PLANNING AND PREPARATION The indications for microsurgical varicocelectomy are: (i) in men with infertility, abnormal semen values and a clinical varicocele; (ii) in those with scrotal pain related to a clinical varicocele; (iii) in children with a clinical varicocele associated with ipsilateral testicular atrophy; and in cases of hypogonadism with clinical varicocele. Thus patients with a clinical varicocele and no contraindications to surgery are those selected
Specific equipment/materials required are an operating microscope (×12–20), and microsurgical instruments (needle driver, jeweller’s forceps). The only specific patient preparation required is shaving or clipping of the pubic hair on the day of surgery; no other specific measures are necessary
POSTOPERATIVE CARE
Dressing is with sterile strips, covered by a dry
dressing. The only specific medication is with
analgesics (acetaminophen or codeine) as
needed. The patient is instructed to use icepacks
and scrotal elevation as needed
FROM SURGEON TO SURGEON
The difficult case: A history of previous
inguinal or subinguinal surgery (particularly,
varicocelectomy) will make the dissection
more difficult, with a greater potential for
arterial or lymphatic injury. In these cases,
percutaneous embolization of the varicocele
might be a safer option.
Things to make life easier: Division of the cord
package as described above has simplified the
procedure.