Varicocele Treatment

1. Physical examination: The doctor will feel the non-tender mass above the testicle. This test is necessary to evaluate the severity of varicocele. The doctor will evaluate the varicocele while the patient is in a standing position.
2. Valsalva maneuver: This is a type of breathing technique in which the doctor will ask the patient to breathe out strongly through the mouth while holding the nose tightly closed in a standing position. This enables the doctor in detecting the presence of any abnormal vein enlargement in the scrotum.
3. Scrotal or Doppler Ultrasound: This test creates clear images of the organs inside the body using sound waves. The size of the lump present in the scrotum and the direction of blood flow in the scrotal veins can be evaluated using this test.
4. CT scan or MRI scan of the scrotum region: A CT scan or MRI scan may be performed to obtain better images of the varicocele if the ultrasound is not very clear.
5. Scrotal infrared digital thermography: This is a type of non-invasive test that helps in detecting varicocele in its initial stage. This test enables measuring the temperature of the skin surface around the scrotum and diagnosis of low-grade varicoceles.
6. Semen tests: This test helps the doctor to determine if the varicocele has affected the fertility of the man.
7. Blood tests and urine tests: These are routine diagnostic tests performed before surgery to check for any infections or medical conditions.
8. Chest x-ray: This test is performed to check the condition of the heart and lungs before surgery.
9.  Electrocardiogram (ECG): This test enables measuring the electrical activity of the heart.

Non-surgical treatment:

1. Varicocele embolization:
This is a non-surgical procedure in which a small catheter is inserted through the groin region into the scrotal vein.
A coil will then be inserted through the catheter into the varicocele to block the affected veins.
This will redirect the flow of blood to the circulatory system via the healthy veins, ultimately resulting in the collapse of the damaged veins.

Surgical treatment: The different types of surgeries that can be performed to treat varicocele include:

1. Open varicocelectomy:
This is a traditional method of treating varicocele.
It is performed under general anesthesia, in which the patient is made to fall asleep during the procedure.
A large incision is made by the surgeon on the scrotum, groin, or lower abdominal region.
The surgeon will then find and tie off the affected blood vessels.
The incision is then closed using sutures.

2. Laparoscopic varicocelectomy: 
This procedure is generally performed in the advanced stages of varicocele.
It is performed under the effect of general anesthesia.
The surgeon will first make many small incisions or cuts in the abdominal area.
A thin lighted scope with a camera on one end, known as a laparoscope, is then inserted through one of the incisions made. It enables inflating the abdomen using carbon dioxide gas to help in obtaining a better view of the internal organs.
Once the doctor identifies the swollen veins, these veins will be cut and the ends will be closed off using medical instruments inserted through the other incisions.
After sealing off the ends of the affected veins, all the surgical tools will be removed and the incisions will be closed using sutures or clips, and a dressing will be applied on the top.

3. Microscopic varicocelectomy:
This procedure is usually recommended when there is a risk of infertility.
The surgeon makes a tiny incision in the scrotum region to perform this procedure.
The surgeon then separates the testicular arteries and the vas deferens (a coiled tube that will carry the sperm out of the testes or testicles) in the scrotum region with the help of a microscope.
While keeping the lymphatic drainage intact, the surgeon will then dissect down to the spermatic cord (a cord-like structure consisting of the blood vessels, lymph vessels, nerves, and vas deferens).
Once the abnormal veins are found, each vein will be dissected circumferentially and tied off to disrupt the blood flow before the blood is drained away from the testicle into the pelvic and inner thigh region.
The incision is then closed using sutures and a bandage is applied on top.

If a varicocele is left untreated, it may lead to the following complications:

1. Fertility issues
2. Shrinking of the testicles or testicular atrophy
3. Hormonal imbalance
4. Erectile dysfunction
5. Azoospermia (a complete absence of sperm from the semen)

The risks associated with varicocelectomy are:

1. Infection
2. Hemorrhage
3. Blood clot formation
4. Hydrocele (build-up of fluid in the varicocele)
5. Damage or injury to the testicle
6. Bladder obstruction or difficulty in emptying the bladder
7. Chronic pain
8. Varicocele recurrence
9. Testicular atrophy (shrinkage of the testicles)

The following are the post-procedure steps following surgery:

1. You will be kept under observation for two to three hours in the recovery room after surgery. If there are no complications, you can go home immediately.
2. It is normal to have some pain, bruising, and swelling at the surgical site for a few days after surgery.
3. The doctor will recommend painkillers to relieve your discomfort.
4. Most patients can start working within a few days after surgery.
5. Complete recovery following surgery may take three to six weeks, depending on the type of surgery performed and the condition of the patient.

Home remedies:

The following home care tips can help in a smooth recovery after varicocele treatment:

• Avoid strenuous activities for at least two to three weeks after surgery.
• Apply an ice pack to the scrotum for at least 10 minutes, many times a day.
• Take all the medicines prescribed by the doctor regularly.
• Avoid sexual intercourse for at least two weeks after surgery.
• Avoid swimming or taking a bath till the incisions close completely.
• Keep the incision area dry and clean.
• Wear a jockstrap for proper support.
• Eat a fiber-rich diet to avoid constipation. Use a stool softener or muscle relaxer in case of difficulty while passing stools.
• Quit smoking and alcohol consumption.
• Limit the consumption of caffeine.
• Avoid processed food items.

Cost of varicocele treatment in India- 

The cost of varicocele embolization (non-surgical treatment of varicocele) in Mumbai is between INR 1,00,000 to INR 1,80,000.
The cost of varicocele embolization in Delhi is between INR 95,000 to INR 1,70,000.
The cost of varicocele embolization in Bangalore is between INR 95,000 to INR 1,70,000.
The cost of varicocele embolization in Chennai is between INR 90,000 to INR 1,60,000.

The cost of varicocelectomy (surgical method to treat varicocele) in Mumbai is between INR 40,000 to INR 80,000.
The cost of varicocelectomy in Delhi is between INR 35,000 to INR 75,000.
The cost of varicocelectomy in Bangalore is between INR 35,000 to INR 75,000.
The cost of varicocelectomy in Chennai is between INR 30,000 to INR 70,000.