Microsurgical treatment of varicocele

A varicocele is a vascular lesion characterized by dilatation of the spermatic veins due to valvular malfunction. It affects approximately 15% of adult males and predominantly appears on the left side (90%) and the rest are bilateral (10%). Unilateral right sided varicoleles are extremely rare.

The most frequent symptoms secondary to this dilatation are:

The appearance of a mass similar to “bag of worms” on the top of the scrotal sac.
Pain or scrotal discomfort when standing (less frequent).
The diagnosis is made mainly through a good clinical examination and can be confirmed with a scrotal ultrasound. In the diagnosis of a clinical varicocele and in the case of fertility desire, a seminogram is performed to evaluate sperm quality.

Microsurgical treatment of varicocele

The main indications for the treatment of a varicocele are: pain (rarely), reduced testicular size or infertility. Currently, the main techniques used to treat varicocele are the following:

Sclerotherapy/embolization: percutaneous occlusion of the affected spermatic veins. Due to its high rate of relapse, it has a very limited indication.

Surgery: spermatic vein ligation.

Open or laparoscopic retroperitoneal varicocelectomy (high): the ligation of the main gonadal vein is performed at the abdominal level.

Subinguinal microsurgery varicocelectomy (low): the selective ligation of the pampiniform plexus veins is performed at the level of the inguinal cord with a microscope, with respect to the testicular artery. Currently, it is considered as the “gold standard” technique, with a lower incidence of recurrences, better results in seminal parameters and pregnancy and a lower rate of complications. It requires widespread micro-surgical experience and the use of magnifying glass or surgical microscope.