Varicocele Surgery (HIGH RISK, LOW REWARD)

SURGERY QUESTION

Hey man, it's me again. I've been reading up some more on varicocele surgery and embolization and honestly can't find any significant studies or evidence indicating that the procedure is dangerous or has a high rate of failure.

Where is such literature that you adamantly insist exists? Do you have any evidence that these procedures are dangerous beyond basic conjecture?

My left-sided varicocele is huge, about 3x the size of my right testicle. When I hold it, it honestly feels like it's almost a half a pound weighing down. I'm worried that it's lowering my testosterone levels extremely significantly and I have no way to fix it because my spine and posture are permanently messed up as we discussed before. I have very bad anxiety and I don't know what to do.

I don't want to have to get spinal fusion surgery but it may be the only way to fix this thing....

ANSWER

Well, I'll provide you the references at the end of this email.

1) Surgical results vary depending on the surgeon's skill. It can increase or decrease the chances of surgical failure by 10%. 

2) Surgical results vary depending on the type of surgery you perform. 

3) There is no right or wrong Surgical option at this time, Unless you have bilateral or right-sided varicocele, then you should NOT perform embolization, because it has a very high chance of hydrocele (30%). 

4) There is a 1% chance of rupturing an artery during surgery or for coil migration. This results in testicular loss. 

5) There is a 1-30% chance of hydrocele depending on the type of surgery. 

6) There is a 5-25% chance of varicocele re-occurrence post surgery, also depending on the type of surgery. 

7) Embolization is uses x-rays and x-ray dye. Therefore there is exposure to radiation, and possibliity of allergic reaction to the injected dye. 

8) General anesthetics have their own risks. 

9) There is a chance of infection (not well sourced in literature) 

10) There is a chance of increased pain (not well sourced, but I have had MANY clients come to me regarding increased pain post-surgery)

That's just what comes to mind at the moment.

Add all of those together, and you have a risky surgical procedure. Then you have the very questionable efficacy. Only 14% improvement in fertility... Minimal improvement in testosterone... Not significant reduction of pain... Testicular hypertrophy (size gain) in only a small subset of people...

So, that's why I make the argument that varicocele surgery is high risk & low reward. Therefore, I consider it as an ineffective procedure for varicocele treatment. There is a reason why it is such a controversial procedure. And you have to realize that a lot of the publications are very biased. They focus only on hydrocele, fertility, and pregnancy. It is almost impossible to find publications on pain, surgical complications, etc. This is because vaircocele surgery is a $300,000,000 + year business, just in United States. So, the top search results you get are All bias, they're almost all paid for and owned by surgeons.

SOURCES: (PLEASE EXCUSE MY LACK OF ORGANIZATION!) Many of these sources and meta-analysis of all the surgical publications thus far.

DOI: 10.2164/jandrol.108.005967 DOI: 10.5489/cuaj.11064

1. World Health Organization The influence of varicoceles on paramaters of fertility in a large group of men presenting to fertility clinics. Fertil Steril. 1992;57:1289–93. [PubMed]
2. Jarow JP. Effects of varicocele on male fertility. Hum Reprod Update. 2001;7:59–64. [PubMed]
3. Goldstein M. Surgical therapy of male infertility. J Urol. 1993;149:1374–6. [PubMed]
4. Witt MA, Lipshultz LI. Varicocele; a progressive or static lesion. Urology. 1993;42:541–3. [PubMed]
   Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. Cayan S, Shavakhabov S, Kadioğlu A J Androl. 2009 Jan-Feb; 30(1):33-40.

[Varicocele and its repercussion on infertility. Indications and limitations of surgical intervention]. Austoni E, Cazzaniga A, Gatti G, Baroni P, Gentilini O, Levorato CA Arch Ital Urol Androl. 1998 Apr; 70(2):103-7.

Subinguinal microsurgical varicocelectomy: evaluation of the results. Kumar R, Gupta NP Urol Int. 2003; 71(4):368-

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