Surgical treatment of male infertility caused by varicoceles

A varicocele is an enlargement of the veins that drain the testicle. It is a very common condition present in 15% of the general male population and 40% of men evaluated for infertility. A varicocele develops because of defective, small one-way valves that normally allow for blood to flow away from the testicle toward the heart.

The diagnosis of a varicocele can usually be made on physical examination of the scrotum while the patient is standing. The varicocele feels like a “bag of worms” and often disappears or becomes smaller when the patient lies down. If the patient is asked to bear down, the back flow of blood can usually be felt in varicoceles. Some varicoceles are so large they can be seen through the skin.

When a varicocele exists, the circulation of blood away from the testicle is impaired.  This results in an increased temperature of the testes which is believed to contribute to compromised sperm parameters.  Increased testicular temperature can damage sperm and also impede the production of health, new sperm.  Therefore, varicoceles are thought to compromise not only the quality of sperm but also the quantity of sperm.

There are a variety of techniques that have been used to correct a varicocele.  All methods involve blocking the slow flow that exists in the dilated veins leaving the testicle (varicocelectomy).   Two common techniques which are used to repair varicoceles are the microscopic inguinal repair and laparoscopic repair.   In microscopic inguinal repair, a 2-3 cm incision is made in groin to allow for visualization of the varicocele.  Each dilated vein is then identified and tied off.  The laparoscopic varicocele repair has also been used with great success to treat varicoceles.  In this technique, small incisions are made in the abdomen to allow for passage of small working instruments.  These instruments are used to identify, dissect, and clip off dilated veins from the testicle as they enter abdomen.