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A. Laparoscopic varicocelectomy involves tying or clipping the testicular veins (pampiniform plexus) by passing a telescope into the abdominal cavity.
A. you have following alternatives:
Observation, open surgery, microscope assisted open surgery, radiological embolisation.
A. You will usually be admitted on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.
You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
Please be sure to inform your urologist in advance of your surgery if you have any of the following:
• Co-morbidities like Diabetes, Hypertension, Coronary artery disease or, stroke, epilepsy
• Any transmissible disease like HIV/AIDS, Hepatitis B or C etc
• Presence of implants, pacemakers, graft etc
• You are taking prescription drugs like-
o Blood thinners/ anti-platelets i.e. Warfarin, ecosprin, clopidogrel etc
o Anti-epileptics like phenytoin, valproate etc
A. You will be operated under general anaesthesia and you will be asleep throughout the procedure. The urologist will introduce a number of access ports into the abdomen (pictured below). Using a telescope inserted below the umbilicus (belly button), the large veins draining blood from the testicle can be identified, running along the back wall of the abdominal cavity. The veins are then clipped or tied after which the skin incisions are closed.
A. You will be given fluids to drink from an early stage after the operation and you will be encouraged to mobilise as soon as you are comfortable to prevent blood clots forming in your legs.
You may experience discomfort or pain for a few days after the procedure. You will be prescribed painkillers for the same.
The average hospital stay is one to two days.
A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
Common (greater than one in 10)
• Temporary shoulder tip pain
• Temporary abdominal bloating
• Swelling of the scrotum lasting several days
• The external appearance of the varicocele may not change significantly although the symptoms are relieved
• Late recurrence of the varicocele (in approximately 14%)
• Development of fluid around the testis several months after the procedure (15-30%)
Occasional (between one in 10 and one in 50)
• Bleeding, infection, pain or hernia of the incision requiring further treatment
• Collection of blood around the testis requiring surgical treatment
• Failure to remove the varicocele completely
• Damage to or shrinkage of the testicle if the blood supply is affected by the operation
• Development of a fluid swelling (hydrocele) around the testicle at a later stage
Rare (less than one in 50)
• Infection of the incision or the testis requiring further treatment
• Bleeding requiring conversion to open surgery or requiring blood transfusion
• Recognised (or unrecognised) injury to organs/blood vessels requiring conversion to open surgery (or deferred open surgery)
• Involvement or injury to nearby local structures (blood vessels, spleen, liver, kidney, lung, pancreas, bowel) requiring more extensive surgery
• Damage to or shrinking of the testicle If the blood supply is affected by the operation
• Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)
A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. There may be some discomfort from the small incisions in your abdomen but this can normally be controlled with simple painkillers.
It will be at least 14 days before healing occurs and you may return to work when you are comfortable enough and your urologist is satisfied with your progress. You should not expect to return to work within seven days.
The varicose veins above your left testicle may become slightly more prominent initially because they thrombose after the surgery. Once things have settled, they will become less obvious. Do not, however, expect the veins to disappear completely because they rarely do so.
A. If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your urologist.
A. Give your body a rest during the first week after the procedure. Be careful lifting heavy objects and doing strenuous exercises. Wear loosely fitting and comfortable undergarments. A follow up outpatient appointment will be arranged for you at one week.
A. When you have:
• Fever higher than 38.5 degrees; Nausea and vomiting
• Increasing abdominal pain or dizziness
• Increased redness, throbbing or drainage at the site of the operation
• A serious burning sensation (not mild) when urinating
• Inability to urinate
• Tell your doctor right away if bleeding or pain is severe or if problems last longer or worsen after you leave the hospital.
A. A follow-up appointment will be scheduled with you prior to discharge from the hospital.