Think Critically: Make an Informed Decision.

​Surgery (Varicocelectomy) Is Not a Cure​

• Only 6-14% of those who undergo surgery attain a benefit.
• Cutting out swollen veins is not curing them, and it does Not address the real problem.
• Surgical results are questionable.
• Surgery is a high risk procedure.
• You do not return to a normal/healthy baseline post-surgery.

While the benefits of surgery are certain, the risks are very real. Be critical, ask lots of questions, and make an informed decision before committing to a permanent procedure that could injure you for life.

​Benefits of Varicocelectomy & Embolization

The reported 20-40% improvement in semen parameters is not associated with successful pregnancy. The best results for surgery state that for every 7 people undergo surgery, only 1 additional pregnancy will be attained. You're more likely to suffer from negative side-effects than to have any benefit from varicocele surgery. The following tables assess the real benefits and risks of surgery:

The Risks of Varicocele Surgery & Embolization

There are many severe risks associated with varicocele surgery. I advise that you carefully consider the pros & cons before making your decision. You can also learn more about how surgery is likely not effective at all.

	Inscisional Surgery	Laparoscopic Surgery	Embolization (Radiology)
Pregnancy	​1 in 7	​1 in 7	1 in 17
Semen Improvement	20-40%	20-40%	10-35%
Testosterone	​None to mild improvement	​None to mild improvement	​None to mild improvement
​Pain Relief	​None to mild improvement	​None to mild improvement	None to mild improvement

​​	Incisional Surgery	Laparoscopic Surgery	Embolization (Radiology)
Pre-Operative Risks: Local Anesthetic	n/a	n/a	minimal risks
Pre-Operative Risks: ​General Anesthetic	Hypotension Hypoxia Arrhythmia	Hypotension Hypoxia Arrhythmia CO2 Embolus Acidosis Hypercarbia​	Hypotension Hypoxia Arrhythmia​
Intra-Operative Risks	Bleeding Injury to the pubic arteries Arterial ligation Nerve damage Failure at attempt (1%-5%) Loss of testicle on side of the surgery (1%) Injury to a nerves in the pubic area	Injury to the pubic arteries Trocar injury (bowel, bladder) Preperitoneal insufflation Failure at attempt (1%-5%) Loss of testicle on side of the surgery (1%) Injury to a nerves in the pubic area	Adverse reaction to contrast (x-ray) dye  Vascular allergy X-ray radiation exposure Bleeding from vein perforation (rupture) (1%) Thrombosis of major veins Failure at attempt (15-30%)
Post-Operative Risks	Hematoma Shrinking of the testicle on the side of the surgery (1%) Hydrocele (5-10%) Persistent/recurrent varicocele (5-10%) Pain pills (2-6 weeks) Genitofemoral Nerve Injury Scrotal Emphysema Umbilical Granulomas Infection at site of surgery (1%) Deep venous thrombosis (DVT) (5%) Pulmonary embolus (PE) (1%) Onset of pain where there was none before (1%) Failure to relieve pain (15%) Continued infertility (86%) ​Decreased fertility Permanent scarring at incision site  ​​Lowered testosterone levels	Unrecognized bowel injury Omental eviscertain  Abdominal wall emphysema (4.5%) Pneumoscrotum (2.6%) Deep venous thrombosis (DVT) (5%) Hydrocele (5-15%) Persistent/recurrent varicocele (10-25%) Pain pills (2-6 weeks) Infection at site of surgery (1%) Shrinking of the testicle on the side of the surgery (1%) Pulmonary embolus (PE) (1%) Onset of pain where there was none before (1%) Failure to relieve pain (15%) Continued infertility (86%) ​Decreased fertility Permanent scarring at incision ​site ​Lowered testosterone levels	Hematoma (2%) Coil migration resulting in testicular loss (1%) Hydrocele (10-20%) Persistent/recurrent varicocele (10-30%) Pain pills (2 days - 1 week) Continued infertility (94%) Failure to relieve pain Onset of pain where there was none before Decreased fertility ​​Lowered testosterone levels

Watch: Varicocele Surgery (Full)

