Microscope). In this method, the risk of damage to healthy veins, lymphatic vessels, and arteries is very low. Therefore, complications are also less.

How do you prepare before surgery?

Your doctor will give you a set of instructions a few days before the surgery.

• Tell your doctor about any medications you are taking: Be sure to tell your doctor about any medications, vitamins, or herbal products you are taking. Especially if you are taking blood thinners like aspirin, you will be asked to stop taking them a few days before the surgery.
• Tell your doctor about any allergies you have (such as to medications, skin cleansers, latex).
• Fasting: You will be advised not to eat or drink anything for a few hours before the surgery. This is very important . If you have food in your stomach while you are under anesthesia, you may vomit it up and it may go into your lungs. This can cause a serious infection (aspiration pneumonia).

What happens during surgery?

There is nothing to be afraid of. This surgery is performed by a team of specialists in the urinary and reproductive systems (Urologist), an anesthesiologist, and a nursing staff.

You will be given a general anaesthetic, so you will not feel any pain during the surgery. It will be as if you are fast asleep.

After you are unconscious, the doctor will make an incision according to your chosen method and locate the swollen vein (varicocele). Then, the vein is cut and the two ends are sealed. This stops the blood from flowing through that vein and allows the blood to flow through other healthy veins in the scrotum.

Sometimes, small silicone tubes (drains) may be placed to drain any blood or fluid that collects after surgery. Finally, the incision is closed with stitches.

Typically, a laparoscopic surgery can take about 30-40 minutes, while a microsurgical surgery can take about 1-3 hours.

What happens after the surgery?

After the surgery, you will be taken to a recovery room, where medical staff will monitor your condition until you regain consciousness.

When you regain consciousness, you may feel a little dizzy and have some pain at the incision site. After confirming that everything is normal, you will be allowed to go home in a few hours. However, you must have someone to take you home. It is very important to have someone to help you for the first day or two.

What are the benefits and risks of this surgery?

Like any surgery, this one has benefits as well as a few minor risks.

Advantages

• A very safe surgery: the risk of complications is very low.
• Increased fertility: Due to increased sperm production and testosterone levels, the chances of having children can increase by up to 70%.
• Pain relief: The pain and heaviness in the testicles completely disappear.
• Improved appearance: The uncomfortable "ball of worms" appearance disappears, and the appearance of the scrotum returns to normal.

Risks

These don't happen very often, but it's good to be aware of them.

• Risks associated with anesthesia.
• Wound healing problems or infections.
• Blood clot (Hematoma).
• Swelling, bruising, and scarring.
• Hydrocele (fluid accumulation around the testicles).
• Damage to an artery that supplies blood to the testicle (very rare).
• Varicocele recurrence.

Recovery time and things to follow at home

The time it takes to fully heal varies from person to person. Usually, swelling and bruising will go away in 3-4 weeks. However, some pain in the groin area may persist for up to 6 weeks.

• Pain management: Take your doctor's prescribed painkillers on time. To reduce swelling, place an ice pack wrapped in a clean cloth over the wound for about 10 minutes. You can do this several times a day.
• Keep the wound clean: Wash your hands thoroughly with soap and water before touching the wound. Change bandages as directed by your doctor.
• Bathing: Avoid soaking in a tub or swimming until you are healed. It is okay to shower.
• Lifting weights: Do not lift weights exceeding 5 kg for at least two weeks. Avoid strenuous exercise and heavy work.
• Diet: It is very important to avoid constipation. Straining during bowel movements is not good for the wound. Therefore, eat lots of high-fiber foods like greens, vegetables, and fruits. Drink plenty of water throughout the day.
• Sexual activity: Avoid having sex or masturbating for at least a week .
• Going to work or school: Most people can return to their normal activities in about three days.

When to see a doctor immediately

If you experience any of the following symptoms, call your doctor immediately.

• Excessive bleeding from the cut.
• Having a fever of 100°F (38°C) or higher.
• If the wound is swollen, red, and oozing pus (signs of infection).
• If the pain is getting worse.