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Varicocelectomy for Varicocele

Typical recovery: Varicocelectomy is commonly performed as day-care or short-stay surgery. Walking and light daily activity are usually possible within a few days. Groin or scrotal soreness and bruising generally improve over one to two weeks. Return to strenuous exercise, heavy lifting and sexual activity is individualised according to the operative approach and recovery. When surgery is performed for infertility, semen improvement is assessed over subsequent months rather than during the immediate postoperative period.

Key points

  • Not every varicocele needs surgery.
  • A clinical varicocele is one that can be detected on physical examination. A subclinical varicocele seen only on ultrasound is treated differently.
  • For male infertility, current guidelines support repair most strongly when there is a palpable clinical varicocele, abnormal semen parameters and otherwise unexplained male-factor infertility.
  • Varicocelectomy is not routinely recommended for infertile men who have normal semen parameters or for a subclinical ultrasound-only varicocele.
  • Semen analysis should be interpreted in the context of the couple rather than as a fertility test in isolation.
  • If the first semen analysis is abnormal, contemporary European guidance recommends at least two consecutive semen analyses before major fertility decisions are made.
  • Varicocele repair can improve semen parameters in appropriately selected men, but it does not guarantee natural conception.
  • Improvement in semen quality is not immediate because sperm production takes time. Changes are generally assessed over the following months.
  • For persistent varicocele-related pain, other causes of scrotal pain should be excluded before surgery is advised.
  • Pain relief after repair is common in appropriately selected patients but cannot be guaranteed.
  • Microsurgical inguinal or subinguinal varicocelectomy has the lowest recurrence and complication profile in much of the contemporary evidence, although it requires microsurgical expertise.
  • Open non-microsurgical, laparoscopic and radiological approaches remain reasonable in selected circumstances.
  • Preservation of lymphatic drainage reduces the risk of postoperative hydrocele.
  • A sudden-onset, atypical, non-reducing or isolated right-sided varicocele deserves careful clinical assessment for an underlying cause rather than being treated automatically as a routine left-sided varicocele.
  • Treatment of non-obstructive azoospermia solely by varicocele repair is a specialised and uncertain area; evidence is less robust and individual counselling is important.

Overview

A varicocele is an abnormal dilatation of veins of the pampiniform plexus around the testis, most commonly on the left side. Many varicoceles cause no symptoms and require no treatment. In some men, however, a clinically palpable varicocele is associated with a dragging scrotal ache, reduced testicular growth or function, or abnormal semen parameters and male-factor infertility. Varicocelectomy is an operation that interrupts the abnormal refluxing spermatic veins while preserving the arterial supply, lymphatic drainage and other important structures of the spermatic cord as far as possible. The aim is not simply to remove visible veins but to reduce abnormal venous reflux around the testis. Several operative approaches exist, including subinguinal or inguinal microsurgical repair, conventional open ligation and laparoscopic repair. Percutaneous venous embolisation is a non-surgical alternative in selected patients. Current evidence suggests that microsurgical inguinal or subinguinal repair has lower recurrence and complication rates than non-microsurgical approaches when appropriate expertise and equipment are available. Surgery is not appropriate for every varicocele. For infertility, the strongest indication is a palpable clinical varicocele associated with abnormal semen parameters in a couple with otherwise unexplained male-factor infertility. Varicocelectomy may also be considered for persistent characteristic scrotal pain after other causes have been excluded and conservative measures have failed. Treatment decisions should consider symptoms, clinical grade, semen analysis, testicular size, fertility goals, the female partner's reproductive status and patient preference.

Signs & symptoms

  • A dragging, aching or heavy sensation in the scrotum, often worse after prolonged standing, exercise or towards the end of the day.
  • Visible or palpable enlarged veins above or around the testis, sometimes described as feeling like a 'bag of worms'.
  • A varicocele detected during evaluation for male infertility.
  • Abnormal semen parameters in a man with a palpable clinical varicocele.
  • Reduced size or impaired growth of the affected testis, particularly in younger patients.
  • Scrotal discomfort that improves when lying down and recurs during standing or physical activity.
  • Occasionally, concern about scrotal appearance or asymmetry.
  • Many varicoceles are completely asymptomatic and are discovered during examination for another reason.

What the procedure involves

  1. 1

    Confirm the diagnosis clinically, usually by examining the patient while standing and during the Valsalva manoeuvre.

  2. 2

    Assess the indication for treatment rather than operating solely because a varicocele is present.

  3. 3

    For infertility, obtain an appropriate reproductive history and semen analysis. If an initial semen analysis is abnormal, repeat testing may be required because semen parameters vary between samples.

  4. 4

    Use scrotal Doppler ultrasound when the physical examination is uncertain, when another scrotal abnormality needs assessment, or when persistent or recurrent varicocele is suspected after previous treatment.

  5. 5

    Discuss the available approaches, which may include microsurgical subinguinal or inguinal repair, conventional open ligation, laparoscopic repair or radiological embolisation depending on anatomy, expertise and individual circumstances.

