Urology

Microsurgical varicose vein treatment

What does this procedure entail?

This procedure is based on microscopically guided interruption of small vessels (1-3 mm in diameter) by incision into the subcutaneous tissue in the groin area. These very fine veins drain blood from the testicle area. Any blood congestion in these vessels is most often manifested by dull pain in the scrotum. If the problems persist for a longer time, fertility problems may develop. The use of a microscope during surgery makes it possible to distinguish abnormal veins from other structures that will be retained (arteries, lymph vessels). Compared to other methods, this procedure is the most gentle approach for the patient with the desired effect.

What are the alternatives to this procedure?

• Follow-up
• Conservative treatment using dietary supplements containing rutoside, drugs; food containing buckwheat.
• Extraperitoneal or laparoscopic approach – associated with higher surgical burden for the patient and with more frequent recurrences (return of problems) and complications.
• Embolism and sclerosing methods – closure of a vein by the injection of a special substance.

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

At the request of the referring physician, you will have to schedule preoperative examinations to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.

You will be asked not to eat or drink for at least 6 hours before the surgery!

In the evening before the surgery, you will receive medication from an anaesthesiologist to calm you down so that you sleep well.

Remember to inform your physician about the following possible facts before the surgery:

• artificial heart valve
• coronary artery stent
• pacemaker
• artificial joint
• artificial vascular graft
• neurosurgical bypass
• other implanted foreign body
• use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
• drug and other allergies
• any abnormalities or eventualities

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first.

The procedure is performed under general anaesthesia (you will be asleep during the procedure). The procedure begins with an incision in the lower abdomen on the affected side. The surgical field is visualised with a microscope, as the prepared structures are only several millimetres small. All abnormally dilated veins are gradually severed, the artery and vas deferens are retained. A drain (plastic drainage tube) is inserted into the wound. The surgery takes about 45-60 minutes.

What will happen immediately after the procedure?

You will wake up at the intensive care unit equipped for the continued monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.

After the effects of the anaesthetic have completely disappeared, you will be able to eat, drink and move normally, initially with the help of medical staff. Pay close attention to eventual dizziness, uncontrollable weakness, and to gait stability. Otherwise immediately inform medical personnel or anyone in the vicinity.

The wound is sutured with non-absorbable sutures – it will be necessary to remove them on day 9 after the surgery. The drain is removed on day 1-2 after the surgery. The total length of hospitalisation is 2 to 3 days. Duration of sick leave is 2 to 3 weeks. Oedema of the soft tissues of the scrotum is quite common in the postoperative course, it will gradually disappear within a few days.

Once you are fully conscious, you should:

• ask if the planned outcome was achieved
• inform the medical staff about any problems
• ask what you can and cannot do
• ask all the questions you have for the healthcare professionals and members of the medical team.
• remember (and understand) why the surgery was performed, how it turned out, and what will follow

What are the postoperative risks or complications?

Common (10% of procedures of this type)

• Scrotal oedema, which may last for several days
• Serous (wound) secretion up to a few days after the surgery
• Recurrence of varicocele (approximately 14% of patients)
• Fluid formation around the testicles (hydrocele) several months after the procedure (15 to 30%)

Occasional (2-10% of procedures of this type)

• Incision site infections requiring additional surgical or antibiotic treatment
• Bleeding requiring further surgery

Rare (may occur in 2% of procedures of this type)

• Chronic scrotal pain
• Damage to the artery and subsequent atrophy of the testis

Hospital infections

• MRSA colonisation (0.9% – 1 of 110)
• Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
• MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

• Get recommendations on recovery at home
• Ask when you can return to normal activities such as work, exercise, driving, housework
• Get a contact number for further questions after returning home or in case of trouble
• Ask about the date and place of suture removal and follow-up visits (hospital or your doctor).

Make sure you are aware of the reason, the course and outcome of the surgery, the results of the examination or the removal of tissues or organs.

At your departure from the hospital (sometimes several days later), you will receive a hospitalisation report. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

What else should I watch out for?

The wound should be clean and dry for a full 24 hours. If clothes stick to it, they can be removed after a short bath or shower. You should not bathe until this area has healed (shower only).

It is recommended to wear tight underwear or a suspender until the swelling subsides or until any problems disappear.

You should stay at home for 10-14 days and avoid any strenuous exercises or lifting heavy loads to enable the wound to heal. You should avoid sexual intercourse for about 14 days, or until all eventual problems improve.

Important information?

In case of fever, redness, pulsation or secretion at the site of the surgical wound, contact your attending physician. Tell your doctor if you have any other problems associated with the procedure.

Date and place of your check-up at the outpatient urological office or at the GP will be determined at the discharge (usually 6-8 weeks after the surgery, suture removal about 9 days after the surgery).

Further follow-up at the outpatient urological office is a usual practice.

We cooperate with health insurance companies
in the Czech Republic