This study may also detect a subclinical varicocele, although it is also useful in men with tight scrotal skin, short spermatic cords, or to examine the right side in the presence of a palpable left varicocele. The goals of varicocele repair are to relieve pain in symptomatic cases and to improve semen parameters, testicular function, and pregnancy rates in couples with male factor infertility associated with varicocele. Studies have shown that varicocele repair can improve all three of these parameters. Varicocele repair results in a significant improvement in semen analysis in 60 to 80 percent of men. Men with large varicoceles tend to have poorer preoperative semen quality than men with small varicoceles, but repair of large varicocele results in greater improvement than repair of small varicoceles.
Treatment consists of either radiologic ablation or surgical ligation.
The surgery is typically performed as an outpatient and consists of a small incision just below the groin. Most men prefer general anesthesia, however the procedure may be performed under local with intravenous sedation. The open surgical procedures can be performed with loupe or microscope magnification. The advantages of the microsurgical approach to varicocele repairs are reliable identification and preservation of the testicular artery or arteries, cremasteric artery or arteries, and lymphatic channels and reliable identification of all internal spermatic veins and gubernacular veins. Use of a microscope enables a surgeon to find and preserve the tiny artery that brings blood to the testes.