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Microscopic Varicocelectomy

Microscopic Varicocelectomy

Microsurgery Treatment of Varicocele

Ass. Prof. Dr Muhsin BALABAN

   Ass. Porf Muhsin BALABAN is a member of Biruni University School of Medicine, Urology Department. After graduated from Marmara University School of Medicine (English), he completed urology residency at Kartal Training and Research Hospital in Istanbul, 2010.

To increase his knowledge and experience for varicocele microsurgery he had been 3 months residental visits at Cleveland Clinic in Ohio and  Albert Einstein University in Newyork, USA.

   In adition to USA residental visits, he have been 1 month fellowship on male infertility microsurgery in San Carlo Clinic, Milan University, Italy.

   Ass.Prof. Dr Muhsin BALABAN is a pionered microsurgery varicocele surgeon in Istanbul during 2010 and work as Andrologist in IVF unit. He had more than 3000 microsurgery cases experince in last 10 years.

Learn more about varicocele;

                                            Watch microscopic surgery videos on Youtube: muhsin balaban


Treatment of Varicocele

We need at least one symptoms (Pain, Fertility issues and affecting of testosterone level) to plan varicocele treatment. Sometimes varicocele impair sperm quality and can cause Azospermia (No sperm in ejaculate materials)




Intraoperative 3 mm Dopper : A new technology to increase Microsurgery Varicocele oucomes

   The last researches showed that intraoperative doppler technology, leads to increase the ligated veins with more safe surgery. By this technology, microsurgeon can localize the testicle artery easily and can ligate veins around that artery so the outcome become more successful than other techniques.


Microscopic Varicocele Surgery

   The surgery takes time approxiamtely 45 minutes and spinal or general anestsia can preferred. Microsurgery performed by 2 cm incision on the inguinal area. Then the spermatic cord taken out and dilated vessels outside and inside the cord ligated. The spermatic artery, vas deferens and lymphatic vessels protected under microscopic magnified view.



Why I prefer subinguinale Microsurgery Technique

   The inguinale muscle protecyed by this technique so patient feel less pain after the surgery. Morever, recurrences rate is less than 5% and hydrocele ( fluid collection around scrotum) risk near to zero.


Complication of the Varicocele surgery:


  1. 5% recurrence can be seen
  2. Hydrocele (Hopefully with microscopic surgery this rate is near to zero)
  3. Testicular Artery damage ( By microscopic surgery this rate is 0%)


A varicocele might cause


  • Shrinkage of the affected testicle (atrophy). The bulk of the testicle comprises sperm-producing tubules. When damaged, as from varicocele, the testicle shrinks and softens. It’s not clear what causes the testicle to shrink, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.
  • Infertility. Varicoceles might keep the local temperature in or around the testicle too high, affecting sperm formation, movement (motility) and function


Azopermia Patient and Varicocele Surgery


Recent studies showed that, after the microscopic varicocele operation, 10% of azospermia patients with varicocele, the sperm production started in 1 year period.


In case of failed IVF cycles, can Varicocele disease Treated?

In some cases, the number, motility and morphology (shape) of the sperm can be in normal limit hovewer the IVF treatment can be failed. In that cases, the DFİ (DNA Fragmantation Index) should check and if DFİ affected, varicocele surgery can be planned.


Check the list before microsurgical varicocele surgery

1- Be sure to bring your varicocele-related test results all the way to the hospital

2- If you want to clear the surgery region before, shave 10 cm of the groin area upward from the root of the penis with both sides completely clean. Staff at the hospital can also do this process when you are laid.

3- You must be hungry for at least 6 hours before the surgery; this hunger should be like fasting in the form of not eating anything or even drinking.

4- Should not use anticoagulant drugs such as Aspirin in the previous week before the surgery.


What You Need To Know Upon Arriving To The Hospital For Microsurgical Varicocele Operation:

1- I will visit you before the operation and after the operation

2- Do not eat or drink, as you would expect surgery .

3- It is highly recommended that you do not stand up alone and eat other than the foods given on the first day because of the possibility of dizziness depending on the anesthesia.

4- Start using your prescription drugs at once during 5 days and pain killer if you needed.

5- You can take a shower 1 days after the surgery.

6- The sutures are under the skin so you cant’t see them (aestetic sutures) or need to take them out.

7- After 2 weeks you can have a sexula intercourse observantly.

8- Heavy lifting after surgery can just cause pain for the first 15 days or one month

9- After 3 months, make a sperm analysis an appointment for a free checkup.





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