Varicocelectomy Unilateral

Varicocelectomy unilateral surgery

Unilateral varicocelectomy surgery is a type of surgery that involves the treatment of a varicocele, or swelling of the veins in the scrotum, which occurs on one side (typically the left-hand side). The aim is to cure normal blood supply, testicular function, relieve discomfort and in most instances, enhance male fertility.

What Is a Unilateral Varicocelectomy?

A unilateral varicocelectomy is an operation to remove or tie off with the help of the surgeon the distended veins on one side of the scrotum. The varicocelectomy is mostly left-sided because most varicoceles are on the left side owing to anatomical factors.

Indications of Varicocelectomy

Unilateral varicocelectomy may be prescribed by doctors in instances where:

• The chronic pain of the scrotum is not amenable to conservative treatment.
• Aberrant spermic parameters infertility.
• Testicular atrophy (shrinking of the testicle) was noted.
• Symptomatic or detectable Grade 2 or Grade 3 varicocele.
• Asymmetry, heaviness or swelling is present.

Types of Unilateral Varicocelectomy Procedure

The process may be undertaken in a number of ways:

Microsurgical Subinguinal Varicocelectomy

• Under general or spinal anaesthesia.
• Makes use of a small subinguinal opening.
• The bulky veins are diagnosed and ligated with the help of a microscope.
• Veins and lymphatic are maintained.

Open Inguinal or Retroperitoneal Surgery

• Traditional approach
• Has a slightly bigger incision.
• There is an increased chance of recurrence relative to microsurgery.

Laparoscopic Varicocelectomy

• Abdominal ports.
• Veins removed laparoscopically.
• Available in high-grade varicocele.

Percutaneous Embolization (Non-surgical option)

• Radiologist puts a catheter and blocks the vein with coils.
• Less intrusive, faster recovery.

Unilateral varicocelectomy procedure

Unilateral varicocelectomy refers to a surgical operation that is undertaken to remedy a varicocele on one side of the scrotum (usually the left). It seeks to eliminate the abnormal veins and enable blood circulation to normalcy, minimize pain, and enhance fertility.

Preoperative Evaluation

The following steps are followed before the surgery:

• Check physical examination to ascertain the grade of varicocele.
• Scrotal Doppler ultrasound to determine blood circulation.
• Semen analysis (in case fertility is an issue)
• Blood tests CBC, kidney/liver function, coagulation profile.

Anaesthesia assessment

Patients are advised to:

• Preoperative starvation 6-8 hours.

• Discontinue anticoagulant medications (at the recommendation of a doctor)

Anaesthesia

Unilateral varicocelectomy is done under:

• General anaesthesia (most prevalent)
• Spinal anaesthesia (alternative).
• Local anaesthesia and sedation (uncommon; applied to subinguinal approach)

Surgical Approaches

Microsurgical Subinguinal Varicocelectomy (Most Preferred)

• It is the gold standard since it is the least recurring and complication.

Procedure Steps:

• Incision is done at the subinguinal area (just above the scrotum) with a small 23 cm.
• The spermatic cord is lifted out.
• The swollen veins are found under a microscope which is active.
• The surgeon ties off (ligates) all the abnormal veins with fine sutures.
• Vessels of the arteries, lymphatic system and vas deferens are taken good care of.
• The cord is reinserted and the incision is sewn using absorbent sutures.

Inguinal or Retroperitoneal Open Varicocelectomy.

• A cut is made in the lower abdomen or in the groin.
• The spermatic cord is explored and distended veins are detected.
• The veins are made off without magnification.
• Sutured incision.
• This technique is more recurrent than microsurgery.

Laparoscopic Varicocelectomy

• Minor abdominal incisions are carried out.
• An instrument and a laparoscope (camera) are introduced.
• The gonadal vein is cut or burnt.
• Instruments taken off and ports closed.
• Applicable in case of a high varicocele or bilateral disease.

Non-Surgical: Percutaneous Embolization

• The catheter is inserted either in the neck or the groin.
• This is pushed forward by the radiologist to the testicular vein.
• The faulty vein is blocked by the use of coils or agents.
• Blood is diverted via healthy veins.
• Minimally invasive and rapid recovery.

Duration of the Procedure

• Microsurgical varicocelectomy: 45-90 minutes.
• Laparoscopic: 30–60 minutes
• Open surgery: 45–60 minutes
• Embolization: 30–45 minutes

Postoperative Care

After surgery:

• The patients are observed between 2 and 4 hours.
• Most go home the same day.
• The slight swelling or pain is normal.

Care Instructions:

• Apply ice packs for 24 hours
• Do not do heavy lifting, running, or gym exercises in 2-4 weeks.
• Use scrotal support during several days.
• Sex after 1-2 weeks (or as recommended)
• Wound check follow-up in 1 week.
• Indication of 3 months of semen analysis only when one is fertile.

