Varicocelectomy
& Orchidectomy

Laparoscopic Varicocelectomy

Development of the testicle begins inside the abdomen near the lower end of the kidney. Before birth, it migrates down the abdomen, through the inguinal canal (just above the fold where the leg joins the abdomen) and into the scrotum. As it migrates the testicle takes its blood supply with it which therefore follows a long and twisting course in the male.

Dilation of the veins that drain the testicle may occur as the one-way valves that help return blood to the heart stop functioning effectively. This may happen because the vein represents a long, standing column of fluid under the influence of gravity. The varicocele that develops is comparable to varicose veins commonly seen in the legs. It may cause a low grade dragging discomfort and theoretically impair fertility to some degree (thought to be due to the effect of temperature changes from the inefficiently drained blood on sperm formation).

The role of laparoscopy in this condition is less well defined than for some other urological problems. Many effective and well-tolerated traditional open operations exist which are a good alternative. The main indication for a laparoscopic approach is when varicoceles need to be repaired on both sides. Image-guided sclerosant (scarring) therapy may also be an option. The most appropriate choice for you should be discussed further in the clinic.

Laparoscopy allows the surgeon to inspect the abdominal cavity using a telescope inserted below the umbilicus (belly button) through a 1cm incision. The blood vessels running towards (artery) and away from (veins) the testicle can be seen and dissected using instruments inserted through 2 further 5-10mm ports. The vessels are then clipped.

After the operation

Laparoscopy does not eliminate post-operative pain however any discomfort experienced should be easily controlled using the painkillers you will be prescribed. The expected hospital time is usually overnight however some people may be able to go home on the same day. The stitches used to close the wounds are buried and will dissolve.

Laparoscopic Orchidectomy

Development of the testicle begins inside the abdomen near the lower end of the kidney. Before birth, it migrates down the abdomen, through the inguinal canal (just above the fold where the leg joins the abdomen) and into the scrotum. As it migrates the testicle takes its blood supply with it which therefore follows a long and twisting course in the male. In around 97% of male babies, the testis has reached the scrotum and by 2 years of age, this figure reaches 99%. Those testicles that do not reach the scrotum are referred to as "undescended”.

Despite being undescended the testicle may have an essentially normal hormone and sperm-producing capability that is initially salvageable. Orchidopexy or surgical transferral of the testicle into the scrotum is recommended after the age of 2 for this reason. Once beyond puberty, viable sperm production from the undescended testicle is unlikely. In addition, the risk of developing cancer in an undescended testicle is many times higher than in a normal testicle and as such surgical removal is recommended.

If the undescended testicle can be felt in the groin, a small operation can be performed through the groin to either relocate the testicle or remove it. If the testis cannot be felt, it either did not form at all or is still located somewhere in the abdomen. A scan (ultrasound or MRI) may be recommended to try and identify the testicle but neither is as accurate as direct visualization with surgery.

Laparoscopy allows the surgeon to inspect the abdominal cavity using a telescope inserted below the umbilicus (belly button) through a 1cm incision. If the testis has not developed then nothing further is required, however if the testis is seen it may be dissected out, and removed through 2 further 5-10mm ports. If the blood vessels that supply a normal testis are seen leaving the abdominal cavity towards the scrotum an incision will be made in the groin to look for a testis.

If you want to have an artificial testis inserted it is important that you discuss it before the operation for planning purposes. It may also require an additional incision in the groin for placement.

After the operation

Laparoscopy does not eliminate post-operative pain however any discomfort experienced should be easily controlled using the pain-killers you will be prescribed. The expected hospital time is usually overnight however some people may be able to go home on the same day. The stitches used to close the wounds are buried and will dissolve. Other follow-up will depend on the exact nature of the operation.

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