Varicocelectomy Is Not a Cure.
Learn the facts. Make an Informed Decision.
Mr. Daniel Johnson, B.Sc.
The enlarged and inflamed veins in your scrotum, especially those in the spermatic cord, that are producing your varicocele need to be removed so your testicles can receive the proper nutrients and oxygen they need. If not treated, your testicles will begin to suffer from the blood stasis, affecting your fertility in the long run and producing testicular and inguinal pain.
A varicocelectomy is a surgical procedure that could provide some benefits to varicocele patients. It is usually recommended to (Woo Suk et al, 2013):
General things to do days before surgery.
After your doctor explained to you how the procedure is done, what is the best thing for your case, its benefits, risks, and possible complications, you will have to follow certain guidelines and know some things before going into surgery.
What happens in the moments prior to surgery?
When you arrive for surgery, you will usually be attended by the nurses who will ask you to change your clothes for a hospital gown. The anesthesia personnel will lie you down on the surgical table and will usually administer a sedative to calm you down and the anesthesia medication, either a local or a general one, depending on what you and your doctor decided when talking about the procedure.
Is a norm to use a bladder catheter to remove the urine during the procedure, but do not worry, it will be introduced after the anesthesia. If you decide to go with the general anesthesia, the doctor will intubate you. From this moment on, your vital signs will be checked by the responsible team, who will check them before, during, and after the surgery.
During the procedure…
The most popular method is the microsurgical varicocelectomy, either with the inguinal or sub-inguinal technique, as several studies show (Binsaleh et al, 2007; Zini, 2007; Woo Suk et al, 2013; Mehta et al, 2013; Gde, 2013). Other options include the laparoscopic method, the open surgery technique, and the embolization option, which is likely to be the least beneficial one of all.
The main focus of the surgeon is getting inside the pelvic region and cut the enlarged veins found in the spermatic cord, which are compromising the blood flow, for then clamping, tying or cauterizing them.
After the surgery recommendations.
You will wake up in the recovery room, where the nurses and doctors will assist you. You will spend some time recovering, while you receive painkillers and maybe some sedative, if you want them. At this moment you can be accompanied by a companion, either family or friend.
The doctor will give you prescriptions for medications you need to take, such as antibiotics, painkillers, anti-inflammatory, etc. You will receive guidelines to clean your incisions, as well as recommendations like putting ice on your scrotum several times a day, avoiding sexual activity for up to 2 weeks to 1 month, avoiding exercising and taking home rest for work for a few weeks, etc.
After surgery consultations with the doctor will be scheduled to observe your progression as well as a new spermiogram to analyze sperm quality and count.
So, what could go wrong?
As is well known, a surgical procedure can have its complications, some minor, some more serious. As stated above, the preferred surgical method is the microsurgical varicocelectomy, which provides the least number of complications (Carbone et al, 2003; Baazeem et al, 2011; Woo Suk et al, 2013; Mehta et al, 2013). Either way, here is a list of some of the complications that could happen, taking into consideration that the experience of the surgeon, as in others procedures, can sometimes make the difference.
In the end, is it worth it?
As several studies mentioned above show, microsurgical varicocelectomy is the best option among the surgical procedures, dealing with minor complications rates and better outcomes. However, the same and other studies (Kantartzi et al, 2007; Shamsa et al, 2010; Baazeem et al, 2011; Kroese et al, 2012; Woo Suk et al, 2013; Gde, 2013) conclude that more investigation is needed to make microsurgical varicocelectomy the best option to treat varicocele.
In the major part of these studies, varicocelectomy did not improve sperm quality or count in a significant way compared to the control group (in the studies that provided a control group), while in others it did improve the sperm parameters, but the studies were not well-designed.
As per the pregnancy outcome, most of the conclusions were suggesting but not conclusive, giving low pregnancy rates after varicocelectomy. More studies should be done based on pregnancy rates after varicocelectomy as the primary outcome to have a definitive information.
Other than that, these studies showed that the microsurgical varicocelectomy NNT (number needed to treat) is 7, meaning that for every 7 patients who receive surgery, 1 gets the benefits. When compared with the embolization option, which has an NNT of 17, the previous method received more recommendations. However, an NNT of 7 is not that good, considering that the patients are going into surgery taking many risks when they could consider alternative treatment methods instead.
Either way, having all the information, is up to every patient to decide what he thinks is best for him.
Dealing with an informed consent.
Before the surgery, you will be asked to read and sign an informed consent in which the whole process with its benefits, risks, complications, anesthesia, and different phases are explained in total details. This informed consent is a way of mixing health with laws and bioethics.
Is basically a legal document where you declare you know everything there is to know about the procedure and let the doctors do their jobs, accepting their terms and conditions. For this reason is very important for you to discuss every single detail with your health care team before signing any paper and going into surgery.
These are some questions you could ask your doctors before deciding for surgery:
Author: Dr. Stefano Pizzo
Dr. Stefano Pizzo is a general practitioner. He graduated from Universidad de Oriente (UDO), Barcelona, Venezuela. In his last year as a Medical student, he lent his services in the Departments of Gynecology and Obstetrics, General Surgery, Traumatology, Internal Medicine, and Pediatrics at the "Luis Ortega" Central Hospital in Nueva Esparta State, doing assistance work in its Emergency and Hospitalization areas. Since then, he became a trained expert in Neural Therapy and he occupies the majority of his time writing valid and certified medical and scientific articles, especially in the Anti-Aging and Alternative Medicine fields.
