Pace Hospitals | Best Hospitals in Hyderabad, Telangana, India
VARICOCELE TREATMENT

Varicocele Treatment in Hyderabad, India - Surgery Cost & Recovery time

PACE Hospitals is recognized as the Best Hospital for Varicocele Treatment in Hyderabad, India, offering world-class medical and surgical care for scrotum varicose veins that can impact fertility and cause discomfort. Our team of highly skilled and experienced urologist and andrologist specializes in diagnosing and treating varicocele using the latest advancements in minimally invasive techniques, such as microsurgical varicocelectomy and laparoscopic procedures. These approaches not only ensure precision in treatment but also result in quicker recovery times, reduced pain, and lower risk of recurrence. At PACE Hospitals, we prioritize patient-centric care, providing personalized treatment plans tailored to each individual's needs, whether addressing fertility issues, managing pain, or preventing further complications. With cutting-edge facilities and a compassionate approach, PACE Hospitals ensures the best possible outcomes, making them the best varicocele treatment hospital in Hyderabad.

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Best varicocele treatment in Hyderabad, India

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Varicocele diagnosis

Varicocele is diagnosed based on medical history and physical examination, that involves palpation and examination of the scrotum at rest and during the Valsalva maneuver (bearing down). The majority of varicocele patients do not experience any symptoms. Other varicocele patients may experience scrotal swelling over the testis or experience dull pain in the scrotum or groin that worsens with prolonged standing or an erection. The urologist considers the following parameters before selecting the appropriate tests to diagnose varicocele: 


  • Medical history
  • Physical examination

🔷 Patient's Medical history

Adult males with varicoceles are frequently found during a male factor infertility screening, whereas adolescent varicoceles are commonly discovered by chance during a physical examination. A detailed reproductive and sexual history must be gathered for the initial evaluation.

🔷 Physical examination

  • Varicoceles are usually found during a routine physical examination or as part of an infertility treatment. They are generally asymptomatic; however, 2% to 10% of individuals experience pain. The pain usually appears aching, dull, or throbbing, with rare exceptions of intense, acute, or stabbing. Patients sometimes experience heaviness in the scrotum.
  • Varicoceles appear as soft lumps above the testicle, usually on the left side of the scrotum. 
  • If the varicocele is large enough, the patient may describe it as a "bag of worms". Varicoceles can also be right-sided or bilateral.
  • Large varicoceles are easily diagnosed by simple inspection and have the usual "bag of worms" appearance. 
  • Medium varicoceles can be identified with palpation or physical examination without the patient bearing down. 
  • Small varicoceles can only be detected during a vigorous Valsalva maneuver (bearing down). 
  • Subclinical varicoceles are only detectable with ultrasound imaging scans, not through clinical examination.

✅ Varicocele test​s for Diagnosis

Based on the above information, a urologist advises the diagnostic tests to detect varicocele. The following are the tests that might be recommended to diagnose varicocele:


  • High-resolution color-flow Doppler ultrasound
  • Venography 
  • Thermography
  • Scrotal ultrasonography
  • Computed tomography (CT) imaging
  • Magnetic resonance imaging (MRI)
  • Testicular strain elastography


High-resolution color-flow Doppler ultrasound

Following the physical examination, the varicocele can be confirmed with high-resolution color-flow Doppler ultrasound, which will reveal dilation of the pampiniform plexus vessels, which are often 3 mm or larger. This is particularly beneficial in uncertain or borderline cases. 

Color-flow Doppler ultrasonography characterizes the anatomic and physiological characteristics of varicoceles by combining real-time ultrasound with pulsed Doppler in a single scan. 


Venography 

An X-ray, in which a specific dye is injected into the veins to "highlight" abnormal blood vessels. Venography is the most sensitive test, as nearly all people with clinically palpable varicocele have spermatic vein reflux.


Thermography

Thermal imaging is an additional noninvasive, painless, and noncontact approach for examining and confirming a suspected varicocele. Scrotal thermography and scintigraphy were originally developed as noninvasive alternatives to venography. Thermography is a technology that uses a flexible film containing heat-sensitive liquid crystals to detect variations in scrotal temperature. Varicoceles were identified by the presence of hyperthermia over the pampiniform plexus or testis.


