Prof. Dr. Emel Akoğlu
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Andrology & Men's Health
Varicocelectomy
What varicocelectomy is, how the swollen scrotal veins are tied off, what the evidence says about sperm quality, pregnancy and pain, how microsurgical, laparoscopic and embolisation methods compare, approximate costs in Turkey against the UK, US and Germany, recovery, risks and how to check a urology team.
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Prof. Dr. Zerrin Biçik Bahçebaşı
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Varicocelectomy in Turkey: what it is and how it works
A varicocele is a collection of enlarged, twisted veins in the scrotum, in the bundle of veins (the pampiniform plexus) that drains blood from the testicle. It feels like a bag of worms above the testicle, is far more common on the left side, and appears in roughly one in seven men, usually from puberty. Varicocelectomy is the operation that closes the abnormal veins so that blood stops pooling around the testicle. The surgeon ties or clips the dilated veins while preserving the testicular artery, the lymphatic vessels and the sperm duct, which is the key to a good result.
Most varicoceles cause no problems and need no treatment. Surgery is considered for pain, for a smaller testicle in a teenager, or when a palpable varicocele coexists with abnormal semen results in a couple who cannot conceive. This guide explains how the operation works, what research says it can and cannot do, which technique is used, what it costs in Turkey compared with other countries, how recovery goes and what the risks are. For the wider specialty see our urology treatments in Turkey.
Does varicocelectomy improve fertility? What the evidence says
This is the question most men ask, and the honest answer is that it helps some men and not others. A varicocele raises the temperature around the testicle and may damage sperm production. Studies show that after surgery sperm concentration, motility and DNA integrity improve in many men, and some series report higher natural pregnancy rates. However, systematic reviews such as those from the Cochrane Collaboration have found the trial evidence for improved pregnancy rates in couples to be mixed, partly because the trials differ in who they include.
Guidelines from the European Association of Urology and the American Urological Association support surgery when the varicocele can be felt, the semen analysis is abnormal, the couple is trying to conceive and the female partner has normal fertility or a treatable problem. They do not recommend surgery for a varicocele found on ultrasound only, or when semen is normal. Semen is retested three to six months after surgery, as sperm take about 74 days to develop and mature.
Does varicocelectomy relieve pain, and what about the testicle size?
Some men with a varicocele have a dull ache or dragging heaviness that worsens after standing or exercise and eases lying down. Surgery relieves this in most men, with published series reporting improvement in roughly 70 to 90 percent, but it is less predictable when the pain has other causes, so a urologist should rule these out. In adolescents, a varicocele can slow the growth of the left testicle; surgery is considered if there is a clear size difference that persists. Testicular size may partly catch up after repair, but this is not guaranteed.
Which technique is used: microsurgical, laparoscopic or embolisation?
Several methods close the veins. They differ in where the incision is, how many small veins are found and how often the varicocele recurs.
| Technique | Best suited to | Typical limits |
|---|---|---|
| Microsurgical subinguinal varicocelectomy | Adults and adolescents; lowest recurrence and hydrocele rates in most series | Needs a microscope and a trained microsurgeon |
| Inguinal or retroperitoneal open surgery | Settings without microsurgery | Higher recurrence and hydrocele rates; artery harder to spare |
| Laparoscopic ligation | Bilateral cases or combined abdominal procedures | General anaesthesia; more complex; hydrocele risk |
| Embolisation (radiology) | Recurrent varicocele after surgery; avoids an incision | X-ray exposure; coil migration or failure possible |
Most urologists regard the microscope-assisted subinguinal approach as the most precise because it lets the surgeon identify and spare the testicular artery and lymphatics. See our pages on microsurgical intervention for varicocele and embolization of varicocele for those methods in detail.
Varicocelectomy cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for a one-sided operation, not hospital quotes. The final price depends on the technique, one or both sides, the anaesthesia and the length of stay.
| Country | Approximate cost range |
|---|---|
| Turkey | €1,200 – €3,500 |
| United Kingdom | €3,000 – €6,500 |
| United States | €5,000 – €14,000 |
| Germany | €2,500 – €5,500 |
What changes the price: microsurgical against standard technique, unilateral against bilateral repair, general against local or spinal anaesthesia, the pre-operative tests (scrotal Doppler ultrasound and semen analysis) and whether you stay overnight. A package normally includes the tests, operation, surgeon and anaesthetist, medication, a check-up and airport transfers. Ask for the list in writing.
Who is a good candidate for varicocelectomy, and who is not?
Candidates are men with a palpable varicocele and one or more of the following: abnormal semen parameters while trying to conceive, persistent testicular pain, or a clear size difference of the testicle in adolescence. It is generally not advised if the varicocele is only visible on ultrasound, if semen is normal and there is no pain, or if there is no sperm at all in the semen without other work-up; in that situation other causes of infertility must be assessed first. A sudden varicocele on the right side only or one that does not empty when lying down needs scans to exclude a pelvic or kidney mass. You will be asked about fertility history, and your partner should be assessed too, since male surgery only helps if the couple's overall fertility picture is reasonable.
