Varicocele surgery

Most varicoceles do not present symptoms, which is why they are usually diagnosed during an examination of the scrotum to investigate infertility or determine the presence of non-specific discomfort in the groin or testicular area (enlargement and twisting of the veins in the scrotum). These conditions improve by 60-70% after appropriate treatment (varicocelectomy).

The most common diagnostic procedure involves examining the contents of the scrotum, in which the tissues and sac are observed. This examination is usually performed during male fertility testing, as varicocele is the most common cause of infertility in men. Likewise, the use of new technologies also allows for an analysis of the area through:

• Ultrasound
• Doppler ultrasound
• Venography, occasionally used to examine the veins in the scrotal area and the duct.
• Thermography, which is used to determine the intra-scrotal temperature, which is usually 34.37 ± 0.87º, with a normal temperature of 33.07 ± 1º. Improving the temperature helps restore proper sperm function. Currently, thermography is used on very rare occasions.

The treatment performed in the case of varicoceles is subinguinal microsurgical varicocelectomy. This technique involves locating the dilated testicular veins in order to ligate and section them using a surgical microscope to preserve the arteries, lymphatic vessels and the vas deferens that carries the sperm. It is a procedure performed under spinal anaesthesia, which takes effect more quickly, and is carried out by introducing the anaesthetic into the spinal cord through a fine needle, resulting in a faster recovery and allowing for a shorter hospital stay.

The incision made is 2-2.5 cm in the external inguinal ring, which will allow access to the internal inguinal ring. Through this incision, the spermatic cord can be accessed to observe the dilated veins that intermingle with the testicular artery. After that, the testicular artery and lymphatic vessels are located so that they are not ligated, and the veins are sectioned as they are ligated in order to prevent blood reflux from the kidney to the testicle.

The results of the intervention show an improvement in 60-70% of males, with the percentage of pregnancies ranging from 20-65%, with an average of 35%. Likewise, damage to testicular

hormonal function is also very important.

The results are higher in younger patients, with the greatest post-surgical improvement seen in patients with more severe varicocele.

• Hydrocele. A hydrocele is the accumulation of serous fluid in a cavity, in this case occurring in the spermatic cord, leading to a possible inguinal hernia. To avoid this potential complication, which occurs in 4–33% of cases, it is important to use magnifying lenses to preserve the lymphatic vessels.
• Injury or ligation of the testicular artery. The testicular artery is usually between 0.5 and 0.8 mm in diameter. In 40% of cases, the artery is attached to the dilated spermatic vein and in 20% of cases it is surrounded by a fine network of veins and is mostly spasmodic or contracted, making dissection and preservation difficult and potentially leading to testicular atrophy. The risk is reduced by using magnifying glasses or a microscope.
• Failure or persistence of varicocele despite surgery.