Scrotal ultrasonography

  • Physical examination is of little benefit in individuals who are extremely obese, have high-located testes, have a history of scrotal or groin surgery, have a coexisting hydrocele, or have a postoperative varicocele recurrence. In such cases, an ultrasound examination could be extremely beneficial.
  • Ultrasound is the preferred imaging method. In certain cases, ultrasound may identify varicoceles when a physical exam is difficult because of the patient's anatomy or when other symptoms prompt a clinician to order a scrotal ultrasound.
  • Scrotal ultrasonography is the most often used method for diagnosing varicoceles. With the use of high-frequency ultrasound probes and the introduction of Doppler technology, scrotal ultrasound has become more accessible. It can generate high-resolution pictures and characterize vascular flow within the testes and surrounding structures. 
  • Scrotal ultrasound with Doppler examination is the preferred method for evaluating scrotal and testicular disease due to its high sensitivity and specificity (97% and 94%, respectively), noninvasive nature, and convenience of use compared to venography.


Computed tomography (CT) imaging

Although CT imaging can be used to evaluate varicocele, it is not practical due to significant radiation exposure. Although lower-dose CT procedures are now being assessed against traditional protocols, ultrasound remains the favored initial imaging modality due to its low cost and widespread availability. CT imaging's increased resolution has made it a useful additional technique for studying retroperitoneal anatomy.


Magnetic resonance imaging (MRI)

Current research focused on using MRI to evaluate varicoceles' sequelae, offering valuable predictive information for management options. MRI offers advantages over other imaging modalities, such as lack of operator dependency and accurate delineation of retroperitoneal anatomy. When a retroperitoneal cause of varicocele is suspected, MRI can help confirm and evaluate the cause. 


Testicular strain elastography

Elastography can detect structural changes in varicocele-bearing testicles. Although the importance of the modality in grading is unknown, elastography has demonstrated a significant association with spermatogenesis characteristics. Mainly, elastography measurements can predict the improvement in sperm parameters after varicocelectomy, which is useful for making decisions in infertile men with varicocele.

✅ Varicocele grading 

Varicocele grading systems help in determining the size of the varicocele, which in turn guides treatment. Varicocele grading is based on the capacity to visualize and/or palpate the varicocele in both a relaxed and Valsalva position. Various systems have been developed, however, the most often used scale currently is as follows:

  • Varicocele grade 0: Seen on ultrasonography but not physically observable (also known as "subclinical varicocele")
  • Varicocele grade 1: Palpable (felt on examination) while the patient is undergoing the Valsalva maneuver ("bearing down")
  • Varicocele grade 2: Palpable even without the Valsalva maneuver (A breathing method that includes forcibly exhaling against a closed airway)
  • Varicocele grade 3: Varicocele, which causes a prominent scrotal deformity


Even among grades II and III, experienced physicians can detect differences in size, and the results can help determine whether to treat the varicocele.

✅ Varicocele differential diagnosis

A differential diagnosis includes a list of possible medical conditions or diseases that can share the same symptoms in a person. Varicocele has a broad differential diagnosis, which includes the following:


  • Epididymitis: It is an inflammation of the epididymis, a tube-like structure on the testis where sperms mature. It is typically caused by an infection and is treated with antibiotics.
  • Inguinal hernia: It occurs when the contents of the abdomen bulge through a weak region in the lower abdominal wall. Inguinal hernias can develop through either of two channels in the lower abdominal wall, one on either side of the groin. These passageways are known as inguinal canals.
  • Hydrocele: It is an abnormal accumulation of serous fluid between the 2 layers of the testicular tunica vaginalis. It may be congenital (by birth) or acquired.
  • Epididymal tumors: These are rare subtype of paratesticular neoplasms, with the huge majority of these tumors showing benign (non-cancer) behavior. 
  • Spermatocele: Also known as epididymal cysts. These are benign fluid-filled cysts that form in the epididymis, commonly at the testis' superior pole. Spermatoceles may develop in various locations, including the testicle and along the vas deferens. 
  • Testicular torsion: Twisting of the spermatic cord structures results in venous congestion, loss of arterial input, and ischemia of the ipsilateral testis. This is a urologic emergency condition that requires correct diagnosis and treatment to preserve testicular function. 
  • Scrotal lipoma: Primary scrotal lipomas are benign (non-cancerous) fatty tumors that form in the scrotum from adipocytes. Their actual cause of development remains uncertain. They are usually painless and may cause signs of heaviness and discomfort.

