Think Critically: Make an Informed Decision.

​Surgery (Varicocelectomy) Is Not a Cure​

• Only 6-14% of those who undergo surgery attain a fertility benefit.
• Surgery is neither effective nor recommended for pain relief.
• 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.
• A successful operation does not mean that you have recovered.

While the benefits of surgery are uncertain, 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 who 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:

Incisional Surgery Benefits

• Pregnancy: ​1 in 7 (14%)
• Semen Improvement: 20-40%
• ​Testosterone: ​None to mild improvement
• ​​Pain Relief: ​None to mild improvement

​Laparoscopic Surgery Benefits

• Pregnancy: ​1 in 7 (14%)
• Semen Improvement: 20-40%
• ​Testosterone: ​None to mild improvement
• ​​Pain Relief: ​None to mild improvement

Embolization (Radiology) Benefits

• Pregnancy: ​1 in 17 (4%)
• Semen Improvement: 10-35%
• ​Testosterone: ​None to mild improvement
• ​​Pain Relief: ​None to mild improvement

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.

Incisional Surgery Risks

• ​Pre-Operative Risks: Local Anesthetic: N/A
• Pre-Operative Risks: ​General Anesthetic: 
  • 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
• ​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

Laparoscopic Surgery Risks

• ​Pre-Operative Risks: Local Anesthetic: N/A
• Pre-Operative Risks: ​General Anesthetic: 
  • Hypotension
  • Hypoxia
  • Arrhythmia
  • CO2 Embolus
  • Acidosis
  • Hypercarbia​
• ​Intra-Operative Risks:
  • 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
• ​Post-Operative Risks:
  • 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

Embolization (Radiology) Risks

• ​Pre-Operative Risks: Local Anesthetic: Minimal risks
• Pre-Operative Risks: ​General Anesthetic: 
  • Hypotension
  • Hypoxia
  • Arrhythmia​
• ​Intra-Operative Risks:
  • 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 (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.
15. Godbole, Prasad P.; Wilcox, Duncan T.; Koyle, Martin A. (2015-07-20). Pediatric Urology: Surgical Complications and Management. John Wiley & Sons.ISBN 9781118473313.