Microsurgical Varicocelectomy
Varicocele surgery performed under the operating microscope: the dilated veins are separated one by one, while the testicular artery and the lymphatic vessels are preserved.
Last medically reviewed: October 6, 2026 — Assoc. Prof. Dr. Müslüm Ergün
This page describes the OPERATION. Varicocele itself, who needs treatment and the non-surgical options are covered on a separate page. Go to the varicocele page
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- Procedure time
- 45–90 minutes (one side)
- Anesthesia
- Local with sedation, spinal or general
- Hospital stay
- Day case
- Stay in Türkiye
- 5–7 days
- Catheter duration
- Not needed
- Return to work
- 3–7 days (desk work), 2–3 weeks (heavy work)
- Flight clearance
- After the review appointment
About the condition
A varicocele is dilatation of the veins draining the testis. It is most often on the left and causes no symptoms at all in many men. Surgery comes into consideration where it causes symptoms or affects semen parameters.
MICROSURGICAL VARICOCELECTOMY is varicocele surgery carried out under the operating microscope. An incision of about 2–3 cm is made just below the groin crease (subinguinal); the spermatic cord is opened under magnification and the structures within it identified one by one. The dilated veins are ligated while the TESTICULAR ARTERY and the LYMPHATIC VESSELS are preserved.
THE PRACTICAL MEANING OF THAT PRESERVATION: keeping the testicular artery safeguards the blood supply to the testis; keeping the lymphatics reduces the chance of fluid collecting in the scrotum afterwards (a hydrocele). Without a microscope these structures cannot always be told apart with the naked eye.
THE DECISION TO OPERATE COMES FROM THE CLINICAL PICTURE, NOT THE SCAN. In a man whose varicocele is seen on ultrasound but who has no pain and whose semen parameters and testicular volume are normal, surgery is not advised. The decision rests on concrete findings: a varicocele palpable on examination, pain, impaired semen parameters, reduced testicular volume, or growth delay of the testis in an adolescent.
AN HONEST STATEMENT OF EXPECTATION: the aim of surgery is to create a chance of improvement in semen parameters; PREGNANCY CANNOT BE GUARANTEED. Assessment of infertility is the assessment of a couple — operating on the man alone, without knowing the partner’s situation, is not a sound plan. We therefore also ask about your partner’s age and any gynaecological assessment.
CHANGES IN SEMEN PARAMETERS TAKE TIME. Sperm production runs on a cycle of about three months, so the first follow-up semen analysis is usually requested at three months and the second at six. An analysis done a month later means nothing and causes needless disappointment.
WHERE PAIN IS THE PROBLEM, EXPECTATIONS DIFFER. Surgery can help a dull ache attributed to the varicocele that worsens through the day; but not every groin pain comes from a varicocele. If the pain has another cause (an inguinal hernia, musculoskeletal pain, chronic pelvic pain) it will continue after surgery. That distinction is made beforehand.
Who is it suitable for?
May be suitable
- Men with a varicocele palpable on examination and impaired semen parameters
- Men with a dull ache attributed to the varicocele that worsens through the day and does not respond to supportive measures
- Adolescents with a varicocele and reduced testicular volume on the affected side
- Men whose varicocele has recurred after surgery by another technique
- Selected couples in whom improving semen parameters before assisted reproduction is planned
May not be suitable
- Men whose varicocele is seen only on ultrasound, is not palpable and causes no symptoms
- Men with normal semen parameters and testicular volume and no pain — surgery is not advised
- Men in whom the pain has been shown not to arise from the varicocele
- Men with active scrotal or urinary infection: the infection is treated first
- Couples in whom the partner has not been assessed at all — the plan is built around the couple
Technology used
- Operating microscope — to distinguish veins, artery and lymphatic vessels
- Microsurgical instruments and fine suture material
- Intraoperative micro-Doppler to identify the artery (in selected cases)
- Scrotal colour Doppler ultrasound to demonstrate the varicocele and measure testicular volume
- Semen analysis (at least two separate samples) and hormone tests where indicated
- High-magnification loupes for the closure
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Review of your file
AT LEAST TWO semen analyses, the scrotal Doppler report, hormone tests (FSH, LH, total testosterone), any previous operation notes, and your partner’s age and any gynaecological assessment are reviewed. A decision is not made on a single semen analysis.
- Day 1
Examination and tests
Examination standing and lying establishes whether the varicocele is palpable and its grade. Testicular volumes are measured. Tests are repeated where needed.
- Day 2
Surgery
A small incision is made just below the groin crease and the spermatic cord opened under the microscope. The dilated veins are ligated one by one while the testicular artery and lymphatics are preserved. You go home the same day.
- Days 3–5
Review
The wound and the scrotum are assessed. The return flight is planned for after this review.
- Month 3
First follow-up semen analysis
Because sperm production runs on a cycle of about three months, the first meaningful analysis is done at this point. An earlier one is misleading.
- Month 6
Second review
The semen analysis is repeated and the trend assessed. We look at the direction of two measurements, not at a single value.
