Varicocelectomy Bilateral

Varicocelectomy bilateral surgery

Bilateral varicocelectomy is a medical operation done to repair varicoceles (enlarging of veins on either side of the scrotum). Varicoceles can lead to:

• Male infertility
• Pain or discomfort in the testicles.
• Loss of testicles (shrinkage).

Surgery is to disrupt the abnormal veins and leave the normal flow of blood to testes intact.

Bilateral varicocelectomy procedure

Preoperative Preparation

Medical Evaluation:

• Extensive medical history and physical examination.
• Assess veins and testicular size Scrotal ultrasound.
• Fertility assessment- semen analysis.

Laboratory Tests:

• CBC, kidney and liver test, coagulation profile.
• Anaesthesia clearance

Patient Instructions:

• Eating 6-8 hours before surgery (when under general anaesthesia), should be avoided.
• Discontinue some medications (blood thinners) as prescribed.

Anaesthesia

• It is usually performed by general anaesthesia or spinal anaesthesia.

Surgical Approaches

Microsurgical Subinguinal Approach (Best Preferred):

• Little cut below the groin.
• Microscope to be used to detect veins and save arteries and lymphatics.
• Reduced recurrence/complications.

Inguinal Approach:

• Incision at the inguinal canal.
• Dilated veins ligated
• Very slight increased risk of recurrence.

Laparoscopic Approach:

• Minimally invasive
• Cuts made in the lower abdomen.
• Internal spermatic vein ligation.

Step-by-Step Procedure

• Patient is lying on his back on the operating table.
• Incisions are done on each side (inguinal/subinguinal or laparoscopic ports inserted).
• Bare and isolated spermatic cord.
• Expansive veins diagnosed and bound.
• Spermatic arteries and lymphatics retained to prevent such complications as hydrocele or testicular atrophy.
• Wound closed with sutures.
• Dressing in place, scrotal support suggested.
• Time: 1-2 hours bilateral surgery.

Postoperative Care

• Weakness: plus 24-48 hours; do not take up vigorous exercise within 2-4 weeks.
• Support to the scrotal area and cold packs to diminish the swelling.
• Suffering controlled using prescribed analgesics.
• Until the clearance of the surgeon (usually 2–3 weeks), avoid sexual activity.

Factors Affecting Varicocelectomy bilateral surgery cost India

The following are some of the major considerations that influence the price of a bilateral varicocelectomy (surgery on both sides):

Type of Surgical Technique

• Inguinal/sub-inguinal Traditional open surgery is generally the cheapest. 
• Microsurgical / microscope-assisted varicocelectomy (utilizing a surgical microscope) is pricier due to equipment and special expertise. 
• Minimal invasive surgery (Laparoscopic) is also expensive when compared to open surgery. 
• When bilateral surgery (both sides) is being performed, it will cost more to have unilateral surgery (one-side surgical interventions). 
• Bottom line: The less invasive/ more advanced/higher skill methodology is more expensive.

Skills and Experience of a Surgeon

• Very experienced surgeons are highly trained in the art of microsurgery or very successful and usually charge more. 
• Another way that hospitals can charge a premium is that the urologist or andrologist performs the surgery instead of another surgeon who is more generic.

Type, Location and Infrastructure of hospitals

• The cost structure (greater room charges, staff costs, overheads) in hospitals in major metro cities (Delhi, Mumbai, Bengaluru, Hyderabad) tends to be higher than in cities of tier-2 or smaller cities. 
• High-end hospitals in the form of private, multi-specialty hospitals are usually more expensive than smaller clinics or publicly-operated hospitals. 
• Extra services (single room, personal attention to the nursing, comfort leaps) also drive the price.

Diagnostics, Pre- and Post-operative Respite

• It is not only that the surgery does not come cheap: before the procedure, ultrasound, Doppler, semen analysis, blood tests, hormones and so on, are all included in the bill. 
• Possible post-operative follow up: length of stay in hospital, medication use, follow-up visits, potential physiotherapy, can have any complications- all have an impact on the overall cost. 
• In case of other comorbidities (e.g., diabetes, hypertension) in the patient or complications with the varicocele (large grade, recurrence, bilateral, infertility work-up) then the complexity of investigation/treatment and cost is followed. 

