What is a varicocele, and what does varicocele surgery do?
A varicocele is a group of swollen veins in the scrotum, just above the testis. These veins normally carry blood away from the testis and help keep it slightly cooler than the rest of the body. When the valves inside them fail, blood pools and the veins stretch, much like varicose veins in the leg. The pooled warm blood can reduce sperm production and, over years, the size of the testis.
Varicoceles are common, found in roughly one in seven adult men, and more often in men being checked for infertility. Most are on the left side, because of the way the left testicular vein drains. Many men with a varicocele have normal fertility and never need treatment.
Grades of varicocele
| Grade | How it is found |
|---|---|
| Subclinical | Seen only on ultrasound; cannot be felt |
| Grade 1 | Felt only when you strain or bear down while standing |
| Grade 2 | Felt while standing, without straining |
| Grade 3 | Visible through the skin, often described as a "bag of worms" |
Varicocele surgery (varicocelectomy) ties off the faulty veins so that blood drains through healthy veins instead. The testis keeps its artery and its normal drainage.
Who needs varicocele surgery, and who does not
Treatment is usually advised when:
- A couple cannot conceive, the man has a varicocele that can be felt, his semen analysis is abnormal, and the female partner has normal fertility or a treatable problem
- The veins cause a dull ache or heaviness that keeps returning after standing or exercise, and other causes of pain have been ruled out. Read more about testicular pain and varicocele.
- An adolescent’s testis on the varicocele side is smaller than the other and stays smaller on repeat measurement, or semen tests in an older teenager are abnormal
Surgery is usually not advised for a varicocele seen only on ultrasound, for a varicocele with normal semen and no pain, or when the couple will need IVF or ICSI for another reason anyway, although repair is sometimes still discussed before IVF. Many teenagers are simply checked once a year.
A varicocele that appears suddenly in an older man, is on the right side alone, or does not empty when lying down, needs an abdominal scan to rule out a growth, such as a kidney tumour, pressing on the veins.
Tests and preparation before varicocele surgery
- Examination standing and lying down, with and without straining
- Scrotal Doppler ultrasound to confirm the varicocele, measure vein width and backflow of blood, and measure the size of both testes
- Two semen analyses, and hormone tests (FSH, LH and testosterone) in men with infertility
- An assessment of the female partner, so the couple’s plan is clear
- Routine tests for anaesthesia: blood count, sugar, kidney function and an ECG if needed
You will be told when to stop eating and drinking. If you take blood thinners, tell the clinic early; they are stopped or continued only on medical advice. Bring close-fitting briefs or a scrotal support to wear afterwards.
How varicocele surgery is done: microsurgical and laparoscopic
Microsurgical subinguinal varicocelectomy
- Under general or spinal anaesthesia, or sometimes local anaesthesia with sedation, a cut of about 2-3 cm is made just below the groin crease.
- The spermatic cord, which carries the artery, veins, lymph vessels and the vas deferens, is gently lifted out.
- Under high magnification, the swollen veins are found one by one, tied and divided. The testicular artery, the lymph vessels and the vas are kept safe.
- The wound is closed with dissolvable stitches. One side usually takes about 1-2 hours.
Magnification helps the surgeon see the small artery and lymph vessels clearly. This is designed to lower the chance of the varicocele returning and of fluid collecting around the testis.
Laparoscopic varicocelectomy
Under general anaesthesia, a camera and instruments are passed through three small cuts in the abdomen, and the veins are clipped higher up, where there are fewer of them. Both sides can be treated through the same cuts. Fluid around the testis is somewhat more common afterwards unless the lymph vessels are spared.
Embolisation
An interventional radiologist passes a thin tube through a vein in the groin or neck under X-ray guidance and blocks the faulty vein with small coils or a sealing liquid. There is no cut, but X-rays are used, and the vein cannot always be reached. Where it suits a patient, it is arranged with the radiology team.
Equipment and where it is done
Surgery is done at ManglamPlus Medicity using an operating microscope or high-power magnifying loupes, fine microsurgical instruments and very fine stitches, or a laparoscopic camera, instruments and clips for the keyhole approach. Doppler ultrasound is used before and after surgery to check the veins and testes.
