Marmara varicocelectomy
Varicocele is an enlargement of the veins within the spermatic cord. It may cause scrotal pain or discomfort and affect sperm quality. Marmara varicocelectomy is a microsurgical treatment in which the affected veins are ligated through a small incision in the groin. Surgery may be considered when clinically indicated, including in cases of persistent pain, abnormal semen analysis results or fertility problems associated with varicocele. Not every case requires surgery – the decision is made by a urologist after an assessment.
Varicocele in men and its potential effects
Varicocele may be accompanied by chronic scrotal pain, a reduction in the volume of the affected testicle, and a decline in sperm quality. Potential consequences include:
- Scrotal pain and heaviness – discomfort often worsens later in the day, after prolonged standing or physical activity, and may improve when lying down.
- Changes in testicular function – in some men, varicocele is associated with reduced testicular volume or impaired function.
- Abnormal semen parameters – sperm concentration, motility and other characteristics may be affected.
- Difficulty conceiving – when varicocele is associated with abnormal semen parameters, it may be one of the factors contributing to male infertility.
These effects do not occur in every patient. Varicocele does not automatically mean that a man will have fertility problems or need surgery. Treatment decisions depend on symptoms, examination findings and reproductive plans.
Specialists
Boiko Mykola Ivanovych
Urologist, Андролог, Сексопатолог
Shulaia Tsotne Valerianovych
Ultrasound doctor, Urologist
When is surgery needed for varicocele?
- Persistent scrotal pain or heaviness associated with varicocele.
- Reduced sperm concentration or motility on semen analysis.
- Couple infertility alongside clinically detectable varicocele and abnormal semen parameters.
- Reduced testicular volume in adolescents on the affected side.
- Worsening semen analysis results during follow-up.
- Varicocele that may affect fertility when the man is planning to have children.
- Symptoms that interfere with daily activities and persist despite conservative measures.
- Other examination findings that the urologist considers an indication for surgical treatment.
How does the Marmara procedure differ from other techniques?
The Marmara technique is a microsurgical varicocelectomy performed through a small incision in the groin, usually below the external inguinal ring. The surgeon uses magnification to distinguish abnormally dilated veins from important anatomical structures.
During the procedure, the veins responsible for the varicocele are ligated while the testicular artery and lymphatic vessels are preserved whenever possible. Preserving the lymphatic vessels helps reduce the risk of hydrocele, a buildup of fluid around the testicle.
Unlike the laparoscopic approach, the Marmara procedure does not require access through the abdominal cavity. Compared with open techniques performed without microsurgical magnification, precise visualisation of the anatomical structures may reduce the risk of certain complications and recurrence.
Can varicocele affect fertility?
Varicocele can interfere with sperm production and affect sperm concentration, motility and other semen parameters. One possible explanation is altered temperature regulation and blood flow around the testicle. However, this effect does not occur in every man.
If a couple is trying to conceive without success, a urologist may recommend semen analysis and an assessment of other factors affecting male fertility. Surgery may be appropriate when clinical varicocele and abnormal semen parameters are present, following an assessment of both partners’ reproductive circumstances.
Semen parameters improve in some men after varicocelectomy, but the outcome depends on the initial condition of the testicles and other factors. The response is assessed using a follow-up semen analysis at a time recommended by the doctor.
If semen analysis results are normal and varicocele is detected only on ultrasound, without being palpable on examination, surgery is generally not recommended solely to prevent possible infertility.
What to expect during Marmara varicocelectomy and recovery
Marmara varicocelectomy is performed under local or general anaesthesia, depending on the clinical situation and the anaesthesiologist’s recommendations. The surgeon makes a small incision in the groin, identifies the dilated veins using microsurgical magnification and ligates them while preserving the testicular artery and lymphatic vessels. The incision is then closed with sutures.
In most cases, patients can return home on the same day. Mild pain, swelling or bruising around the surgical site may occur during the first few days. These symptoms subside gradually.
During recovery, it is important to follow the surgeon’s instructions, keep the wound clean and temporarily limit physical activity. Many patients return to their usual daily activities within a few days. Strenuous exercise and heavy lifting are generally restricted for 2–4 weeks, depending on recovery and the surgeon’s recommendations.
If the procedure was performed to address fertility concerns, changes in semen parameters are assessed over time. The doctor may recommend a follow-up semen analysis after several months. Sudden or severe pain, increasing swelling, fever or discharge from the wound require medical assessment.
Take a step towards protecting yourse
Is surgery always necessary for varicocele?
Can Marmara varicocelectomy improve male fertility?
Can varicocele recur after the Marmara procedure?
How soon after surgery can changes in semen parameters be assessed?