Bilateral vs Unilateral Surgery

• As you are dealing with bilateral surgery (both sides), the price will be naturally more expensive than a unilateral surgery, as you are essentially treating two sides, which may necessarily increase the time of operation, the supplies and the post-surgery observations. 
• Other hospitals might consider bilateral as another group and bill it so.

Anaesthesia, Operating Room & Duration

• Cost will go up in case general anaesthesia is applied (as compared to local or regional). 
• The extended working hours or intricacy of the surgery field increases OR costs, man hours and equipment resources.
• Application of modern equipment (microscope, laparoscope, special ligation tools) is cost-adding.

Medical Tourism and International Patients

• In the case of international patients (medical tourism), hospitals will tend to provide a more inclusive package (including accommodation, translation, airport pickup etc) at the expense of increasing the list price but including a wide range of services. 

Room Type, Length of stay at a hospital

• The room-charges will be much higher in case you stay in a premium room (single room, deluxe).
• In case you are required to remain more (because of complications or monitoring) the price becomes higher.

Best hospital for bilateral varicocelectomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Bilateral varicocelectomy recovery time

The following is a step-by-step plan on the post-surgery recovery following bilateral varicocelectomy:

Immediate Postoperative Period (0-48 hours) 

• Scrotal pain, swelling or bruising is mild to moderate.
• Scrotal support (suspensory) and cold packs aid in the decrease of pain and swelling.
• Suffering can normally be treated by analgesics.
• Patients are advised to walk slowly in order to avoid blood clots.

Short-term Recovery (1–7 days)

• A majority of patients are able to engage in some light tasks like walking and desk work in 2-3 days.
• Light lifting, intense exercise or long standing should be avoided.
• Showering should occur usually after every 24 hours and it should be kept dry and clean around the incision.

Medium-term Recovery (2–4 weeks)

• The swelling and bruising normally get healed in 2 weeks.
• Patients can slowly resume a moderate exercise but not sex until they are cleared by the surgeon (typically 2 -3 weeks).
• Recommendation to visit the wound on a regular basis to check the healing and to verify that there is no hydrocele or recurrence.

Long-term Recovery (4–6 weeks)

• Exercise with complete body involvement such as going to the gym, running, or lifting heavy items can typically be reintroduced.
• In case the procedure was performed due to infertility, the fertility changes might require 36 months before the parameters of the semen have improved.

Conclusion

Bilateral varicocelectomy is a safe and effective surgery that is used to treat the varicoceles on both sides of the scrotum. It assists in alleviating pain, avoiding the atrophy of the testicles, and enhancing the fertility of men with bilateral varicoceles. Microsurgical, laparoscopic or open (inguinal/subinguinal) with the lowest recurrence and complication rates being in the microsurgery. The majority of the patients resume light exercise a few days later, moderate exercise after duration of 2-4 weeks, and full exercise after 4-6 weeks. The fertility might require 3-6 months. All in all, bilateral varicocelectomy is a safe and effective procedure that has good results, where proper operation and aftercare can ensure it is performed successfully, as well as it may be a good way to relieve the symptoms and possibly even improve the fertility.

Varicocelectomy bilateral surgery in India with GetWellGo

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• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
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FAQ

1. Is bilateral surgery more painful than unilateral?

• Slightly more discomfort at first because both sides will have been operated on.
• Pain is usually mild to moderate and can be controlled with medication as prescribed.

2. When can I resume sexual activity?

• Usually after 2–3 weeks, or when cleared by the surgeon.

3. Will the surgery improve fertility?

• Fertility can be enhanced, especially in those males with poor semen parameters.
• The changes in semen quality generally appear after 3–6 months following surgery.

4. How can I take care of myself after surgery?

• Wear scrotal support for a few days.
• Avoid heavy lifting, strenuous activity and sexual activity until cleared. 
• Apply cold to reduce swelling. 
• Take your medications as prescribed by your doctor, and continue to follow up with your surgeon. 

5. Is the surgery safe among young men? 

• Yes, indicated bilateral varicocelectomy in adolescents and young adults is safe, especially in the case of testicular growth problems or discomfort.