Varicocele
DEFINITION
Varicocele is characterised by the presence of dilated blood vessels around the testicle. It is most common on the left side, and usually presents around the onset of adolescence.
Varicocele is usually idiopathic (meaning no specific cause is found), and very rarely it can be a result of a more serious underlying diagnosis such as a tumour of the kidney.
Varicocele severity is classified in to a grading system.
Grade 0 - Visible only on an ultrasound, but cannot be seen or felt.
Grade 1 - Can be felt during coughing and straining (val salva)
Grade 2 - Can be felt without straining
Grade 3 - Can be seen
Varicocele can run in families, may cause discomfort, and may affect fertility. Many people with a varicocele can also have no symptoms or complications.
The most concerning complications of varicocele are inhibition of growth of the testicle, and reduced fertility.
GOALS OF CARE
Determine if the varicocele is causing symptoms, or complications.
Decide if operation is required.
Intervene early enough to prevent complications.
OUTCOMES
If a varicocele is untreated, it may not cause any issues at all. Many grown men with a varicocele suffer no pain, and are able to have children without assisted reproduction techniques.
For patients who have a varicocele that is causing problems, the outcomes are expected to be very good.
There are a number of different approaches to Varicocele surgery, including open operations (through a medium sized groin incision), laparoscopic/key hole operations, and interventional radiology procedures, usually performed through the blood vessels in the groin using an X Ray machine, a needle, a wire and catheters.
The open technique and laparoscopic techniques both have a 98% success rate, and the laparoscopic technique has a lower rate of post operative hydrocele (fluid around the testicle). The incisions are smaller and there is less post operative pain and a faster recovery. There is little to no risk of compromising testicle blood flow. As a result the laparoscopic technique is the most widely practiced.
Radiology techniques are similar to laparoscopic repair, with no visible incisions, a marginally lower rate of success than surgery, and a lower rate of hydrocele, a higher rate of recurrence.
If the hydrocele is causing faltering growth of the testicle, and the varicocele is repaired promptly, your son can expect catch up growth of the affected testicle.
The effect on fertility of varicocele repair in adolescents is poorly defined, but literature in adult populations has demonstrated improvement in sperm quality parameters after varicocele repair.
You may find further reading here
OUR APPROACH
Dr Rob offers a laparoscopic approach, that involves mass ligation of the artery, veins and lymphatic channels, as this has the lowest risk of recurrence.
Most of the hydroceles that occur after this operation will never require an operative intervention and will resolve spontaneously.
For patients who suffer a recurrence, Dr Rob’s recommends a radiology guided procedure, and will help to arrange this for you.
POST OPERATIVE CARE AND RECOVERY
The procedure is a day case operation, so you will be able to take your son home on the same day. He will have three small incisions on his abdominal wall, and these will be closed with dissolving sutures, and covered with glue. Over the next few weeks the glue will flake off and the stitches will vanish. Your son may need some paracetamol and ibuprofen for a couple of days, but in general should be very comfortable. He will be able to shower the day after surgery, return to school in less than a week, and return to sports in 2 weeks.
Dr Rob will see you in his clinic 1 week after the surgery to ensure your son has made the expected recovery.