Precise microsurgical treatment for varicoceles
A varicocele — essentially varicose veins in the scrotum — can cause pain, testicular atrophy, and reduced fertility. Microsurgical varicocelectomy is the gold-standard treatment, with the lowest recurrence and complication rates of any approach. Performed at Prestige Medical Group by Dr. Hari Sawkar, MD — a board-certified urologic surgeon.
What is a varicocele?
A varicocele is a network of enlarged, twisted veins in the scrotum — essentially the same problem as varicose veins in the legs, but affecting the small veins that drain the testicles. Varicoceles are surprisingly common, occurring in about 15% of adult men and up to 40% of men presenting with infertility. They usually develop on the left side due to anatomical differences in vein drainage.
Most varicoceles don’t require treatment — but when they cause testicular pain, testicular atrophy (shrinkage), or impaired fertility, surgical repair is the definitive solution. The most effective and precise approach is microsurgical subinguinal varicocelectomy — a small-incision procedure performed with an operating microscope that allows the surgeon to identify and preserve the testicular artery, lymphatic vessels, and vas deferens while ligating (tying off) all the abnormal veins.
At Prestige Medical Group, varicocele repair is performed by Dr. Hari Sawkar, MD — a board-certified urologic surgeon with expertise in microsurgical scrotal procedures and male infertility. Microsurgical technique offers the lowest rates of recurrence, hydrocele formation, and other complications — considered the gold standard for varicocele repair.
Dr. Hari Sawkar, MD
Dr. Sawkar’s expertise in microsurgical scrotal surgery — combined with his broader clinical interest in male urologic health — means patients get the technique with the best published outcomes and the most careful attention to preserving normal testicular blood supply and lymphatic drainage.
Who is a candidate for varicocele repair?
Not every varicocele needs treatment — many are asymptomatic and never cause problems. Repair is typically considered when specific symptoms or clinical concerns are present.
Chronic testicular pain
Aching, dragging, or heaviness that worsens with prolonged standing, exercise, or at the end of the day — where conservative measures like supportive underwear and lifestyle changes haven’t helped.
Testicular atrophy
Documented shrinkage or arrested growth of the affected testicle — a sign that the varicocele is impairing testicular function and warrants intervention, especially in adolescents.
Male infertility
Abnormal semen analysis (low count, poor motility, or abnormal morphology) in a couple trying to conceive — varicocele repair often improves semen parameters significantly.
Low testosterone
In select cases, varicocele repair can improve testosterone levels — particularly relevant when combined with other indications for repair.
Why microsurgical repair is the gold standard
Several techniques exist for treating varicoceles. Microsurgical subinguinal varicocelectomy consistently demonstrates the best outcomes across the metrics that matter most.
Conservative management
Supportive underwear, activity modifications, and OTC pain relief — appropriate for mild symptoms without atrophy or fertility concerns.
Embolization (interventional radiology)
Non-surgical approach through a catheter — no incision but higher failure and recurrence rates than microsurgery.
Laparoscopic or open non-microscopic repair
Traditional surgical approaches that don’t use the operating microscope — higher rates of hydrocele and recurrence than microsurgical technique.
Microsurgical subinguinal varicocelectomy
Small incision, operating microscope, precise preservation of artery and lymphatics — lowest complication and recurrence rates. The gold standard.
Three microsurgical advantages
The microscope isn’t just about magnification — it fundamentally changes what the surgeon can identify, preserve, and treat during varicocele repair.
Preserves the artery
The tiny testicular artery is easily identified under the microscope and carefully preserved — protecting the testicle’s essential blood supply and reducing complication risk.
Preserves the lymphatics
The small lymphatic vessels are also identified and preserved. Damage to these vessels is the primary cause of post-op hydrocele — a complication that microsurgery largely avoids.
Complete vein ligation
The microscope allows identification and ligation of even the smallest abnormal veins — including tiny branches that would be missed in non-microscopic techniques and cause recurrence.
What to expect on surgery day
Microsurgical varicocelectomy is typically performed as an outpatient procedure — same-day home discharge. Total surgery time is usually 1-2 hours depending on whether one or both sides are treated.
Consultation & workup
Dr. Sawkar examines the varicocele, may order ultrasound imaging, reviews semen analysis if fertility is a concern, and confirms surgical candidacy.
Surgery day
Under anesthesia (usually general), a small incision (~2-3cm) is made in the lower groin. Using the operating microscope, Dr. Sawkar identifies and preserves the artery and lymphatics while ligating all abnormal veins.
Home to recover
Same-day discharge in most cases. You’ll go home with pain management, ice instructions, and clear guidance for the first days of recovery.
Follow-up
Post-op check to monitor healing. If treated for fertility, follow-up semen analysis at 3-6 months documents the improvement (which develops gradually as new sperm are produced).
What recovery looks like
Recovery from microsurgical varicocele repair is generally straightforward. Most men are back to office work within a few days and to full activity within 2-3 weeks.
Varicocele questions answered
Have a question not answered here? Call (949) 825-7650 to speak with our team.
Do all varicoceles need treatment?
Will varicocele repair improve my fertility?
Why choose microsurgery over embolization?
What if I have varicoceles on both sides?
Who performs varicocele repair at Prestige Medical Group?
Is varicocele repair covered by insurance?
What are the risks?
Ready to learn more?
Whether you’re dealing with pain, concerned about testicular changes, or working through fertility questions, Dr. Sawkar can help you understand what’s going on and what your best options are. Schedule a consultation to discuss whether varicocele repair makes sense for you.