Surgical options include hydrocelectomy (a hydrocele is removed from the scrotal contents) and varicocelectomy (“tying off” the affected veins). Radiographic occlusion plugs the affected vein with a small balloon. Spermatocelectomy is outpatient surgery in which the spermatocele is located and a suture (thread) is tied around the part connecting it to the epididymis. Sclerotherapy is a procedure in which a chemical agent is injected into veins.
Performed on an outpatient basis under general or spinal anesthesia, hydrocelectomy usually lasts between 30 and 90 minutes. The physician locates the hydrocele and removes it. The hydrocele fluid must be drained and the hydrocele sac edges partially stitched or removed and cauterized to prevent recurrence.
Needle aspiration of the fluid, with or without an injection of medication that hardens tissue, also treats hydroceles. However, surgery is usually preferred over aspiration.
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There are several different methods of varicocelectomy, all of which involve tying off the affected veins, including:
- Microsurgical subinguinal varicocelectomy;
- Inguinal varicocelectomy;
- Laparoscopic varicocelectomy;
- Retroperitoneal varicocelectomy; and
- Radiographic occlusion.
The incidence of the varicocele recurrence following surgery varies widely, with an average rate of 9 percent. In cases of recurrence, the surgery is usually repeated. It takes at least 4 months to see any significant improvement in sperm quality. Surgery may cause men who have low testosterone levels to experience increased muscle mass, body hair, and sexual interest.
Spermatocelectomy is a type of outpatient surgery. The physician makes an incision in the skin of the scrotum and gently pulls the testicles and the epididymis through the incision. A suture (thread) is tied around the spermatocele, separating it from the epididymis.
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This procedure is usually performed on a man past his reproductive years because of the risk of complications. A needle is inserted into the cyst and the fluid is drained. The physician then injects the cyst with a chemical agent, called a sclerosant solution. The chemical hardens or closes the cyst and prevents it from collecting more sperm.
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