Treatment of Varicocele

Regardless its size, all grades of varicocele (mild, moderate or sever) can cause infertility, though to different extents. Pain, however, is usually a result of the larger grades of varicocele. Treatment of varicocele is essentially by surgery (varicocelectomy), which is a one-day rocedure that does not usually re!uire hos ital stay for more than a cou le of hours, and does not usually re!uire more that one day bed rest. "hen it comes to large grades of varicocele (#rade $), there is a consensus that it should be treated surgically, otherwise it will result in total dysfunction of the testis (atro hy). %ild and moderate varicocele (grade & and ') may not cause atro hy of the testis but do cause infertility that increases by time as long as the varicocele is left untreated, which is why it should be surgically eliminated. (aricocelectomy (surgical treatment of varicocele) is erformed by interru ting the abnormal veins in which blood ools, leaving behind the normal veins through which blood flows normally. )nterru ting the continuity of abnormal veins is erformed by closing the vein at two close oints by sutures, and cutting the vein in-between the two oints. The next figure shows the incision for *subinguinal varicocelectomy*, which is one of the most favored surgical a roaches due to the very short convalesence. The incision is situated to one side of the enis.

The incision is mostly '-+ cm long, o erative time ranges from $,-+, minutes, and the atient may leave the hos ital in the same day and may return to light wor- the next day or the day after, with few exce tions.

This is the se!uence of ste s from left to right. -)ncision -/urgical sutures are assed around the varicocele veins, while identifying and rotecting the other im ortant structures (the artery and vas deferens) -The sutures are tied -(eins are cut between the sutures

-)ncision is closed by subcuticular sutures (stitches that are underneath the s-in, can be chosen such that they dissolve on their own, not re!uiring removalr

0lternative surgical and non-surgical a roaches to the treatment of varicocele. &-1 en /urgery. 0s shown in the illustration, one of three incisions can be used, each having its ros and cons. 2or exam le, the lowest incision is the oint of meeting of all ossible vein systems, while the highest incision rovides access to only one system of veins (three are three systems). 1n the other hand, the highest incision rovides access to the veins and not the arteries which -ee s the arteries safe, while the lowest incision rovides access to all vessels which necessitates avoiding the arteries. The two high incision involve o ening the abdominal muscles, while the lowest does not, leading to easier recovery and less ain. 3owever, varicocelectomy should 45(5R be done in the scrotum. '-6a arosco y. This is endosco y of the abdomen, that is erformed through three se arate incision, & cm each. The virtue of endosco y is that it rovides access to the right and left varicocele through the same small incisions. 3owever, it rovides access to only one system of veins, and the other two systems cannot be accessed. )t is therefore that la arosco ic varicocelectomy is reserved for lower grades of varicocele when resent on both sides.