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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have Varicocele Pain, Advised Surgery After Fertility. Can Surgery Be Delayed?

right varicocele pain for more than 3 years, can surgery be delay?
hi i'm 22 years old, i'm suffering for right varicocele for more than 3 years, it has mid pain but it is tolerable :) . My doctor advised me that surgery is NOT necessary. he advised me that i can have surgery after marriage, when fertility is issue, my question is that can i have surgery after 5 more years? i'm am suffering varicocele more than 3 years now. is my doctor advise right? thanks! :
Fri, 18 Oct 2013
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General & Family Physician 's  Response
hello there mate!
varicocele is 15-20% mens problem of which only 40 percent has infertility problem.Varicocele is associated with impaired semen quality. why dont you do a semen analysis to see where you stand.its 80 to 90 % left testicle in your case its right, abit atypical presentation.
which grade your varicocele is? you did not mention but as you advised surgery it must be grade three. if its just visible on inspection, if occurs with bearing down or valsalva maneuver then its small, if palpable with out bearing down than moderate. so you see for yourself where do you stand.
now you said delay, well it can be delayed if indications for surgery are not met and symptomatic treatment is helping you. if testicular volume is less than 20 ml and length remember not all varicoceles lead to infertility. 10 to 15 % of fertile people have it. plus if you early treat it it will prevent infertility plus you are 22 only i believe if you operate now you wont lose your fertility..
so if you have pain in testicle , size and volume i mentioned, and your semen analysis comes abnormal i am afraid you would have to go for the repair instead of delaying it.
some authorities correlate right sided varicocele with abdominal retroperitoneal pathologies so i would recommend abdominal U/s and CT with scrotal doppler sonography(high resolution color flow) to be on the safer road too.

lets discuss some surgical options.
there are 3 approaches.
1.through groin
2.through abdomen
3.below groin

there are interventional radiological approaches too with minimal invasion. providing the expertise are there.

So in nutt shell if you fir the criteria for surgery as i mentioned you should have a surgery cause it will involve your left one too if left uncure and it will progress.

Its outcome will be good..

rest correlating your condition clinically with the situation is the best option and the surgeon whose hand and eyes are on your testicles can decide better, from here i can advise sincerely only with the provided facts which will never be enough compared to one to one confrontation of patient and doctor.

Any ways i will be here to help if you need me

Regards
Dr Shafi Ullah Khan
my patient is my family

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General & Family Physician Dr. Veera Raghava Rao Buddha.'s  Response
Hi, if at all it is to be operated, should be done for pain purpose, the other reason for surgery is male infertility. If it should occur, many people may not get it, it may be operated early, so it the surgery is planned accordingly.
You can consult a urologist for excluding the fertility problem , if it is not there you can avoid or can have it at your ease. Thank you.
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Have Varicocele Pain, Advised Surgery After Fertility. Can Surgery Be Delayed?

hello there mate! varicocele is 15-20% mens problem of which only 40 percent has infertility problem.Varicocele is associated with impaired semen quality. why dont you do a semen analysis to see where you stand.its 80 to 90 % left testicle in your case its right, abit atypical presentation. which grade your varicocele is? you did not mention but as you advised surgery it must be grade three. if its just visible on inspection, if occurs with bearing down or valsalva maneuver then its small, if palpable with out bearing down than moderate. so you see for yourself where do you stand. now you said delay, well it can be delayed if indications for surgery are not met and symptomatic treatment is helping you. if testicular volume is less than 20 ml and length remember not all varicoceles lead to infertility. 10 to 15 % of fertile people have it. plus if you early treat it it will prevent infertility plus you are 22 only i believe if you operate now you wont lose your fertility.. so if you have pain in testicle , size and volume i mentioned, and your semen analysis comes abnormal i am afraid you would have to go for the repair instead of delaying it. some authorities correlate right sided varicocele with abdominal retroperitoneal pathologies so i would recommend abdominal U/s and CT with scrotal doppler sonography(high resolution color flow) to be on the safer road too. lets discuss some surgical options. there are 3 approaches. 1.through groin 2.through abdomen 3.below groin there are interventional radiological approaches too with minimal invasion. providing the expertise are there. So in nutt shell if you fir the criteria for surgery as i mentioned you should have a surgery cause it will involve your left one too if left uncure and it will progress. Its outcome will be good.. rest correlating your condition clinically with the situation is the best option and the surgeon whose hand and eyes are on your testicles can decide better, from here i can advise sincerely only with the provided facts which will never be enough compared to one to one confrontation of patient and doctor. Any ways i will be here to help if you need me Regards Dr Shafi Ullah Khan my patient is my family