What are the possible complications of varicocele treatment?

Updated: Jan 02, 2019
  • Author: Wesley M White, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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The prevalence of adverse effects following varicocele repair is remarkably low. Hydrocele or increased fluid around the testicles occurs in 2-5% of patients. Successful surgery often increases conception rates in infertile couples. The overall recurrence rate for varicoceles has been reported as high as 10%.

The long-term occurrence of hydroceles and varicocele recurrence was analyzed in a study comparing 67 patients who received lymphatic-sparing laparoscopic varicocelectomy with 30 patients who received a plain laparoscopic varicocelectomy. The risk of hydrocele formation was significantly less in lymphatic-sparing group (4.5% vs. 43.3%). In addition, none of the patients with hydrocele formation in the lymphatic-sparing group required a hydrocelectomy, compared with 31% in the plain laparoscopic group. [30]

The varicocele recurrence rate was higher in the lymphatic-sparing group (6% vs 3.3%) but when the artery was not preserved, the rate in the lymphatic-sparing group fell to 1.3%. The success and complication rates of lymphatic-sparing, non–artery preserving, laparoscopic varicocelectomy were comparable with those of subinguinal microsurgical varicocelectomy. [30]

Injury to the testicular artery has been reported in 0.9% of microsurgical varicocele repairs. This incidence may be higher when optical magnification is not used for varicocele repair. Because the testis typically has additional arterial supplies from the vasal and cremasteric arteries, testicular atrophy is uncommon (5%) after division of the testicular artery. Smaller atrophic testes may be at greater risk for accidental testicular artery injury because of the smaller size of the artery in these cases.

In a patient in whom a varicocele is first identified during a vasectomy reversal, varicocelectomy at the time of the vasectomy reversal is controversial. Delaying the varicocelectomy preserves some venous return in these patients and avoids possible injury to the testicular artery. Consider varicocele repair 6 months later, after new vascular channels form.

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