✅ Considerations of a urologist in treating varicocele

When a male partner in a couple attempting to conceive has a varicocele, treatment is considered by a urologist if the following conditions are met: 


  • If the physical examination of the scrotum reveals that the varicocele is palpable.
  • If the couple is known to be infertile.
  • If the female partner has normal fertility or a treatable reason for infertility.
  • If the male partner's semen parameters or sperm function test findings are abnormal.
  • Varicocele treatment for infertility is not recommended for individuals with normal semen quality or a subclinical varicocele. 
  • Adolescent male persons with unilateral or bilateral varicoceles and decreased testicular growth on the ipsilateral side can be considered for varicocele surgery.

✅ Goals of varicocele treatment

The goals of varicocele repair are to reduce pain in symptomatic conditions along with improving the quality of semen, testicular function, and rates of pregnancy in couples with infertility issues associated with a man's varicocele.

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Varicocele treatment

Varicoceles are treated mainly through surgery. Because the varicocele has the potential to cause severe testicular injury, it needs to be evaluated during the physical examination. The presence of a varicocele does not mean that surgical treatment is required. Different treatment options for varicocele include: 


  • Medical management of varicocele 
  • Surgical management of varicocele 
  • Percutaneous embolization of varicocele


Medical management of varicocele 

  • Conservative treatment and observation are important for managing varicoceles with testicular pain in a few patients. However, there are no effective medical treatments for varicoceles. 
  • Prolonged observation can reduce pain from various sources, such as minor injuries or strained groin muscles.
  • Conservative therapies include elevating the scrotum, using non-steroidal anti-inflammatory medications, and limiting physical activity. 
  • Dietary supplements, such as vitamins A, E, C, and B complex, glutathione, coenzyme Q10, carnitine, pantothenic acid, and micronutrients like copper, selenium, and zinc, have some evidence to support their intake in varicocele patients. These may enhance antioxidant enzyme levels while decreasing inflammatory markers.
  • The efficacy of conservative treatment for painful varicocele varies across reports. Yaman et al. reported that conservative therapy relieved pain in 5/119 (4.2%) men. However, Chen observed that after 4 weeks of conservative treatment, 15/99 (15.2%) of the males got pain relief.
  • Medical therapy for varicocele-related male infertility includes antioxidants, hormone medications, and some Chinese medicines.
  • Preclinical investigations suggest that these medicines may be effective in treating varicocele-associated testicular pain with minimal side effects. However, no research has been conducted on their use in this regard.


Surgical management of varicocele 

  • Procedural intervention is recommended for patients who do not respond to conservative therapy or have persistent symptoms after a sufficient period of observation, or unable to perform limited activities.
  • Varicocele ligation, also known as varicocelectomy, is a useful treatment for painful varicocele. 
  • The use of a scrotal incision for varicocele repair has declined due to high rates of injury to the testicular artery and recurrence.
  • The scrotal approach challenges in maintaining arterial supply to the testis because the pampiniform plexus of veins uncoils the testicular artery at the scrotum.
  • Various venous ligation approaches have been developed to halt (prevent) retrograde flow within internal spermatic veins. These include retroperitoneal (Palomo), inguinal (Ivanissevich), subinguinal, and scrotal approaches. 
  • These approaches have been improved with laparoscopy, loupe magnification, and an operating microscope for better visualization. Each technique varies in complexity, success rates, complications, and recurrence rates.
  • Varicocele can be surgically treated by open varicocelectomy, laparoscopic varicocelectomy, or microsurgical varicocelectomy.
  • Open varicocelectomy can be performed by multiple incisions to expose spermatic veins at different levels. The Paloma procedure, also known as high retroperitoneal ligation of varicocele, involves making a horizontal incision medial and inferior to the ipsilateral anterior superior iliac spine, extending medially. 
  • The inguinal technique involves making an incision in the groin above and lateral to the ipsilateral pubic tubercle, extending laterally along the skin lines of the inferior abdominal wall. The open sublingual varicocelectomy incision is performed at the level of the external inguinal ring, allowing the spermatic cord to be delivered without separating any abdominal muscle or fascia.
  • Laparoscopic varicocelectomy isolates the internal spermatic veins proximally, at their point of draining into the left renal vein. Only a few veins will be ligated.
  • Microsurgical varicocelectomy reduces complications and recurrences compared to open varicocelectomy procedures. The technique is safe and can be done with local or general anesthesia. The operating time is quite short. Testicular arteries can be clearly detected and preserved at 10-25x magnification.