  6. 6

    During surgical varicocelectomy, expose the spermatic cord or internal spermatic vessels through the chosen operative approach.

  7. 7

    Identify and interrupt the refluxing venous channels while preserving the testicular artery, vas deferens and lymphatic structures as appropriate to the technique.

  8. 8

    Use magnification when performing a microsurgical approach to help distinguish veins, arteries and lymphatics.

  9. 9

    Check haemostasis carefully before closure.

  10. 10

    Close the incision and apply a small dressing. Most uncomplicated procedures are performed as day-care or short-stay surgery.

  11. 11

    Review recovery and, when fertility is the indication, reassess semen parameters after sufficient time has passed for new cycles of spermatogenesis.

Preparation

  • Tell the surgeon whether the main reason for treatment is infertility, pain, testicular size difference or another concern.
  • For fertility treatment, bring previous semen-analysis reports and relevant fertility investigations.
  • If the initial semen analysis was abnormal, additional semen testing may be appropriate before surgery because semen parameters can vary substantially.
  • The female partner's age, ovarian reserve and fertility evaluation should be considered when varicocelectomy is being planned for infertility.
  • Bring any previous scrotal Doppler ultrasound reports and images.
  • Tell the surgeon about previous inguinal, scrotal, hernia or varicocele surgery.
  • Mention any history of undescended testis, testicular injury, infection or previous fertility treatment.
  • Bring a complete medication list, particularly anticoagulants and antiplatelet drugs.
  • Do not stop blood-thinning medicines without specific instructions.
  • Follow the fasting instructions provided by the anaesthesia and surgical team.
  • Arrange transport home after day-care surgery and follow instructions about postoperative support and activity.

Recovery and aftercare

  • Mild groin or scrotal discomfort, bruising and swelling are common during the first few days after surgery.
  • Use prescribed or recommended pain relief as directed.
  • Scrotal support or supportive underwear can improve comfort during the early recovery period.
  • Keep the wound clean and dry according to the instructions provided at discharge.
  • Walking and light routine activity can usually be resumed early according to comfort.
  • Avoid heavy lifting, strenuous exercise and activities that markedly increase groin discomfort until advised that they can be resumed.
  • Return for wound review or postoperative follow-up as advised.
  • Seek review if swelling or pain progressively increases instead of improving.
  • When infertility is the indication, semen analysis is usually reassessed after several months rather than immediately after surgery.
  • Improvement in semen parameters may take up to approximately two spermatogenic cycles, and spontaneous pregnancies after successful repair commonly occur over the following six to twelve months rather than immediately.
  • Continue simultaneous fertility assessment and management of the couple rather than assuming that varicocelectomy alone will resolve every fertility problem.
  • Persistent or recurrent varicocele may require repeat clinical examination and Doppler ultrasound.

Risks and possible complications

  • Temporary groin or scrotal pain, bruising and swelling.
  • Bleeding or haematoma.
  • Wound infection.
  • Hydrocele caused by disruption of lymphatic drainage.
  • Persistence or recurrence of the varicocele because not all refluxing venous channels were successfully interrupted or because collateral veins develop.
  • Chronic or persistent scrotal pain despite technically successful surgery.
  • Injury to the testicular artery, which is uncommon but can compromise testicular blood supply and, rarely, lead to testicular atrophy.
  • Injury to structures of the spermatic cord.
  • Numbness or altered sensation around the incision.
  • Anaesthetic complications.
  • Failure to improve semen parameters.
  • Failure to achieve pregnancy despite improved semen parameters because fertility depends on both partners and multiple biological factors.
  • Need for further treatment if the varicocele persists or recurs.

When to arrange prompt medical assessment

  • Persistent or recurrent scrotal aching, heaviness or discomfort that interferes with daily activity.
  • A newly noticed scrotal swelling or prominent veins that have not previously been assessed.
  • Fertility difficulty associated with a clinically palpable varicocele.
  • Progressive reduction in size or asymmetry of one testis, particularly in an adolescent or young adult.
  • Persistent pain despite supportive underwear, activity modification and appropriate simple analgesia.
  • Recurrence of visible veins or typical varicocele symptoms after previous surgery or embolisation.
  • A new isolated right-sided, sudden-onset or non-reducing varicocele, particularly if the presentation is atypical.

When to go to an emergency department now

  • Sudden severe testicular pain, especially with nausea or a high-riding testis, because testicular torsion must be excluded urgently and should not be assumed to be varicocele pain.
  • Severe rapidly increasing scrotal swelling or significant bleeding after surgery.
  • High fever, spreading redness or severe worsening pain after an operation, which may indicate infection or another complication.

Myth vs fact

Frequently asked questions

Sources

Medically reviewed by Dr. Shams Alam Mohammed Tahir, MBBS, MS (General Surgery). Last reviewed 2026-09-18.

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