Learn About Varicocele Home Treatment:
It seems like doctors lose all rationality as soon as you're diagnosed with varicocele. They blame your condition (varicocele) on unknown factors, and any symptoms that you may have (e.g. infertility, low testosterone, testicular pain, hypogonadism, etc.) on your varicocele. Now, they give you one of two options:
Oh, and if you have pain, they might recommend some pain killers.
If you get "lucky" and get a really "good" doctor, he might recommend a scrotal supporter.
Seems like all rationality and the last 1,000 years of medical and scientific advancement just went right out the window.
Your doctor is likely setting you up for failure with all of these strategies!
✗ Wait & See If Your Varicocele or Symptoms Will Improve
As it turns out, when it comes to varicocele, the worst thing that you can do is: Wait! Both varicocele grade and severity increase with time if left untreated. So, telling you to "do nothing" and "wait and see" is the same as telling you that there is nothing that can be done to improve your condition other than to wait until it is bad enough for you to be forced to have surgery. Yep, setting you up to fail.
✓ Don't Do "Nothing"!
Don't wait for surgery. If you have a varicocele, there is a lot that you can do. Sign up for the 100 Free Varicocele Treatment Tips & see for yourself.
✗ Take Pain Killers
If you have varicocele pain, it is pretty normal for your doctor to recommend temporary pain relief medication. But, the problem is that these medications typically have the symptom of worsening digestive health. Poor digestive health is a varicocele risk factor. So, when get off these medications, when you get off them, your symptoms typically worsen!
✓ Improve Digestive & Bowel Health
Constipation, poor digestive health, irregular bowel movements, and bloating all varicocele risk factors. They exacerbate the Nutcracker Syndrome. So, if you have any of those risk factors, you'll notice improvement of your varicocele and symptoms by correcting them!
✗ Scrotal Supporters
I find this one really backwards. Doctors treat testicular varicocele as if it is a varicose veins in the legs, and recommend that you wear compressive undergarments to help improve testicular blood circulation. While it sounds like it makes sense at first, it completely ignores that the testicles are completely different than the legs... Sure, compression helps, but, normal scrotal support underwear overheats the testicles, and at the same time prevent the testicles from dropping down to cool. Oops, they missed the only reason why you have a scrotum.
✓ Proper Scrotal Support Underwear
Proper scrotal support underwear takes into consideration that your testicles need both scrotal support and maximum cooling. Avoid generic brands. Get STUD Varicocele Therapeutic Underwear.
✗ Surgery or Embolization?
Which is better: Embolization or varicocelectomy?
✓ Avoid Both!
Both surgery & embolization are bad options! Don't fall for the surgery vs embolization marketing tactic. Embolization is typically sold as a "non-surgical" alternative to varicocelectomy (surgery), with only a small "small incision", "no general anaesthetic", and on an "out-patient bases". Hmmm, that sounds great, right?
Hmmm, I think we forgot something... Oh yeah, Results! Will it treat your varicocele? Will it improve your fertility and help you attain successful pregnancy? Will it cure your pain? Well, as it turns out the answer to all of these is "likely no", and "we're not certain". The science is really lacking on embolization. Surgery is likely also fairly ineffective for pain relief and improving pregnancy rates. The results for both surgery and embolization are uncertain.
But, you know what is certain? The risks of both surgery & embolization! Comprehensive: Surgery & Embolization Risks & Benefits >
✗ We Don't Know What Causes Varicocele
Genetically faulty valves? Nutcracker syndrome? We just don't know what causes varicocele! There is nothing that you can do, but blame your infertility on varicocele. Blame your testicular pain on varicocele. Blame your hypogonadism on varicocele. Forget your shitty lifestyle: The fact that you sit 8-12 hours a day on a cushion chair that traps heat for work, or the fact that you've inactive, or that you chain smoke. No! Forget about all of that, and just focus on varicocele--that's the real problem here. And, there is NOTHING that you can do about it.
✓ There is a Lot That You Can Do!
Actually, when it comes to varicocele, infertility, testicular pain, etc. there is a lot that you can and should be doing! Here is a quick and easy example: When it comes to infertility, even if caused by "varicocele", is there really nothing that you can do? What about being more active? What about cooling down your testicles? What about improving your diet and managing your stress?
There are many specific varicocele lifestyle risk factors, and many at home varicocele natural treatments. Now, again, just sign up for the 100 Free Varicocele Treatment Tips and see for yourself. Or, start with one of my Varicocele Natural Treatment Programs now & get varicocele under control!
Remember: When it comes to varicocele, the worst thing that you can do is "Nothing", and really, there is a lot that you can do! So, do something!
✓ Don't Do "Nothing"!
✓ Improve your Lifestyle Risk Factors
✓ Wear Proper Cooling Scrotal Support Underwear
✓ If Possible, Avoid Both Surgery & Embolization
✓ There is a Lot That You Can Do!
Well, both are bad options. Don't fall for the surgery vs embolization marketing tactic. Embolization is typically sold as a "non-surgical" alternative to varicocelectomy, with only a small "small incision", "no general anaesthetic", and on an "out-patient bases". Hmmm, that sounds great, right?
Hmmm, I think we forgot something... Oh yeah, Results! Will it treat your varicocele? Will it improve your fertility and help you attain successful pregnancy? Will it cure your pain? Well, as it turns out the answer to all of these is "likely no", and "we're not certain". The science is really lacking on embolization.
But, you know what is certain? The risks of embolization.
Embolization is a radiological procedure, that means x-ray exposure, and x-ray dye injection to help visualize the veins. It also has a high varicocele recurrence rate--up to 35% for right-sided varicoceles. 10-35% chance of hydrocele formation. Oh and my favorite one: Coil migration resulting in testicular loss... And many more risks.
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