What is varicocele surgery? A varicocelectomy is a surgical operation that is performed to treat a varicocele, a condition in which the veins inside the scrotum (called the plexus pampiniformis) become abnormally enlarged. Surgery is usually performed when swelling of the veins causes chronic pain or male infertility. Although surgical treatment is effective in relieving testicular pain, considerable debate remains as to how effective varicocele surgery is in reversing male infertility. What is varicocelectomy? Varicocele surgery, also known as varicocelectomy, describes three different surgical techniques that are usually performed on an outpatient basis. Both men and boys can undergo the treatment. Any type of varicocele surgery aims to restore normal blood flow to the testicles by blocking or cutting off the varicose veins. By restoring normal blood flow, the environment around the testicles also becomes more favorable for the production of testosterone and other hormones. Surgical options include: Microsurgical varicocelectomy � an open operation where the problem site is accessed through an incision in the groin. Blood flow is redirected when abnormal veins are clamped or tied; Laparoscopic varicocelectomy � a laparoscopic procedure similar to microsurgical varicocelectomy in which one or more small incisions are made in the abdomen; Percutaneous embolization � a minimally invasive procedure in which a thin tube is passed through a vein in the neck or groin to the site of the veins in the testicles. Using chemicals or small metal coils, the veins are blocked so that blood flow can be diverted to normal veins. Microsurgical varicocelectomy through a subinguinal (lower groin) incision is known to have the best results and is therefore the procedure of choice in the treatment of symptomatic varicocele. Surgeries are performed by urologists, and percutaneous embolization is performed by interventional radiologists. What are the contraindications for varicocelectomy? There are few absolute contraindications to varicocele surgery other than those associated with surgery in general (such as current infection, adverse reactions to anesthesia, or severe malnutrition). Not every varicocele requires surgery. In most cases of low-grade varicocele, there are no obvious symptoms, and the disorder does not cause problems with infertility or hormone levels. Research shows that treating a higher-grade varicocele has more benefits for the patient. A 2014 panel opinion issued by the American Society for Reproductive Medicine advises against surgery in men with subclinical low-grade varicocele (meaning a varicocele seen on ultrasound but no obvious symptoms) or those with symptoms but a normal number spermatozoa.In cases like these, there is no clear evidence that surgery can improve the quality or quantity of semen. References: 1. Miyaoka R, Esteves SC. A critical appraisal on the role of varicocele in male infertility 2. Practice Committee of the American Society for Reproductive Medicine; Society for Male Reproduction and Urology. Report on varicocele and infertility: A committee opinion 3. Halpern J, Mittal S, Pereira K, Bhatia S, Ramasamy R. Percutaneous embolization of varicocele: Technique, indications, relative contraindications, and complications 4. Lipshultz L, Eisenberg M. Varicocele- induced infertility: Newer insights into its pathophysiology 5. Pastuszak A, Wang R. Varicocele and testicular function