Varicocele Surgery and Hydrocele post surgery

[Its Maui]

Hi all,

I've done a search on here with no results. Does having a varicocele affect the Class 1 in any way? Had a swelling for a while, had a check-up, ultrasound and Doctor recommends surgery to remove blockage and drain the varicocele. Doctor also mentioned a hydrocele can develop post surgery and will need to be drained. Will contact local AME but also interested in other opinions on here too.

Thanks.

[AngioJet]

Based on CAA(UK) guidance, the presence of a varicocele or hydrocele does not seem to be disqualifying. However, there is no specific guidance on these conditions which makes it harder to asses.

Moreover, which operation does your doctor recommend you have done for your varicocele? You can't really 'drain' a varicocele, you could have an open operation where an incision is made around the base of the scrotum and the vein that supplies the side of the scrotum in question is ligated (tied off). This is a relatively minor procedure that (barring any complications) looking at the CAA guidance, would possibly incur a shorter period of unfitness postoperatively but once assessed as fit again by your AME, should probably mean relatively rapid reinstatement of your fitness to hold a Class 1.

The other treatment option which I would imagine is more commonly done nowadays, is so-called embolisation, where little metallic 'coils' are inserted into the vein that drains the left side of the scrotum (which is the affected side in the vast majority of cases). This is done to obliterate the vein and thus reduce the swelling caused by the varicocele. The procedure is done under local anaesthesia on a day-case basis and I would imagine that if well postoperatively, fitness to fly would not be affected beyond the first few days. However, I cannot seem to find anything about this type of procedure in the CAA guidance material so I would suggest getting in touch with your AME.

[Radgirl]

Tell (email) your AME in advance. I suspect he will tell you how long you are grounded and simply ask for the summary from your consultant. You will be sore but depends on the size of the hydrocele.

Open procedure every time. Both can be done awake or anaesthetised. Success rate the same with both. Embolisation needs X rays, contrast (allergic reaction!) and the risk of the agent going elsewhere. Dont use a hammer to crack a nut as they say.

[Its Maui]

Many thanks for the info, it doesn't appear to be a major surgery. Will contact my AME and report back for anyone else interested.

[AngioJet]

Tell (email) your AME in advance. I suspect he will tell you how long you are grounded and simply ask for the summary from your consultant. You will be sore but depends on the size of the hydrocele.

Open procedure every time. Both can be done awake or anaesthetised. Success rate the same with both. Embolisation needs X rays, contrast (allergic reaction!) and the risk of the agent going elsewhere. Dont use a hammer to crack a nut as they say.

I think there are more evidence-based tools for making an informed decision with regards to which method of treatment to choose.

To the OP, good luck! Do let us know what the aeromedical outcome is once you've had the procedure done!

[Radgirl]

Aha Angiojet, I suspect from your handle that you have a vested interest in the radiological option. I merely sit on the fence, being neither a surgeon nor radiologist

You are of course welcome to educate both OP and myself. I have observed the surgical procedure for decades with never an issue, so I would need to see some good reasons for advising a newer procedure. Also, I dont know where you are based, but where I am it would not be available locally and unless OP wanted to be wide awake, any sedation or anaesthesia would be a hassle to arrange.

But open to correction!

[obgraham]

I've no ball in this game either (!), except that varicocele is an occasional cause of male infertility. After my initial lab testing, off he'd go to my neighborhood urologist.

I'm a bit with Radgirl here: never saw it be a major issue, the guys didn't moan any more than usual, and we frequently got our desired result. I'd be surprised if the aviation folks made more of varicocele/hydrocele than just a postop recovery time.

I'm not surprised, though, that high tech gets involved now, especially with recent reports of the decline in sperm counts these days.

[AngioJet]

Aha Angiojet, I suspect from your handle that you have a vested interest in the radiological option. I merely sit on the fence, being neither a surgeon nor radiologist

You are of course welcome to educate both OP and myself. I have observed the surgical procedure for decades with never an issue, so I would need to see some good reasons for advising a newer procedure. Also, I dont know where you are based, but where I am it would not be available locally and unless OP wanted to be wide awake, any sedation or anaesthesia would be a hassle to arrange.

But open to correction!

I think the scientific community is still out on which of the two options provides the best reduction in symptoms while offering the least risk of complications. TBH, I don't have a strong opinion on the matter either. However, given that the OP and most readers of these posts will be non-medics, I would be a bit more hesitant making recommendations, especially if available practice guidelines aren't 100% clear on the matter.

Finally, just to clarify, varicocele embolisation is usually done in LA only, with a smidgeon of midazolam as required. Works a treat...

[Radgirl]

Thanks obgraham and Angiojet

This forum should be for pilots asking questions, not us lot having our usual ready room banter but I did do a search before posting and the outcome was the same for both procedures, but little data on downside with embolisation. The punters need our advice and we cant tell them we cant advise because the guidelines are unclear.....

In most countries 'a smidgeon of midazolam' needs an anaesthetist and in many countries organising this in radiology is a nightmare. In the US many surgeons and radiologists give their own sedation or leave it to a nurse or technician. We dont allow that elsewhere for very good reasons. So location plays a part! although in Maui it would not be an issue!

For any pilots still following this, it is a good example of the adage

ask 2 doctors and you get 3 opinions

and underlines the fact that this site can only give general advice and can never replace a face to face with your own doctor!

[AngioJet]

I think you are contradicting yourself. Your last paragraph is sensible but therefore, I don't think your first paragraph makes sense ('The punters need our advice and we cant tell them we cant advise because the guidelines are unclear.....').

Moreover, I can't see the reason for your preoccupation with the form of sedation/anaesthesia available. I'm sure either procedure (open or endo) will be done in the best way possible depending on where the OP will be treated.

You are not the only medically qualified person giving advice on these boards and there is no need to be contrary just for the sake. Like you said, ask two doctors and get three opinions, and your opinion is not the correct one by default.

[Radgirl]

It is not contrary to give an opinion. And no doctor should ever claim their opinion is the CORRECT one. By definition it is an opinion, not a fact. Other doctors may well give other opinions. I respect yours.

[Its Maui]

Just a follow up to help others in the future.

Had a full general anesthetic and was home that night after the surgery to repair the hydrocele. Off work for about five days in total. My AME just wanted the report from before and after and that was that. And at my Class 1 renewal recently; it wasn't even brought up in conversation. So very much a non-event.

Also, for info; it is pretty much a non-issue in China as well...