Andrological microsurgery
Varicocele - microsurgical treatment
A varicocele of the spermatic cord is one of the most common reversible causes of male infertility. I operate on it microsurgically - under an operating microscope, sparing the testicular artery and the lymphatic vessels.
Book a qualification consultation(opens in a new tab)What a varicocele of the spermatic cord is
It is the dilation and insufficiency of the testicular veins that form the pampiniform plexus within the scrotum. The problem affects about 15% of men and most often occurs on the left side - a consequence of the anatomy of where the left testicular vein drains into the renal vein.
Symptoms and impact on fertility
The most common symptoms are scrotal pain and impaired semen parameters. These are caused, among other things, by a raised temperature in the scrotum and the effect of metabolites whose outflow with the venous blood is impeded. If you are visiting because you are trying to conceive, a varicocele is one element of a broader male infertility work-up.
Diagnosis
The diagnosis is based on a palpation examination in the standing position (with an attempt to increase intra-abdominal pressure) and an ultrasound assessing the diameter of the varicose veins and reverse blood flow. I also order a semen analysis to assess the varicocele's impact on fertility.
Why microsurgery
Treatment of a varicocele is surgical and involves dividing the insufficient veins, so that blood returns from the testicle through collateral circulation. The microsurgical technique - under the high magnification of an operating microscope - makes it possible to isolate and divide the venous plexuses precisely while sparing the testicular artery and lymphatic vessels, which reduces the risk of complications, in particular a hydrocele of the testicle. The microsurgical technique is recommended in the guidelines of the European Association of Urology (EAU) as the method with the lowest rate of recurrence and complications.
I operate mainly through a subinguinal access - below the external inguinal ring; in selected cases through the inguinal canal.
The “high” techniques - laparoscopy and embolisation - close the testicular vein higher up: in the abdominal cavity or retroperitoneally. They therefore do not reach the additional drainage routes - the cremasteric veins (the external spermatic veins) and the veins running low, next to the testicle - which in some men sustain the reflux. These are often responsible for a varicocele returning despite a correctly performed procedure. Microsurgical access makes it possible to treat every group of insufficient veins under the microscope, while sparing the testicular artery and the lymphatic vessels.
The procedure usually takes 60–90 minutes on one side and 90–120 minutes bilaterally. It is minimally invasive - patients usually leave the hospital a few hours after surgery.
Recovery
In the first days after the procedure I recommend cooling compresses. Showering is possible after 48 hours.
- light desk work - after about 3 days
- light exercise - after 7–14 days
- full activity and sexual activity - after about 2 weeks
Over-the-counter painkillers can be taken as needed, following the instructions given individually after the procedure.
Possible complications
Like any operation, the procedure carries a risk of complications:
- recurrence of the varicocele
- hydrocele of the testicle
- haematoma
- wound infection
- chronic pain
- very rarely, injury to the testicular artery
- very rarely, testicular atrophy or testicular hormonal insufficiency
Such complications are rare; I discuss the exact risk individually during qualification.
Video
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A few words on the treatment of a varicocele of the spermatic cord (in Polish).
Varicocele surgery price in Kraków
I qualify patients at my own practice and operate at the KrakOvi and ARTVIMED fertility centres in Kraków. The price of the surgery follows that centre's own price list - you will get the cost directly from KrakOvi or ARTVIMED.
- Andrology consultation - PLN 350, ultrasound included in the visit when needed
- One-sided and bilateral surgery - performed at KrakOvi or ARTVIMED, priced according to that centre's price list
- Payment by cash, card, BLIK or bank transfer · invoice on request
- Private visits, not covered by the Polish NFZ
The full list is on the pricing page.
Where I perform varicocele surgery in Kraków
The qualification consultation takes place at my office: Andromeda Centrum Medyczne, ul. Mogilska 69A, 31-545 Kraków, Poland. The procedure itself - under general anaesthesia - is performed at two Kraków facilities: KrakOvi and ARTVIMED.
- Mon
- 8–18
- Tue
- 8–17
- Wed
- 9–17
- Thu
- 8–18
- Fri
- 8–18
- Sat, Sun
- closed
Frequently asked questions
Does a varicocele always need surgery?
No. Surgery is indicated primarily for a varicocele coexisting with impaired semen parameters, pain or a reduced testicle. We make the decision after full diagnostics.
How does microsurgery differ from laparoscopy?
In laparoscopy the testicular vein is closed with a clip from inside the abdominal cavity - next to the bowel and the large blood vessels. Microsurgery works through a subinguinal access, through an incision of a few centimetres in the groin (in selected cases through the inguinal canal): the procedure takes place in the superficial layers, without entering the abdominal cavity, under a microscope - sparing the testicular artery and the lymphatic vessels, and with a lower risk of recurrence and hydrocele.
Does the surgery improve semen parameters and the chances of pregnancy?
In most men with a clinical varicocele and abnormal semen, parameters improve after the procedure - meta-analyses show a significant improvement in sperm concentration and motility, and a reduction in DNA fragmentation. The chance of pregnancy depends on many factors on both partners’ side, which is why I discuss the prognosis individually after full diagnostics.
Can a varicocele come back?
It can, but after microsurgical surgery this is rare - around 0.5–1% in the literature, the lowest of all techniques. Recurrence is usually caused by additional venous drainage routes, which microsurgical access is precisely what allows us to treat.
When do semen parameters improve?
Semen renews over a cycle of about 3 months, so we usually plan the first follow-up seminogram about 3–6 months after the procedure.
How long is recovery?
Discharge is usually a few hours after the procedure. Light desk work is possible after about 3 days, light exercise after 7–14 days, and full activity including sexual activity after about 2 weeks.
Written and medically reviewed by Michał Swolkień, MD - urologist (FEBU), clinical andrologist (PTA). Last reviewed: .
Next step
Book a qualification consultation
If you have a diagnosed varicocele or worrying semen analysis results - book a qualification consultation. We will determine whether surgery is indicated.
See available appointments(opens in a new tab)KrakOvi · ARTVIMED · Kraków