Successful Microscopic B/L Varicocelectomy for Grade 3 B/L Varicocele

Chief Complaints

A 45-year-old male patient with a body mass index (BMI) of 21 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of bilateral scrotal pain.

The patient had no significant past medical history and no known drug allergies. There were no chronic illnesses or previous surgeries reported, and overall health was good prior to admission.

On general examination, the patient was conscious, coherent, and oriented. He was found to have bilateral scrotal swelling with associated discomfort. Local examination revealed prominent dilated scrotal veins bilaterally without any signs of acute inflammation, and the rest of the systemic examination was normal.

Upon admission to PACE Hospitals, the patient was thoroughly evaluated by the Urology team, including a detailed review of his medical history and a comprehensive clinical examination. He presented with bilateral scrotal pain, raising clinical suspicion of bilateral varicocele.

The patient underwent diagnostic investigations, including clinical evaluation and ultrasonographic assessment of the scrotum, which confirmed the presence of bilateral grade 3 varicocele with normal bilateral testes. Laboratory investigations, including complete blood picture, renal function tests, blood sugar, coagulation profile, serum electrolytes, and viral screening for HIV, Hepatitis B, and C, were all within normal limits. Cardiovascular, abdominal, and neurological examinations were normal, and the respiratory system examination was normal with no abnormalities.

Based on these confirmed findings, the patient was advised to undergo Bilateral grade 3 Varicocele Treatment in Hyderabad, India, under the expert care of the Urology Department.

After a detailed consultation with Dr. Abhik Debnath, Consultant Laparoscopic Urologist, a comprehensive evaluation was conducted focusing on the patient’s presentation of bilateral scrotal pain and scrotal swelling. Clinical examination and diagnostic assessment confirmed the presence of bilateral grade 3 varicocele with no evidence of acute infection or other significant scrotal pathology.

It was determined that bilateral subinguinal microscopic varicocelectomy was the most appropriate intervention to relieve pain, improve venous drainage, prevent progression of symptoms, and preserve testicular function.

The patient and his family members were informed about the diagnosis of bilateral varicocele, the planned surgical management, the associated risks, and the expected benefits aimed at relieving symptoms and preventing future complications.

Following the decision, the patient was scheduled to undergo a Bilateral varicocelectomy Surgery in Hyderabad at PACE Hospitals, under the expert care of the urology department.

The procedure involved the following steps:

• Patient Preparation and Anaesthesia: The patient was taken to the operating room and placed in a supine position. Under strict aseptic precautions, general anaesthesia was administered. The genital and groin regions were shaved, cleaned, and draped in a sterile fashion.

• Surgical Exposure (Subinguinal Approach): A small subinguinal incision was made on each side just below the inguinal canal. The spermatic cord was carefully isolated and delivered into the operative field without opening the inguinal canal.

• Microscopic Identification of Structures: Under operating microscope magnification, the components of the spermatic cord were dissected carefully. The testicular artery, lymphatic channels, and vas deferens were identified and preserved. Dilated and tortuous veins were clearly visualized bilaterally.

• Ligation of Dilated Veins: All enlarged internal and external spermatic veins were meticulously ligated and divided using fine sutures, ensuring complete interruption of abnormal venous reflux while preserving arterial and lymphatic supply.

• Closure and Completion: Hemostasis was achieved, and the spermatic cord was repositioned. The incision was closed in layers with absorbable sutures, and sterile dressing was applied. The procedure was completed without complications.

Post-operatively, the patient was monitored for pain control, wound status, and scrotal swelling. Scrotal support was advised to reduce discomfort and minimize postoperative edema. Regular wound care and dressing changes were performed to ensure proper healing and prevent infection. The patient remained hemodynamically stable with an uneventful recovery and was discharged in stable condition.

Upon discharge, the patient was prescribed medications for prevention of post-operative infection, control of pain, reduction of inflammation and scrotal swelling, gastric protection, and nutritional support to promote healing and recovery following surgery. These were advised for short-term use with continuation based on symptom improvement and follow-up assessment.

The patient was advised to continue a normal diet as tolerated and to use scrotal support to reduce discomfort and aid in recovery following surgery.

The patient was instructed to contact the emergency ward at PACE Hospitals in the event of an emergency or development of symptoms such as fever, increasing scrotal pain, swelling, or wound discharge.

The patient was advised to return for a follow-up visit with the Urologist in Hyderabad at PACE Hospitals after 3 days for dressing.

This case highlights a patient with bilateral scrotal pain diagnosed as bilateral grade 3 varicocele. He underwent successful bilateral subinguinal microscopic varicocelectomy under general anaesthesia without complications. The postoperative course was uneventful, and the patient was discharged in stable condition.