Microsurgical Varicocele Ligation

Definition:

Varicoceles are abnormally enlarged veins draining the testicles. They are usually larger on the left side. Varicoceles cause pooling of blood in the scrotum and a rise in testicular temperature. This rise in temperature has an adverse effect on sperm production and function. Surgical varicocele repair, a varicocele ligation, will halt further deterioration of sperm production and often improves sperm quality to fertile levels. By performing this procedure microsurgically we will virtually eliminate the complications of recurrent varicocele, hydrocele or injury to the testis.

Pre-operative Preparation:

  1. For any elective surgery you should be in the best of health. It is important to let my office know if you have any other health problems which might necessitate consultation with an internist prior to your surgery.
  2. Avoid aspirin and aspirin products for a week before your surgery.

Hospitalization:

  1. You will normally be operated on as an out-patient at an Ambulatory Surgical Center. The week before surgery you will be asked to report to the Ambulatory Surgical Center at which time a medical history, complete examination and necessary laboratory tests will be performed.
  2. On the day of your surgery, you will be asked to report to the Ambulatory Surgical Center at least one hour before surgery and must be accompanied by someone capable of driving you home. You will not have eaten nor drunk anything since dinner the night before. I will meet with you during the hour prior to surgery to examine you and answer any questions.
  3. Your varicocele ligation will take about 45 minutes for each side. The procedure is performed under either a general or a spinal anesthetic, both of which are extremely safe and effective.
  4. You will remain in the recovery room for a minimum of one hour and as long as you need until you feel comfortably alert for travel.

Post-Operative Care

  1. A small amount of bright red blood is to be expected. DO NOT be alarmed if you feel that the amount is excessive–call my office.
  2. At the time of discharge from the Ambulatory Surgical Center you will have been given prescriptions for pain medication and, occasionally, antibiotics. When taking pain medication, be careful as you walk or climb stairs. Dizziness is not unusual.
  3. Do not drive the first week after the surgery, but you can ride in a car if someone else is driving.
  4. The scrotal supporter and any gauze stuffing inside may be removed 48 hours after surgery, before you shower. Keep the dressing dry until then. You may shower 48 hours after the surgery.
  5. Swelling and black and blue are normal. Both will resolve in 3-4 weeks.
  6. If your job involves only desk work and very light activity, you may return 2 or 3 days after the surgery. It is likely that you will have some discomfort for 3-6 weeks after surgery.
  7. No heavy work or sports are allowed for 3 weeks post-operatively.
  8. No sexual intercourse is allowed for 1 week post-operatively.
  9. You will need to wear an athletic supporter (jock strap) for 1 week post-operatively.
  10. You may resume normal activities as you feel up to it.
  11. Remove steri-strips in 10 days. There are no stitches that need to be removed. The stitching is beneath the skin and dissolves.
  12. You will feel a hard ridge, as if a pencil is buried under the skin where the incision was made. This is normal healing, and will gradually soften up and flatten out over 3-6 weeks.

Post-Operative Semen Analysis

We ask that you have sperm counts obtained after your surgery at the following intervals:

1 month, 3 months, 6 months

and every 3 to 6 months after your surgery until your wife becomes pregnant. At the time of your semen analysis, a blood specimen will also be taken to determine antisperm antibody levels. At the time of your first semen analysis appointment, one month post-operatively, I will also give you a full examination.
In general, it will take between 3 to 12 months for sperm counts to return to normal, although on some occasions it may take up to 2 years.

PLEASE INFORM MY OFFICE IMMEDIATELY OF ANY PREGNANCY!!
If you experience any other problems, questions or complications after your surgery, please feel free to call the office.

If you would like more information please contact:

Bruce R.Gilbert, M.D., Ph.D. at 516-487-2700 or info@BruceGilbertMD.com