How does an operation work?
A varicocele is caused by leaky veins. Surgery is to tie off the leaky veins so they don’t fill up with blood any more.
Key-hole varicocele surgery is where we make several small cuts on the abdomen. We put a camera in through the cut in your belly button and fill your tummy with carbon dioxide (a gas).
Small instruments are used to seal the veins which drain towards the kidney. There are other veins which drain the testicle so sealing these veins off does not affect the testicle.
We make a small cut at the top of the scrotum to inject blue dye into the varicocele veins. The blue dye then comes out in the urine after the operation (so it is normal to have blue wee!). This makes it much easier to pick out the veins without disturbing small channels called lymphatics which carry tissue fluid. If these lymphatic channels are disturbed then water can accumulate around the testicle (called a hydrocele). Patients who develop a hydrocele may later need an operation on the scrotum to open this fluid collection up and prevent it coming back.
To make sure we seal all the veins causing the varicocele we inject omnipaque dye which shows up on x-ray.
This picture shows the veins causing the varicocele. We do a before and after picture to make sure all the veins have been treated.
Do I need a general anaesthetic?
We use a general anaesthetic for all operations, so you are completely asleep.
How long do you have to stay in hospital?
Surgery is a day-case procedure; usually you can go home the same day. If you are uncomfortable then it is better to stay in hospital overnight.
What is the recovery time?
We would recommend that you stay off school or work for 1 week but that doesn’t mean you need to stay in bed. We would like you to start walking around as soon as you are comfortable. Please avoid contact sports for 6 weeks. You can have a short shower after 24 hours.
How successful is surgery?
Key-hole surgery is successful in 90-95% of patients. 5-10% of patients need a second operation because the ultrasound shows that the varicocele is still there.
What are the complications?
Key-hole surgery involves one small cut at the belly-button and two small cuts in the lower part of the tummy wall. If a wound becomes infected then we would recommend seeing your GP and getting antibiotics. In less than 5% the testis can get fluid around it after the operation which can take several months to disappear.
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