How is varicocelectomy performed, step by step?
- Assessment. Examination standing and lying, scrotal Doppler ultrasound, and two semen analyses for fertility cases.
- Anaesthesia. Spinal or general anaesthesia is usual; local anaesthesia with sedation is possible for some microsurgical cases.
- Incision. A 2 to 3 cm cut is made in the groin crease (subinguinal approach), near the base of the penis.
- Delivery of the cord. The spermatic cord is lifted out and examined under the operating microscope.
- Ligation. The dilated veins are tied and divided one by one; the artery, the lymphatics and the vas deferens are identified and preserved.
- Closure. The cord is replaced and the incision is closed with dissolving stitches.
The operation takes about 45 to 90 minutes for one side and you usually go home the same day.
Recovery after varicocelectomy: days and weeks
Expect soreness and some bruising in the groin and scrotum for several days, with mild swelling that may last two weeks. Simple painkillers, a scrotal support and ice packs usually help. Most men return to desk work within two to five days. Avoid heavy lifting, running, cycling and gym work for about two weeks, and sexual activity for a week to two, until the wound is comfortable. Showering is allowed after a day or two, and swimming after the wound has healed. For a single operation a stay of three to four nights is sufficient, so that the surgeon can check the wound before you fly. A semen test is repeated three and then six months later, which can be done at home and sent to your own doctor.
What results can I expect, and when?
If the operation is done for pain, relief often begins within days to weeks. For semen quality, improvement is gradual: first changes appear after about three months and the most from six to twelve months, so be wary of any claim of immediate results. Some men see a large improvement and conceive naturally; others see little change and still need assisted conception such as IVF with ICSI, where a repaired varicocele may nevertheless improve the sperm available. Photographs and appearance matter little here; the veins stop being visible and the scrotum looks normal, with a thin groin scar that fades over several months. Recurrence of the varicocele is possible but is low with microsurgery.
What are the risks of varicocelectomy?
As with any operation, risks include bleeding or bruising, wound infection and anaesthetic complications. Specific risks are hydrocele (fluid around the testicle, which appears when lymphatic vessels are tied and is uncommon with microsurgery), recurrence or persistence of the varicocele, injury to the testicular artery with a risk of testicular shrinkage (rare), numbness in the groin and ongoing pain. A hydrocele that bothers a man can be treated later, as described in our guide to hydrocelectomy. Reliable background reading is available from the NHS and the patient pages of the European Association of Urology and the American Urological Association. Contact a doctor if the scrotum becomes very swollen, red, painful or hot, or if you have fever.
How to choose a urologist and hospital, and questions to ask
Choose a urologist or andrologist registered in Turkey who performs microsurgical varicocele repair regularly, in a licensed hospital with a microscope, anaesthesia and Doppler ultrasound. Red flags include promises of guaranteed pregnancy, surgery recommended with no semen analysis, a varicocele seen only on ultrasound being presented as an urgent problem, and no information on technique. Read how our process works and use the free quote page to send your semen analysis and ultrasound. Useful questions:
- Is surgery justified in my case, given my semen results and my partner's fertility?
- Will the operation be microsurgical, and how many do you perform each year?
- What are your recurrence and hydrocele rates?
- When will my semen be retested, and who will review it?
- What does the package include, and who is my contact after I leave Turkey?
Conditions treated with Varicocelectomy
Hospitals with Urology in Turkey
Frequently asked questions
Varicocelectomy is an operation that ties off the enlarged veins in the scrotum (a varicocele) so blood no longer pools around the testicle. It is done for pain, a shrinking testicle in teenagers or abnormal semen in men trying to conceive.
It relieves pain in most men and improves sperm count and movement in many. Trial evidence for higher pregnancy rates is mixed, so results vary and cannot be guaranteed.
Approximate ranges are €1,200 to €3,500 in Turkey, against about €3,000 to €6,500 in the UK. The technique, one or both sides and anaesthesia change the price, and the hospital confirms it in a written quote.
Many men see better sperm concentration and motility three to twelve months after surgery, and some conceive naturally. Surgery is advised mainly for a palpable varicocele with abnormal semen.
You are numb or asleep during the operation. Afterwards there is soreness and bruising for several days, usually managed with simple painkillers, a scrotal support and ice packs.
Most men return to desk work within two to five days. Heavy lifting, running and cycling wait about two weeks, and sex a week or two, depending on comfort.
The surgeon uses an operating microscope through a small groin incision to tie the veins while sparing the testicular artery and lymph vessels. It has the lowest recurrence and hydrocele rates in most series.
Yes, but it is uncommon with microsurgery. A recurrence can be treated with repeat surgery or by embolisation, a radiology procedure without an incision.
Serious problems are uncommon. Risks include hydrocele, recurrence, bruising, infection and, rarely, damage to the testicular artery. Choosing an experienced microsurgeon lowers the risk.
Plan three to four nights, so the surgeon can check the wound before you fly. Semen retests at three and six months can be done at home.
Patient stories