Bilateral Varicocele: Surgery, Recovery, and Testicular Health

Bilateral varicocele

Hello Dr.
Li, I was very satisfied with your previous response, and I apologize for filling out the feedback as very unsatisfied.
I take this condition very seriously.
You mentioned that, in principle, the microscopic inguinal approach allows for ligation of the left to right communicating veins.
Is it difficult to perform this ligation during the actual surgery? Does it require a surgeon with considerable experience and skill to accomplish this? I consulted Dr.
Chen Yu, the director of the Urology Department at Linkou Chang Gung Memorial Hospital, regarding the possibility of testicular volume recovery post-surgery.
He mentioned that if there is testicular atrophy, there is about a 70% chance of recovery to a size close to that before atrophy.
Is this possible? (Below is my previous question).
I have had varicocele for over 10 years and have already fathered children.
In recent years, I have noticed that my left testicle seems to have shrunk, and the right testicle feels slightly smaller as well.
There is moderate reflux on the left side, while the right side shows no significant reflux.
Does the reflux from the left varicocele not only harm the left testicle but also potentially affect the right testicle through the communicating veins? Therefore, could the left-sided reflux possibly cause bilateral atrophy, with the left side being more pronounced and the right side being less affected? I am considering surgery to ligate the left side and not operate on the right side.
Will performing unilateral surgery increase the recurrence rate on the left side? Given that there are communicating veins between the sides, could the right side potentially influence the left side's recurrence through these veins in the future? Can ligation of the communicating veins from the left to the right be performed via the microscopic inguinal approach? Additionally, is there a chance for the surgery to restore testicular volume? Thank you.

Aj, 30~39 year old female. Ask Date: 2016/04/10

Dr. Li Xinyi reply Urology

Statistical figures may not be useful to you, as they are related to the duration and severity of your condition.
The size is not absolutely important; what matters is whether the function is okay.
For this aspect, please make sure to discuss it thoroughly with Dr.
Chen Yu.

Reply Date: 2016/04/10

More Info

Bilateral varicocele, particularly when it has been present for an extended period, can lead to various complications, including testicular atrophy and infertility. The condition involves the enlargement of veins within the scrotum, which can affect blood flow and lead to increased temperature in the testicles, potentially harming sperm production and overall testicular health.

Surgical Considerations:
When it comes to surgical intervention, the most common procedure is varicocelectomy, which can be performed using open surgery or laparoscopically. The laparoscopic approach, especially when done microsurgically, allows for a more precise dissection and ligation of the affected veins. In your case, the concern about ligating the communication between the left and right sides during surgery is valid. While it is technically feasible to ligate these connections, it does require a surgeon with significant experience and skill to minimize complications and ensure that the procedure is effective.

Recovery and Testicular Volume:
Regarding recovery, studies suggest that approximately 70% of patients who undergo varicocelectomy experience a return to near-normal testicular size, particularly if the testicular atrophy was not severe prior to surgery. However, this is contingent upon the extent of damage already done to the testicular tissue. If the left testicle has significantly shrunk due to prolonged varicocele, the chances of complete recovery may be lower, but improvement is still possible.

Impact on Both Testicles:
You raised an important point about the potential for left-sided varicocele to affect the right testicle through collateral circulation. Indeed, the reflux of blood from the left side can impact the right testicle, albeit to a lesser degree. The presence of communication between the two sides means that damage to one side can influence the other, leading to bilateral atrophy over time. Therefore, while the left side may show more pronounced atrophy, the right side can also be affected, albeit subtly.

Recurrence Rates:
As for the recurrence of varicocele after unilateral surgery, studies indicate that performing a unilateral varicocelectomy can lead to a higher recurrence rate on the operated side, particularly if there are significant collateral connections. The risk of recurrence is also influenced by the surgeon's technique and the completeness of the ligation of the affected veins.

Conclusion:
In summary, if you are considering surgery for your varicocele, it is crucial to consult with a urologist who specializes in this area. They can provide personalized advice based on your specific condition, including the potential for testicular volume recovery and the risks associated with unilateral surgery. It is also essential to discuss the implications of your condition on both testicles and the likelihood of recurrence. Proper surgical technique and postoperative care are vital to achieving the best possible outcomes.

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