Varicocelectomy

Overview

The removal of a varicocele. A varicocele is a varicose condition of the veins of the pampiniform  plexus, (basically it is a varicose vein) which forms a swelling that feels like “a bag of worms”, appearing bluish through the skin of the scrotum and accompanied by a constant pulling, dragging or dull pain in the scrotum. Varicocele often causes no symptoms at all, or it may cause an achy or heavy feeling in the scrotum. You may also see swollen veins just under the skin in the scrotum.

Indications

Surgery is indicated when the condition becomes painful and/or the function of the testicle is being compromised.  It is also done if the patient is having fertility issues. When blood collects in the veins above the testicles, changes occur that can reduce the number and the quality of the sperm. More than half of men who have varicocele have a reduced sperm count.

Procedure

An inguinal incision is used to access the affected area. Once the varicocele is located the varicosed portion of the vein is ligated (tied off). The skin may be closed with sutures, staples or steri strips.  Local anesthesia is injected in the incision site to minimize discomfort when the patient wakes up.  The local anesthetic will wear off in 2 – 4 hours and oral pain medication is used after that.

Post-Operative Instructions

Diet

You may return to your normal diet within 24 hours following your surgery. You may note some mild nausea and possibly vomiting the first 6-8 hours following surgery. This is usually due to the side effects of anesthesia, and will subside quite soon. We suggest clear liquids and a light meal the first evening following surgery.

Activity

Physical activity should be restricted the first 48 hours. During this time you should remain relatively inactive, moving about only when necessary. During the first few days following surgery you should avoid lifting heavy objects (anything greater than 15 pounds), and avoid strenuous exercise. If you are employed, ask us specifically about your restrictions for both home and work. We will write a note to your employer if needed.

You should plan to wear a tight pair of briefs or an athletic supporter for the first 4-5 days, even while sleeping. This will keep the scrotum immobilized to some degree and keep the swelling down. Ice packs should be placed over the scrotum the first 48 hours. Ice is a good pain reliever and keeps the swelling down.  Fifteen minutes on and 15 minutes off is a reasonable schedule. Frozen peas or corn in a Ziploc® bag can be frozen, used, and refrozen.

Wound Care

In most cases, your incision will have absorbable sutures that dissolve within the first 10-20 days. Some may fall out even earlier. Expect some redness as the sutures dissolve, but this should occur only around the sutures. If there is generalized redness, especially with increasing pain or swelling, let your doctor’s medical assistant know. The scrotum will very likely get black and blue as blood spreads in the tissues. Sometimes the entire scrotum will turn colors. Black and blue is followed by a yellow and brown color.  In time, this coloration will go away.

Hygiene

You may shower 48 hours after surgery. Tub bathing should be restricted until the seventh day.

If the pain is not too bad, you may take Tylenol (acetaminophen) or Advil (ibuprofen), which contain no narcotic agents and might be tolerated a little better with fewer side effects. If the pain medication you are sent home with does not control the pain, please contact your doctor.

Problems you should report to your urologist:

• Fever over 100.5 degrees Fahrenheit
• Moderate or fever swelling
• Drug reaction such as hives, rash, and nausea or vomiting