Factors Affecting Varicocelectomy unilateral surgery cost India

The following are the major variables that influence the prices of a unilateral varicocelectomy in India:

Type of Surgical Technique

• The least expensive will be open (traditional) surgery. 
• Subinguinal / microsurgical (preserving the lymphatics and arteries) is more expensive because it requires more delicate instrumentation and skill. 
• Laparoscopic or embolisation procedures are even more costly as they require special equipment, imaging, consumables. 
• Rationale: The more sophisticated the procedure, the greater the cost aspect of surgery (surgeon fee + equipment + time).

Surgeon’s Experience & Skill

• A specialist or highly qualified urologist who specializes in micro-surgery or andrology will be more likely to charge more. 

Facility Type and Hospital location

• Large multi-specialty hospitals or those in metro cities have a high room-rate, infrastructure spending, luxuries (private room, meals, comfort) → higher total spend. 
• The city is important: prices in Delhi, Mumbai, Bangalore are usually more expensive in comparison with other small cities. 

Preoperative Tests and Diagnostic Tests

• Prior to surgery ultrasound (scrotal Doppler), semen analysis (in case of infertility), blood tests, and perhaps hormone tests are required. These add to cost. 
• The cost is raised by the number/complexity of tests (e.g. whether genetic/IUI workup is required), etc.

Anaesthesia, Consumables and Surgical Time

• General anaesthesia (as opposed to local or spinal) is more expensive.
• The time of the surgery is the longer the anaesthesia and consumables (sutures, microscope time, etc) are used, the more expensive it is.
• Additional costs are incurred by the use of advanced consumables (microscope, laparoscope, embolisation coils). 

Hospital Stay & Room Category

• The cost of staying in a general ward is less than staying in a private deluxe room.
• In case of post-operative complications, then the length of stay is increased and cost is more. 
• Cost is even affected by day-care vs overnight stay choice.

Aftercare and Drugs

• Follow ups after surgery, any other ultrasounds/semen tests, medication, and dressing change are costly. 
• In case complications appear (hydrocele formation, infection) cost increases.

Severity /Complexity of Condition

• In case the varicocele is large, recurrent, or has other pathologies (i.e. infertility examinations) it might take more time/method → increased cost.

Best hospital for unilateral varicocelectomy India

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

Varicocelectomy unilateral recovery time

Unilateral varicocelectomy recovery usually occurs very fast particularly using the microscopic surgery methods or minimally invasive procedures. Majority of the patients resume normalcy within the span of few days although complete recovery is achieved after several weeks.

Immediate Recovery (Day 0–2)

• Released the same day or more than 24 hours (day-care procedure).
• Light-headed scrotal pain, swelling, or bruising is normal.
• Discomfort is minimized by the use of ice packs and pain medications.
• Same day walking is permitted.

Short-Term Recovery (1–2 Weeks)

• Return to office work: 2–3 days
• Light activities: After 3–5 days

Avoid:

• Heavy lifting
• Running/jogging
• Cycling
• Gym workouts
• Incisions heal in the outside environment within a period of about 10 days.

Resuming Sexual Activity

• Normally, given 1-2 weeks or so, at the discretion of comfort.
• The initial several times are mildly painful.

Total Internal Recovery (4-6 Weeks)

• The length of time taken to heal the scrotal tissues and veins takes approximately 4--6 weeks internally.
• Swelling gradually reduces.
• Do not engage in vigorous exercise until the doctor clears you.

Fertility Improvement (3–6 months)

If done for infertility:

• The quality of sperm begins to improve in 3 months.
• Optimal recovery at 6 months post-surgery.
• The follow-up semen analysis is generally conducted at 3, 6 and 12 months.

Conclusion

Unilateral varicocelectomy is a proven and safe procedure of surgery, used to address unilateral varicoceles of the scrotum. It helps in relieving pain, avoiding testicular damage and also has the potential of greatly improving fertility results. The surgery is very successful, recurrently limited, and has minimal complications with modern methods such as microsurgical or laparoscopic surgery. The recovery process is usually fast and patients can get normal functioning in a few days although complete internal regaining and fertility replacement takes several months. A combination of appropriate preoperative assessment, competent surgical performance, and compliance with the postoperative treatment is essential to the attainment of the optimal results.

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FAQ

1. Is the surgery painful?

• Majority of the patients have mild discomfort or swelling.
• Standard painkillers are good in managing pain.
• The extreme pain is rare and it must be communicated to the physician.

2. How soon can sexual life be resumed?

• Normally 1-2 weeks after, as per comfort.
• Mild pain in the beginning is normal.

3. Is varicocelectomy effective in enhancing fertility?

• Sperm parameters are improved in 70-85 percent of men.
• The pregnancy rates can rise 40-60 percent after surgery.

4. Will the varicocele recur?

• Re-occurrence is uncommon (less than 2) with microsurgical procedures.
• The probability of risk is a bit more with open or non-microsurgical.

5. Is hospitalization required?

• Majority of varicocelectomies unilaterally performed are day-care surgeries.
• Patients can also spend over night under observation on a hospital basis.