Percutaneous embolization of varicocele 

  • Percutaneous transcatheter embolization involves vascular access through an antegrade or retrograde route. It involves inserting a catheter from the femoral vein, up the vena cava, laterally into the left renal vein, and finally inferiorly into the spermatic vein.
  • According to reports, this procedure has an 89% success rate. While less invasive than open surgery, it can be technically challenging and more expensive in the long run.
  • Percutaneous endovascular embolization is a common alternative to open surgery for recurrent varicoceles.
  • A venogram outlines the venous anatomy, followed by embolization using coils, balloons, or sclerotherapy. 
  • The main advantage of this procedure is that it can be performed with local anesthesia. Interventional radiology is typically limited to specialized centers and has a lower success rate compared to surgery because of high radiation exposure.
  • Although not as effective as microsurgical techniques for primary treatment, its significance in recurrent and persistent varicocele is well established. 
  • Recent research suggests that percutaneous transcatheter embolization is a more efficient primary treatment for painful varicocele. However, recurrence rates remain higher than with the microsurgical method.

✅Varicocele prognosis 

A varicocele has a good prognosis. If a varicocele causes pain, surgical treatment can help reduce it. Infertile males with abnormal semen parameters and clinically severe varicoceles usually see an improvement in their semen parameters. Varicocelectomy operations for major varicoceles in adolescents with small testis can promote testicular growth and assist in preventing future infertility. Asymptomatic varicoceles in fertile male people with appropriate testosterone levels do not require treatment and appear to have no side effects.

Frequently Asked Questions (FAQs) on Varicocele

  • Can varicocele cause infertility?

    Some experts believe that varicoceles can impair men's fertility. Men with palpable varicoceles and poor sperm quality who receive treatment may have a better chance of becoming pregnant with their partner. There is evidence that varicoceles may affect men's fertility. However, scientists are still unsure why this is occurring. Some experts believe that the varicocele reduces blood circulation to the affected testicle, resulting in lower sperm quality. Others consider the accumulation of blood in the scrotum increases the temperature of the testicle, possibly affecting sperm production.

  • How long after varicocele surgery does sperm improve?

    Sperm parameters improve three months after varicocele repair but do not improve further. This result may enable physicians to determine whether varicocelectomy was beneficial and, if necessary, immediately plan the use of further medications to manage the couple's infertility.

  • Why varicocele is common on the left side?

    Varicoceles form as an outcome of venous reflux caused by increased venous pressure or damaged venous valves. Most varicoceles form on the left side due to the connection between the spermatic vein and the left renal vein (the spermatic vein opens at a sharp angle into the left renal vein).

  • What are the symptoms of varicocele?

    Varicoceles are normally asymptomatic; however, 2% to 10% of individuals report pain. The pain is typically reported as aching, dull, or throbbing, with very rare exceptions for intense, acute, or stabbing. Sometimes, people may experience heaviness in the scrotum.

What is varicocele? 

A varicocele is a common medical condition that causes abnormal dilation and expansion of the scrotal venous pampiniform plexus that drains blood from each testicle. As a result, a difficult network of swollen vessels is usually formed.