Science Sources

1. In men with varicocele, does surgery improve fertility? Ashleigh Wilkerson-Mike Linder-Carrie Gray-Nick Prylinski-Bilal Islam - https://mospace.umsystem.edu/xmlui/handle/10355/61604, 2017
2. Parrilli, Alejandra; Roberti, Agnese; Escolino, Maria; Esposito, Ciro (2016-10). "Surgical approaches for varicocele in pediatric patient".Translational Pediatrics. 5 (4): 227–232. ISSN 2224-4344. PMC 5107384 . PMID 27867844.doi:10.21037/tp.2016.09.11.
3. Cochetti, Giovanni; Barillaro, Francesco; Cottini, Emanuele; D’Amico, Francesco; Pansadoro, Alberto; Pohja, Solajd; Boni, Andrea; Cirocchi, Roberto; Grassi, Veronica (2015-04-09). "Pneumoscrotum: report of two different cases and review of the literature". Therapeutics and Clinical Risk Management. 11: 581–587. ISSN 1176-6336.PMC 4399391 . PMID 25914539. 
4. Marmar, Joel L (2016). "The evolution and refinements of varicocele surgery". Asian Journal of Andrology. 18 (2): 171–178. ISSN 10
5. 08-682X.PMC 4770481 . PMID 26732111. doi:10.4103/1008-682X.170866.
6. "Six years’ experience of laparoscopic varicocelectomy using bipolar electrosurgery and its effect on semen parameters". Urology Journal. 13 (4). 2016-08-25.​
7. "Deep vein thrombosis and intraperitoneal hemorrhage after thrombolysis: rare complication of laparoscopic varicocelectomy". Int J Clin Exp Med 2016;9(10):20319-20323
8. Chi, Amanda C.; Hairston, John C. (2015-05-01). "Acute Right Varicocele: A Clue to Congenital Vascular Anomaly". Urology. 85 (5): e39–e40.doi:10.1016/j.urology.2015.02.005.
9. ​"Treatment of male varicoceles by transcatheter polidocanol foam sclerotherapy: evaluation of clinical success, complications, and patients' satisfaction with regard to alternative techniques - ProQuest". search.proquest.com. Retrieved2017-07-04.
10. ​Halpern, Joshua; Mittal, Sameer; Pereira, Keith; Bhatia, Shivank; Ramasamy, Ranjith (2016)."Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications". Asian Journal of Andrology. 18 (2): 234–238. ISSN 1008-682X. PMC 4770492 .PMID 26658060. doi:10.4103/1008-682X.169985.
11. Zampieri, N.; Castellani, R. L.; Zampieri, G.; Camoglio, F. S. (2014-10-01). "PS-067 Treatment Of Varicocele In Paediatric Patients With Contraindication For Open Surgery With Transfemoral Retrograde Sclero-embolization Under Local Anaesthesia".Archives of Disease in Childhood. 99 (Suppl 2): A136–A136. ISSN 0003-9888. doi:10.1136/archdischild-2014-307384.363.
12. Favard, Nicolas; Moulin, Morgan; Fauque, Patricia; Bertaut, Aurélie; Favelier, Sylvain; Estivalet, Louis; Michel, Frédéric; Cormier, Luc; Sagot, Paul (2015-12). "Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate".Quantitative Imaging in Medicine and Surgery. 5 (6): 806–814. ISSN 2223-4292. PMC 4700243 .PMID 26807362. doi:10.3978/j.issn.2223-4292.2015.10.10.
13. Ramasamy, Ranjith (2014-06-02)."Percutaneous embolization: a viable treatment option for varicocele". Basic and Clinical Andrology. 24: 10.ISSN 2051-4190. PMC 4345412 . PMID 25741442.doi:10.1186/2051-4190-24-10.
14. Choi, Woo Suk; Kim, Soo Woong (2013-04-01). "Current Issues in Varicocele Management: a Review". The World Journal of Men's Health. 31 (1).ISSN 2287-4208. PMC 3640148 . PMID 23658861.doi:10.5534/wjmh.2013.31.1.12.
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