Varicocele Surgery: What Happens to Blood Flow After Vein Removal?

In cases of varicocele, after the surgical removal of the affected veins, blood should return through the surrounding healthy veins, typically via the testicular vein, which drains into the renal vein or inferior vena cava, depending on the side of the body?

Hello, doctor.
For patients with severe varicocele (where a prominent mass is visibly apparent), I would like to inquire about the venous ligation surgery.
Will all the veins be removed, or will some veins be preserved to allow blood to return? If every vein is swollen, where will the blood flow back to the heart after all the veins are removed? Watching videos of varicocele surgery seems quite frightening, and I am worried about accidentally cutting other structures or leaving knots of surgical sutures inside the testicle.
Currently, I sometimes experience pain and discomfort in the testicles after masturbation.
I visited a large hospital during middle school, and the doctor said it wouldn't affect fertility.
However, now that I am older and concerned about poor sperm quality, I am considering surgery when I want to conceive.

Jíguāng, 20~29 year old female. Ask Date: 2020/12/06

Dr. Cai Zhuorong reply Urology

Is it necessary to remove "all" veins, or will some veins be preserved to allow blood to flow back? A: Only the dilated veins are removed; is it okay to leave the surgical sutures inside the testicle? A: It is not a problem.

Reply Date: 2020/12/06

More Info

Varicocele surgery is a common procedure performed to treat varicocele, which is an enlargement of the veins within the scrotum. This condition can lead to discomfort, pain, and potential fertility issues due to impaired blood flow and increased temperature in the testicular area. Understanding the surgical approach and its implications on blood flow is crucial for patients considering this treatment.

What Happens During Varicocele Surgery?
In a typical varicocele surgery, the surgeon does not remove all the veins in the affected area. Instead, the procedure focuses on ligating (tying off) the affected veins that are causing the varicocele. The primary goal is to redirect blood flow away from the dilated veins while preserving the function of the surrounding healthy veins. This is important because the body has a complex network of veins that can compensate for the removal of the affected veins.

Blood Flow After Vein Removal
After the ligation of the affected veins, blood flow is redirected through the remaining healthy veins. The body has a remarkable ability to adapt to changes in blood flow. The veins that are not affected by varicocele can take over the role of draining blood from the testicular area. This means that even if the dilated veins are removed or tied off, blood can still return to the heart through alternative pathways.

Concerns About Surgery
It is natural to have concerns about the surgical procedure, especially regarding the potential for complications. Here are some common concerns and clarifications:
1. Removal of All Veins: As mentioned, not all veins are removed. The surgery is designed to target only the problematic veins while preserving the healthy ones to maintain adequate blood flow.

2. Risk of Injury: Surgeons are trained to navigate the complex anatomy of the scrotum and surrounding structures. While there is always a risk of injury to nearby tissues, experienced surgeons take great care to avoid such complications.

3. Surgical Materials: Concerns about surgical materials, such as knots from sutures, are valid. However, surgeons typically use absorbable sutures that dissolve over time, minimizing the risk of long-term complications. If non-absorbable sutures are used, they are placed in a way that they do not interfere with the function of the testicles.

4. Postoperative Pain: It is not uncommon to experience discomfort or pain in the testicular area after surgery. This can be due to inflammation or the healing process. If pain persists or worsens, it is essential to consult with your healthcare provider.

Fertility Considerations
Regarding fertility, varicocele can negatively impact sperm production and quality. If you have concerns about your fertility, it is advisable to discuss them with your healthcare provider. They can provide guidance on the timing of surgery and any necessary preoperative evaluations, such as semen analysis, to assess your reproductive health.

Conclusion
In summary, varicocele surgery aims to alleviate the symptoms associated with the condition while preserving the function of healthy veins. The body is capable of adapting to changes in blood flow, ensuring that adequate circulation is maintained even after the removal of affected veins. If you have specific concerns about the procedure or its implications for your health, it is crucial to have an open dialogue with your surgeon. They can provide personalized information based on your medical history and the specifics of your condition, helping to alleviate any fears you may have about the surgery.

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