Method comparison
| Criterion | Microsurgical (subinguinal) | Laparoscopic | Embolisation |
|---|---|---|---|
| Magnification used | Operating microscope | Camera magnification | Imaging guidance |
| Preserving the artery | Aimed for and identified | Harder | Not a direct aim |
| Preserving the lymphatics | Aimed for | Harder | Not relevant |
| Chance of hydrocele | Lower | Relatively higher | Not expected |
| Incision | 2–3 cm below the groin | Three small abdominal ports | None |
| Anaesthesia | Local with sedation, spinal or general | General | Local |
| Treating both sides | Two separate incisions | Easy in one sitting | Possible in one sitting |
| Chance of recurrence | Lower | Intermediate | Depends on technique and anatomy |
This table is not a ranking but a balance sheet. In bilateral varicocele the laparoscopic route can offer a practical advantage; where avoiding hydrocele and recurrence is the priority, the microsurgical route comes to the fore; for a man who does not want an incision, embolisation enters the picture. Tell us your priority.
Risks
- HYDROCELE (FLUID COLLECTING IN THE SCROTUM): caused by damage to the lymphatics. Reducing this risk is the main reason for working under the microscope; it is not eliminated entirely
- RECURRENCE: the varicocele can return because a small vein was missed, and a second procedure may be needed
- INJURY TO THE TESTICULAR ARTERY: uncommon, and less likely with the microscope; if it occurs the blood supply to the testis can be affected
- Wound infection, scrotal swelling and bruising
- Temporary numbness or altered sensation in the groin
- NO IMPROVEMENT IN SEMEN PARAMETERS: surgery creates a chance, it does not guarantee a result. In some men the parameters do not change
- PREGNANCY NOT OCCURRING: even where semen parameters improve, pregnancy depends on many factors; that does not mean the operation failed
- Persisting pain — where the pain did not arise from the varicocele
Alternatives
- Observation — the right option in men whose varicocele is not palpable, causes no symptoms and whose semen parameters are normal
- Supportive measures for pain — supportive underwear, avoiding long periods standing, simple analgesics
- Lifestyle measures — stopping smoking, weight management, avoiding excessive heat; factors affecting sperm health
- Laparoscopic varicocelectomy — ligating the veins higher up through the abdomen
- Open (inguinal or retroperitoneal) varicocelectomy — conventional techniques without the microscope
- Percutaneous embolisation — closing the veins by interventional radiology, with no incision
- Proceeding directly to assisted reproduction — where time is the priority because of the partner’s age or other factors
Recovery
First 48 hours
Scrotal swelling and tightness in the groin are usual. Supportive underwear and cold packs help. Fever, discharge from the wound or marked increase in swelling require immediate contact.
Week 1
Walking is free. Lifting, straining and long periods standing are avoided. Return to desk work is usually within a few days.
Weeks 2–3
Return to sexual activity and light sport is usually discussed in this period. For jobs involving heavy lifting the wait is longer.
Month 3
The first meaningful follow-up semen analysis is performed. An earlier one is misleading because of the cycle of sperm production.
Month 6
A second semen analysis establishes the trend. If needed, the next step is planned with you as a couple.
Long term
If you were operated on for pain, the course of the pain is followed separately. Where recurrence is suspected, examination and Doppler ultrasound are repeated.
Frequently asked questions
If I have the operation, will we have a child?
The aim of surgery is to create a chance of improvement in semen parameters; pregnancy cannot be guaranteed. Infertility is assessed as a couple: operating on you alone, without knowing your partner’s situation, is not a sound plan. If a centre does not tell you this, seek a second opinion.
Why is a microscope used?
Within the spermatic cord the veins, the testicular artery and the lymphatics lie intertwined. Under magnification they can be told apart; preserving the artery safeguards the blood supply to the testis, and preserving the lymphatics lowers the chance of a hydrocele afterwards.
A varicocele was seen on ultrasound but I have no symptoms — should I be operated on?
No. Surgery is not advised for a varicocele seen only on ultrasound, not palpable, and causing no symptoms. The decision rests on concrete findings, not on the scan.
When will my semen parameters improve?
Sperm production runs on a cycle of about three months. The first meaningful analysis is at three months and the second at six. An analysis done a month later means nothing and causes needless disappointment.
Will my pain go?
Benefit is expected for a dull ache attributed to the varicocele that worsens through the day. But not every groin pain comes from a varicocele; if there is another cause, the pain will continue after surgery. That distinction is made beforehand.
I have a varicocele on both sides — can it be done in one sitting?
Yes, both sides can be treated in the same sitting; in the microsurgical technique a separate small incision is used for each side. Recovery may take a little longer.
Can it come back?
The varicocele can return because a small vein was missed. Reducing that chance is one of the purposes of working under the microscope. Where recurrence is suspected, examination and Doppler ultrasound are repeated.
I have been operated on before — can it be done again?
Yes. The microsurgical route is particularly favoured in recurrent cases, because identifying vessels among adhesions from a previous operation is hard with the naked eye. Please send YOUR PREVIOUS OPERATION NOTE.
When can I resume sexual activity?
Usually discussed after 2–3 weeks and after the review appointment. Pain and swelling can be uncomfortable earlier on.
How long should I stay in Türkiye?
Usually 5–7 days. Because the review is carried out here, plan your return flight for after that appointment. Follow-up semen analyses can be done at home and sent to us.
What documents should I send?
AT LEAST TWO semen analyses with their dates, the scrotal Doppler report, hormone tests (FSH, LH, total testosterone), any previous operation notes, and your partner’s age and any gynaecological assessment. A sound plan cannot be made on a single semen analysis.
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This page is for general information only and is not a substitute for medical advice.
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