Varicocele Repair — Procedure Guide, Recovery & Risks | MyMedicPlus

Varicocele repair (varicocelectomy) treats pathological dilation of the pampiniform venous plexus within the spermatic cord, which impairs testicular thermoregulation and function. Microsurgical subinguinal varicocelectomy is the current gold standard due to lowest recurrence and complication rates.

Indicated for clinical varicocele (Grade I–III) with abnormal semen parameters and couple infertility, symptomatic varicocele causing significant testicular ache or discomfort, or adolescent varicocele with ipsilateral testicular volume discrepancy exceeding 20%.

Through a 2–3cm subinguinal incision, the spermatic cord is delivered and examined under surgical microscope or loupe magnification. Internal spermatic veins are individually identified and ligated while the testicular artery, lymphatics, and vas deferens are carefully preserved.

Patients return home on the same day. A scrotal support is worn for 2 weeks. Strenuous exercise and sexual activity are restricted for 2–4 weeks. Semen analysis is repeated at 3 and 6 months post-operatively to assess sperm parameter improvement.

Hydrocele formation is the most common complication, occurring in 3–10% with non-microscopic technique but less than 1% with microsurgical approach. Other risks include testicular artery injury (less than 1%), haematoma, wound infection, and recurrence in 5–15% without magnification.

Microsurgical varicocelectomy improves total motile sperm count in 60–70% of men. Spontaneous pregnancy rates of 30–40% are reported within 12 months. Percutaneous embolisation offers a radiological alternative with equivalent efficacy but a higher recurrence rate of 10–15%.