Microsurgical Varicocele Repair

What is a varicocele?

A varicocele is a collection of dilated, tortuous veins within the spermatic cord inside the scrotum — the venous equivalent of varicose veins. It occurs when the valves within the testicular veins fail to function properly, causing blood to pool and the veins to enlarge. The left side is affected far more commonly than the right, due to the anatomical angle at which the left testicular vein drains into the renal vein.

Varicoceles are present in approximately 15% of adult men overall, rising to around 40% of men investigated for infertility. They may cause a dull aching scrotal discomfort, particularly after prolonged standing or physical activity, and are associated with impaired sperm production in some men.

Who is considered for varicocele repair?

Surgical repair is considered in two main situations:

• Scrotal discomfort: When a varicocele is causing significant ongoing pain or discomfort that affects quality of life and has not resolved with conservative measures such as supportive underwear.
• Male infertility investigation: When an abnormal semen analysis is found alongside a clinically palpable varicocele, in couples who are attempting to conceive. Surgical ligation may improve sperm parameters in suitable candidates.

Varicocele repair is not recommended for incidentally discovered varicoceles in men with no symptoms and normal fertility.

What to expect: before, during, and after

Before the procedure

Pre-operative assessment includes blood tests and a scrotal ultrasound to confirm the varicocele and assess testicular size and blood flow. If the procedure is being considered for infertility, a semen analysis and hormonal profile are reviewed. You will be asked to fast before the procedure if a general anaesthetic is planned.

During the procedure

Dr Hadjipavlou performs exclusively microsurgical varicocele repair — the approach with superior outcomes compared to laparoscopic or traditional open surgery. A small subinguinal incision is made. Under the magnification of an operating microscope, the dilated veins of the spermatic cord are identified and individually ligated, while fully preserving the testicular artery, lymphatics, and the vas deferens. The microsurgical technique substantially reduces the risk of recurrence and post-operative hydrocele. The procedure typically takes 30–60 minutes and is performed as a day case.

After the procedure

You will go home the same day. Scrotal swelling and mild bruising are normal for one to two weeks. Support underwear is recommended. Analgesia can be taken as needed. Strenuous activity and heavy lifting should be avoided for two weeks. Most men return to desk work within a few days.

Results and recovery

Microsurgical varicocele repair is the gold-standard approach, with the lowest recurrence rates and best fertility outcomes compared to laparoscopic or traditional open surgery. Swelling generally settles within two to four weeks.

In men treated for infertility, any improvement in semen parameters typically becomes measurable at three to six months following surgery, as this reflects the time required for a full spermatogenic cycle. A repeat semen analysis is arranged at this interval to assess response.

In men treated for discomfort, symptomatic improvement is achieved in the majority, though a minority may not experience significant relief.