Is varicocele dangerous?

Varicocele itself is generally not life-threatening, but it can have significant health implications, particularly if left untreated. Infertility, Testicular Atrophy, Chronic Pain and Hormonal Imbalances are some potential concerns.


While varicocele are not immediately dangerous, they can lead to complications over time, particularly regarding fertility and testicular health. If you experience symptoms or are concerned about potential fertility issues, seeking medical advice and treatment from a urologist is recommended.

Can a varicocele cause low testosterone?

Varicoceles can cause three significant issues such as impaired fertility, reduced testosterone production by the testis, and scrotal pain. As a result, they are rarely considered until there is cause for concern about one of these issues.

Can varicocele cause azoospermia?

Varicocele can sometimes induce azoospermia, which is the complete absence of sperm in the ejaculate. Because varicoceles are so widespread and frequently go unnoticed throughout life, it is believed that approximately 80% of men with varicoceles can conceive with their partner without any medical intervention.

Can varicocele cause hydrocele? 

A hydrocele is an unusual accumulation of serous fluid in the tunica vaginalis sac. It is the most common complication of varicocele surgery. Hydrocele development after varicocele surgery, also known as a post-varicocelectomy (PV) hydrocele, is caused by the iatrogenic rupture of lymphatics in and along the spermatic cord during varicocelectomy.

What type of doctor treats varicocele?

When considering treatment for a varicocele, it is recommended to consult a urologist, particularly a fellowship-trained urologist in male infertility if fertility is a concern. Practitioners who diagnose and treat varicoceles must understand their presentation and diagnostic criteria, the necessary examination, the indications and repair options, and the proper follow-up and management of patients with treated and untreated varicoceles.

Can ultrasound detect varicocele?

Ultrasound-diagnosed "subclinical" varicoceles are regarded as clinically irrelevant because they rarely cause testicular damage or discomfort. In some cases, ultrasound may reveal varicoceles when a physical exam is difficult due to the patient's anatomy or when other symptoms prompt a physician or urologist to order a scrotal ultrasound.

Is varicocele hard or soft?

Varicoceles appear as soft lumps above the testicle, typically on the left side of the scrotum. If the varicocele is large enough, the patient may describe it as a "bag of worms". Varicoceles can be right-sided or bilateral.

What is the normal size of a varicocele?

The ESUR-SPIWG suggests measuring the largest vein when standing and performing the Valsalva maneuver technique, regardless of its location. A venous diameter of 3 mm or higher is considered diagnostic for a varicocele.

Do all bodybuilders have varicocele?

According to some research, up to 30% of athletes have varicocele, which is much greater than the overall population, and up to 60-80% of bodybuilders are affected. Varicoceles have been demonstrated to increase with the number of hours spent training.

Can MRI detect varicocele?

The use of computed tomography (CT) scans is limited due to the ionizing radiation it produces. Tsili et al. discovered that measuring fractional anisotropy with 1.5 T diffusion tensor imaging (DTI) MRI could help diagnose testes in infertile men with varicocele.

How much does varicocele treatment cost in Hyderabad, India?

Varicocele treatment cost in Hyderabad can vary based on several factors such as the type of procedure, hospital facility, doctor’s expertise, and additional services provided. Here is a detailed breakdown of the costs involved in varicocele treatment:

  • Consultation Fees and Diagnostic Tests: ₹8,500 to ₹16,000 (that includes blood tests, ultrasound/scrotal Doppler, semen analysis etc.)
  • Surgical Varicocele Treatment: ₹65,000 to ₹2,25,000 (microsurgical varicocelectomy or laparoscopic varicocelectomy or open surgery with hospital stay)
  • Post-Surgical Care: ₹5,000 to ₹8,500 (post-surgery medications, including pain relief and antibiotics with follow-up visits)


In an average, varicocele treatment in Hyderabad may cost anywhere between ₹80,000 to ₹1,75,000 (US$950 - US$2,080), depending on the treatment method and hospital (private or general) chosen. It's recommended to consult with the hospital or clinic for a detailed cost estimate based on your specific situation.

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