The Consultation Visit

This visit is important for you to meet and feel comfortable with Dr. Turek, to figure out whether you are a good candidate for a varicocele repair, and to assess if the procedure is right for you. At this visit:

Dr. Turek will ask you questions about your symptoms (pain, infertility, mass in the scrotum) and also ask questions about your medical history.

Dr. Turek will perform a limited and brief physical examination on you to grade the varicocele and to be sure that you are a good candidate for the procedure. There are instances in which Dr. Turek is suspicious but not fully convinced that a varicocele is present. In this situation, he may ask that you plan to undergo a painless scrotal ultrasound to confirm its presence before treatment is given.

Dr. Turek will then discuss the options for varicocele treatment, their benefits and risks, so that you have a good idea of what it involves, the recovery afterward, when you can resume your normal activities and when you can expect relief from symptoms.

At the end of the visit, Dr. Turek will provide you with an information packet that provides additional detailed information for you to review.

If, after meeting with Dr. Turek, you would like to have him do the procedure, you can either schedule your appointment before you leave that day or contact us at 415-392-3200 when you decide to have it in the future.

We would like you to ask questions at this visit or afterwards to ensure that you are completely comfortable with what is planned.

Pre-Procedure Checklist

1. Eat normally the night before surgery, but follow the directions that anesthesia recommends for the morning of surgery. If no specific directions are given, withhold all food and drink after midnight and on the morning of surgery.

2. Do not take any aspirin, or any medications containing ibuprofen (Advil, Motrin, Aleve) at least 10 days prior to the procedure, as these medications have a side effect that can reduce platelet function and therefore lower blood clotting ability.

3. Someone will need to drive you home or to your hotel after the procedure, following your recovery from the procedure. Buy some frozen peas or mixed vegetable bags from the grocery to use as a cold "sandbag" to the area after the procedure.

Post-Procedure Checklist

Please call Dr. Turek's nurse Paula at 415-392-3200 to schedule an appointment to see Dr. Turek in 1-2 weeks for a quick postoperative check if you are in town.

Diet

Regarding diet, start with clear liquids or something light and then progress to your normal diet.

Activity

You should rest for the first 24 hours following the procedure to lessen the chance of swelling. Avoid strenuous exercise (including sex) or heavy lifting for 5 days. After that, you can do all of your normal activities, but at the start, let discomfort be your guide: if it feels uncomfortable, slow down.

Apply ice packs (frozen peas or mixed vegetables work well) to the groin area over the covered area for 24 hours to help with swelling.

Wound care

Shower daily. In 48 hours, remove the outer, clear dressing and gauze just prior to showering. Steri-strips will remain and will curl up and fall off in 7-10 days.

Medications

Take your prescribed pain medicine, usually Vicodin, for moderate discomfort. Always take the Vicodin with food in your stomach, so that you do not get nauseated. You can take Tylenol or Ibuprofen for mild discomfort.

After Anesthesia

Do not make important decisions until the next day as some anesthetics have a delayed metabolism and can interfere with the ability to perform these tasks.

Avoid alcoholic beverages for 24 hours.

Do not drive or operate heavy machinery for 24 hours.

Do not eat any heavy or large meals until the next day, as a heavy meal may be difficult to digest. Spicy and greasy foods should be avoided.

Problems to Report

Problems you should report to your doctor if they occur:

1. Fever > 101°? F, shaking and chills.

2. Nausea and vomiting.

3. Expect a small amount of bloody discharge from the incisions. However, call if it continues and the incision site becomes red, painful or separates.

4. Drug reactions such as hives, rash, nausea or vomiting.

5. You may get black and blue in the scrotum and on the penis. If the amount of swelling concerns you, please call the office.

Pain After Varicocele Repair

Although scrotal pain can be complex, in well-selected patients who undergo varicocele repair for pain, approximately 80% will have complete resolution of the pain in Dr. Turek's hands. Fertility outcomes for varicocele treatment are even more complex, since fertility depends not only on the male partner but also the female partner. However, with Dr. Turek's procedure, pregnancy rates after varicocele treatment are generally double that (30-35% at 18 months) found if the varicocele were not treated (15%) at all. Approximately 65-70% of men will have a doubling of the total moving sperm count in the ejaculate (total motile count = sperm concentration x fraction moving x ejaculate volume) after their surgery. In addition, the average time to conceive after Dr. Turek's procedure is 7-8 months; indeed, among couples who will conceive after the procedure, 90% of couples will have done so within 1 year.

Other Instructions

If you have any further questions please call the surgery center at 415-393-9600 or Paula at 415-392-3200. For evening/weekends please call 415-392-3200.

• Contact Dr. Turek