Microscopic Varicocele Surgery
Varicocele is the most common condition affecting male infertility (resulting in poor sperm parameters such as low count and motility) and can present as dilated varicosities (veins) within the scrotum and testicular discomfort.
It occurs more commonly on the left scrotum. Microsurgical varicocelectomy is considered the standard of care in men with infertility because it has the lowest complication risks and highest success rate. Microsurgical varicocelectomy enables best possible visualization of the testicular artery and lymphatic channels to preserve the testicular function and minimise scrotal swelling postoperatively.
Professor Chung has published extensively on varicocele (see below) and is considered the leading surgeon expert in Australia. He is the first urologist in Australia to receive a formal fellowship training in Andrology that is accredited by the Sexual Medicine Society of North America, and the past Chair of the Andrology section for the Urological Society of Australia and New Zealand. He has mentored many surgeons over the years including being invited as surgeon expert and organised numerous surgical workshops around the world.
What preparation is required?
Since microsurgical varicocelectomy is performed under general anaesthesia, you should be fasted (nothing to eat or drink) for 6 hours prior to surgery. Regular medications can be taken with a sip of water with the exception of blood thinning agents (such as warfarin, clopidogrel) or non-steroidal anti-inflammatory drugs which need to be stopped for 7-10 days.
What happens in the operating room?
You will meet Professor Chung and your anaesthetist prior to surgery. Your procedure will be performed under general anaesthesia with appropriate anti-microbial cover.
What are the risks?
Microsurgical varicocelectomy is a very delicate microsurgery and when performed by expert surgeon, is considered a safe procedure and has minimal complications.
Common complaints include
- Pain
- Swelling (hydrocele)
- Bruising, bleeding or hematoma
- Skin irritation and wound issues (mild infection)
- Recurrent of varicocele
- Testicular injury
What to expect afterwards?
You are usually discharged the same day and you can remove the surgical dressing the next day. Most men return to normal work after a few days. However, you should avoid strenuous physical exertion or sexual activity for 4-6 weeks. It is no uncommon for men to experience dull discomfort at the testis after the surgery as the varicocele reduces in size.
Follow-up
You will have a follow-up appointment with Professor Chung scheduled at 4-6 weeks postoperatively. If microsurgical varicocelectomy was performed for fertility purpose, you will be given an instruction to have repeat semen analysis in 3 months time.
Some of the key articles published by Professor Chung on varicocele
- Chung E. Postvaricocele embolization pain syndrome: A case series report and review of current treatment strategies. J Endovasc Ther. 2022. PMID: 35341383
- Cannarella R, Shah R, Hamoda TAA et al. (Chung E). Does varicocele repair improve conventional semen parameters? A meta-analytic study of before-after data. World J Mens Health 2023. PMID: 37382284
- Shah R, Agarwal A, Kavoussi P et al (Chung E). Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations. World J Mens Health. 2023;41(1):164-197
- Chung E. Chapter: Should a varicocele be repaired before assisted reproductive technology treatment? In: Varicocele and Male Infertility: A Complete Guide. Basingstoke, UK: Springer Nature
- Chung E. Varicocele and male infertility: Evidence in the era of assisted reproductive technology. Reprod Syst Sex Disorder 2014; 3:e114
- Chung E. Andrology- Reproductive years and beyond. Australia Family Physician. 2012;41(10):758-61
- Chung E and Brock GB. Cryptorchidism and its impact on male infertility: a state of art review of current literature. Can Urol Assoc J. 2011;5(3):210-4