What are the options for treatment of Varicocele ?
Varicocele treatment involves blocking the dilated veins that are causing the symptoms. This can be achieved by either tying and cutting the veins (Ligation) or blocking the veins by inserting coils or gels in the veins (Embolization).
There are five mains ways in which varicocele treatment can be done:
Medical Treatment: Gels and medications that deposit calcium in the walls of the veins can be given. This can only work in very mild degree of varicoceles. It takes a very long time to work as the process of repair is slow but it is the preferred treatment for Grade I and Grade II varicoceles
Laparoscopic Repair: 3 small cuts (5mm – are made in the abdomen and the veins are tied or ligated using laparoscopic technique. This technique requires general anesthesia and a stay of one to two days in the hospital. Hydrocele rate and Failure rates are high (10%).
Inguinal Repair involves a long 6 to 7 cm incision in the groin region and all the veins are approached through this incision and ligated. It takes a little longer to heal and rest of 3 to 4 weeks may be required. The advantage over laparoscopic repair is that it can be done under regional anesthesia and full anesthesia is not required. Also the rates of Hydrocele are less compared to Laparoscopic Surgery.
Embolization: Embolization is a procedure in which a catheter is introduced into the blood vessels and a metallic coil is placed into the veins which leads to blockage of flow in these veins. Embolization is a daycare procedure that is minimally invasive but the risk of recurrence is 20% because the coil can itself migrate or move away. Also it is a theoretically challenenging procedure as it is done by puncturing some important blood vessels and complications can be devastating
Subinguinal Microscopic Varicocelectomy: Subinguinal Microscopic Varicocelectomy is considered the gold standard for varicocele repair. Dr. Raman prefers this surgery over the others because of the many advantages it offers.
- Same day return home – 4-6 hours hospital stay only
- Safe and effective
- Less than 1 % hydrocele rate
- Lowest recurrence rates of 0.5-2%
- 6-8mm Incision
- Only one stitch
How to prepare for Subinguinal Microscopic Varicocele repair /Varicocelectomy ?
If there is a high grade varicocele with evidence of testicular damage (Semen related issues/ reduced testicular volume), it is time to look towards a surgical procedure. Since microscopic surgery is the best way forward to treat varicocele, you need to follow these steps to prepare for this procedure:
- Clean the pubic hair
- Take bath prior to the procedure in the morning
- Have a light meal prior to the procedure
- Carry your investigations and consultation records with you to the hospital
- Carry a scrotal supporter of your size to the hospital and a set of tight frenchies as well
How is this Varicocele repair performed ?
The subinguinal microscopic varicocelectomy is performed by Dr. Raman Tanwar under local anesthesia. This makes the surgery absolutely safe from the anesthesia point of view. Local anesthesia testing is done prior to ensure maximum safety from drug related adverse effects.
A small 6 to 8 mm cut is made in the root of the scrotum just beside the penis and the veins are exposed
The veins are individually identified under the high power of the microscope and they are ligated
A 20MHz microvascular doppler probe is used to identify the Testicular artery and preserve it. This is a highly recommended device and only very few centres in India are equipped with this technology.
The vas and lymphatics are carefully separated and the cord is placed back once all but one or two veins are tied securely.
Incision is closed with just one stitch and a dressing is applied
What is the course after this Surgery ?
- After the surgery, bed rest is advised for 24 hours and light work is recommended for the first week.
- Bathing can be started after 48 hours and suture is removed on the 10th day
- After the first week all activities except for running, bicycling and lifting heavy weights are allowed
- Complete healing takes place by one month after which all activities can be resumed.
What are the risks and complications of Subinguinal Microscopic Varicocele Repair ?
- The common problems that arise after the surgery include mild pain and discomfort in the scrotum, fever and occasionally infection at the site of the surgery.
- Rare problems include long standing or more severe pain which requires painkillers.
- Rarer problems which can be labelled as complications include recurrence of the Varicocele, Swelling of the scrotum due to hydrocele and trauma to the testicular artery leading to atrophy or shrinking of the testis.
- Very rarely there may be damage to the Vas, which is the tube that carries sperms leading reduced sperm counts and infertility
You can watch the complete video of this surgery that is being performed by Dr. Raman Tanwar and highlights all the important steps.
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