Recovery after varicocele surgery
| When | What to expect |
|---|---|
| Day of surgery | Home the same evening or next morning; mild groin ache; walking is encouraged |
| Days 1-3 | Scrotal support, cold packs wrapped in cloth for short periods, simple painkillers; shower after 48 hours or as advised |
| Week 1-2 | Back to desk work, usually within 2-5 days; mild swelling settles; sex once comfortable, often after 1-2 weeks |
| Weeks 3-6 | Gym, heavy lifting, cycling and sport usually resume after 2-3 weeks |
| Months 3-6 | Semen analysis at about three months and again at about six months |
Call the clinic if the scrotum swells quickly or becomes very tense, if you develop fever, if the wound leaks pus, or if pain gets worse instead of settling.
Risks and complications of varicocele surgery
- Hydrocele: fluid collecting around the testis, usually because lymph vessels were tied. Small ones may settle; larger ones may need a minor operation. Read about hydrocele.
- Recurrence: a small vein can enlarge later and the varicocele returns. It can be treated again, sometimes by embolisation.
- Injury to the testicular artery: uncommon. The testis usually survives through other blood vessels, but it can shrink.
- Bleeding or a blood collection (haematoma) in the wound or scrotum
- Wound infection, usually treated with dressings and antibiotics
- Numbness of skin near the cut or on the upper thigh, usually temporary
- Ongoing pain in some men who had surgery for pain
Careful identification of the artery and lymph vessels under magnification, gentle handling of the cord and good wound care are used to keep these risks low.
Results: semen tests and fertility after varicocele repair
Sperm take about three months to develop, so no change is expected in the first weeks. Semen analysis is repeated at about three months and again at about six months. In many men with a varicocele that can be felt and abnormal semen, sperm count and movement improve, and some couples then conceive naturally. Not every man improves, and pregnancy also depends on the partner’s fertility and age.
If semen quality does not improve enough, or time is short, the couple moves on to assisted conception. The next steps are set out on the male infertility treatment page, and the condition is explained under male infertility. Many men who had surgery for an ache find it settles once healing is complete, though not all.
Comparing varicocele treatment options
| Microsurgical | Laparoscopic | Embolisation | Observation | |
|---|---|---|---|---|
| Cut | One 2-3 cm cut below the groin | Three small cuts in the abdomen | None; a tube through a vein | None |
| Anaesthesia | General, spinal or local with sedation | General | Local, sometimes sedation | None |
| Chance of the varicocele returning | Low | Low to moderate | Moderate; varies | Not applicable |
| Chance of hydrocele | Low | Higher unless lymph vessels are spared | Very low | Not applicable |
| Often chosen for | Infertility and recurrent varicocele | Both sides at once | Men who prefer to avoid a cut, where available | Subclinical varicocele, or normal semen without pain |
The choice depends on your anatomy, whether one or both sides are involved, any previous surgery, and your preference once the options are explained. Other men’s health problems are covered on the andrology and sexual health page.
Cost of varicocele surgery in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- Whether one or both sides are treated
- The technique: microsurgical, laparoscopic, or embolisation arranged with the radiology team
- The type of anaesthesia, and whether you go home the same day or stay one night at ManglamPlus Medicity
- Tests before and after surgery, such as scrotal Doppler, semen analyses and hormone tests
- Your insurance policy’s terms, which may differ for surgery done for pain and surgery done for infertility
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Varicocele surgery with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
Can a varicocele go away on its own?
No. The stretched veins do not shrink back by themselves. But many varicoceles cause no problem at all and only need checking, not surgery.
Will varicocele surgery improve my sperm count?
In many men with a varicocele that can be felt and abnormal semen, count and movement improve over three to six months. It does not happen in every man, which is why semen tests are repeated after surgery.
Does a varicocele cause erectile dysfunction or low testosterone?
A varicocele does not usually cause erection problems. Some men with larger varicoceles have lower testosterone, and repair may raise it in some of them, but a low level on its own is not usually the reason for surgery.
Can both sides be operated on together?
Yes. When there is a varicocele on both sides that needs treatment, both are usually repaired in the same operation, either through two small groin cuts or by laparoscopy.
Should we have varicocele surgery or go straight to IVF?
It depends on the semen results, the female partner’s age and fertility, and how long you have been trying. When the partner is older or has her own fertility problem, going ahead with IVF or ICSI may make more sense. This is decided together with your partner’s gynaecologist.
Will my testis shrink after surgery?
This is uncommon. The artery is identified and kept safe, and even if it is injured, other vessels usually keep the testis supplied. In teenagers, repair is often done so that a testis that has fallen behind can catch up in growth.
Is varicocele surgery covered by insurance, RGHS or Ayushman?
Cover depends on your policy or scheme, the reason for surgery and the hospital’s empanelment. Confirm with the ManglamPlus Medicity billing desk, and see payment and insurance.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.