Microsurgical varicocelectomy

At Herzliya Medical Center, the leading private hospital in Israel, microsurgical varicocelectomy is carried out by Urologists with the use of unique techniques. Microsurgical varicocelectomy allows achieving excellent results with a lower risk of postoperative complications compared with the classical surgical methods.

Dr. Shay Shefi is the leading urologist-surgeon at Herzliya Medical Center, specializing in the microsurgical treatment of male infertility. Dr. Shefi spent two years studying advanced methods for the diagnosis and treatment of male infertility at the University of San Francisco (USF), USA. To date, he is the only Israeli specialist in this field.

What is varicocele?

Varicocele is an enlargement of the veins in the scrotum that develops due to the insufficiency of the valve apparatus and the weakness of the muscle component of the venous wall. The disease is usually accompanied by the manifestation of varicose in other parts of the body (varicose veins of the lower extremities, hemorrhoids) and has a hereditary predisposition. Due to the peculiarities of the anatomical structure of the testes and appendages, varicocele is most often observed on the left side. A bilateral or isolated right-sided lesion is less common.

Varicocele is accompanied by chronic venous stagnation and an increase in the temperature of the testicles, which negatively affects the natural sperm production, and also reduces the production of the male sex hormone – testosterone. The disease can lead to testicular atrophy and this disease is one of the main causes of secondary male infertility. Timely treatment by urologists allows preventing the development of irreversible changes.

Diagnosis of varicocele

An insignificant varicocele often occurs without particularly pronounced clinical symptoms and, in most cases, is diagnosed when examining patients who can’t conceive spontaneously. Severe forms of varicose are accompanied by a feeling of heaviness and pain in the scrotum, visually determined by the subcutaneous venous mesh, swelling and a decrease of testicular in size. In the urology department of Herzliya Medical Center, ultrasound methods are used, including the Doppler technique (ultrasound scan protocol, which allows to achieve high-quality visualization of blood vessels and to estimate the blood circulation status) in order to confirm the diagnosis. For the differential diagnostics, laboratory quality tests for semen quality and hormonal tests are used.

Preparation before microsurgical varicocelectomy

The necessary preparation before microsurgical varicocelectomy includes laboratory tests, such as the tests aimed to assess the state of the blood coagulation system. During the pre-operative period, patients taking anticoagulants and antiaggregants receive individual recommendations about changing medicinal treatment. At the Herzliya Medical Center anesthesiologists conduct a thorough preliminary examination in order to exclude the possibility of complications during anesthesia. If necessary, patients are also consulted by a general therapist and cardiologist.

Microsurgical varicocelectomy at the Herzliya Medical Center

The purpose of the surgical treatment of varicocele includes the ligation and removal of varicose veins. Microsurgical varicocelectomy is performed under general anesthesia. During the procedure, the urologist makes a small incision (about 2 cm) in the patient’s groin area, through which the spermatic cord is taken out. After extraction of the cord, a thorough visual examination for varicose veins is carried out. Microsurgical advancements now allow bandaging and removal of each damaged vessel and restoring normal venous outflow from the scrotum area. Varicocele microsurgery is a less traumatic treatment and can be performed in day hospital. At the end of the surgery, the surgical incision is stitched and dressed in the aseptic bandage.

Rehabilitation after microsurgical varicocelectomy

After microsurgical varicocelectomy, patients are usually discharged on the same day. Minor hematoma and swelling in the area of surgery usually do not require additional treatment. To prevent pain and discomfort during the first days, patients receive the necessary advice on the correct use of painkillers. Most patients can return to their usual life after 48 hours. Urologists at the Herzliya Medical Center recommend abstaining from sexual activity for 7-10 days after the procedure.

Improvement of the laboratory parameters of seminal fluid is observed in the next three months. During this period, there is also a gradual decrease and complete disappearance of the clinical manifestations of varicocele. After microsurgical varicocelectomy, the restoration of normal laboratory parameters of sperm is observed in 70% of patients, which significantly increases the likelihood of spontaneous pregnancy.