Rigi10™ Malleable Penile Prosthesis
Also Known As
Surgical treatment of varicocele, Varicocele surgery, Varicocele repair, Ligation of spermatic veins, Pampiniform plexus ligation
Definition
A varicocelectomy is a surgical procedure that repairs varicoceles. Varicoceles are a common disorder of the veins inside the scrotum (the pouch of skin behind the penis that typically contains the testes). In individuals with varicoceles, these veins are larger than they should be.1 The procedure aims to reduce testicular pain and can increase male fertility.1 It involves cutting the enlarged veins and sealing off the ends, which redirects blood flow into other healthy veins in the scrotum.1
Clinical Context
Varicocelectomy is clinically indicated for the male partner of a couple attempting to conceive when a palpable varicocele is present, the couple has documented infertility, the female partner has normal fertility or correctable infertility, and the male partner has abnormal semen parameters or sperm function test results.2 It is also indicated to prevent or reverse testicular atrophy in adolescent males, to correct pain from varicoceles, to address elevated sperm DNA fragmentation (DNAF), or to improve testicular function in hypogonadal men with varicoceles.2
Patient selection criteria include the presence of a palpable varicocele and one or more of the aforementioned indications. For adolescents, testicular volume discrepancy (>10% size difference between the affected and normal testis) is a key criterion.2
Surgical procedures vary, but microsurgical subinguinal varicocelectomy (MSV) is considered an optimal technique.2 This involves a small incision, identification and preservation of the testicular artery and lymphatics using a surgical microscope, and ligation of all spermatic veins.2
Expected outcomes include improvement in semen parameters, and for couples with male-factor infertility and clinical varicocele, varicocelectomy can improve IVF outcomes.2 Pain resolution after microsurgical repair is high.2 Pregnancy rates may increase significantly after varicocelectomy.1