Marmar Surgery
Marmar Surgery – is a microsurgical intervention aimed at treating Varicocele. Recommended as the safest and most effective procedure by the European and American Urological Associations. In this article we will describe in detail the nature of surgical intervention for our patients and will cover frequently asked questions.
Varicocele and infertility
What is behind this dry quote and all the numbers? Often it is a young married couple longing to start a family but not succeeding. In over half of the cases the husband undergoes semen analysis only after their wife has been thoroughly checked: checks range from endless hormonal profile tests to diagnostic laparoscopy. It can be even worse when the husband already has children from a previous marriage and the “fault” of infertility is firmly placed on the woman. Meanwhile…”80% of secondary infertility cases can be attributed to varicocele”. Having children in the previous relationship is not a guarantee against infertility.

One might wonder why for decades the medical professionals have stressed the importance of investigating both partners. Clear indication guidelines have been developed for varicocele and it is now very clear that the best and safest way to treat varicocele is the Marmar surgery. But things haven’t budged an inch. In line with an idiotic “tradition” a couple’s infertility it is still considered to be entirely the woman’s “fault”. She is the one left feeling inadequate and is the first to be subjected to multiple and often unnecessary and expensive tests.
Who needs a varicocele operation?
When we say that in our work we are guided by the European Urology Association it is not just us showing off. It is first and foremost the safety of our patients. These recommendations are based on many years of research and have a very strong evidence basis. Should we be “dragging” any man with some testicular vein dilation into the operating theatre? Surely not every single one. There are strict indication guidelines for surgical intervention as well as risk and possible benefits assessment.
MEN WITH NORMAL SEMEN RESULTS SHOULD NOT UNDERGO SURGICAL INTERVENTION

What type of varicocele surgery to choose?
A young patients sits before me. In his hands is a folder with structured data and copied questions. I am not the first doctor he is seeing.
- Doctor, I do understand. You and the other doctors based on the data available have convinced me that I need varicocele surgery. But I have been to see seven doctors and every single one of them praised their own method. Please understand my position, I have no medical training and I am simply trying to understand why Marmar surgery? I have been offered vein hardening procedure in one place and laparoscopic varicocele procedure in two other places. Are you suggesting microsurgery because you are unable to perform a laparoscopy?
-Let’s sort this out. I have two answers to your question. Firstly Marmar microsurgical procedure is recommended by the European and American Urological Associations as the most effective and safest for the patient. Secondly despite being a laparoscopic surgeon I do not perform laparoscopic surgery for treatment of varicocele based on principle.
- But why? It is progress, a new method.
- Simple reasons: Your safety and effectiveness of surgical intervention. Look, laparoscopy for varicocele treatment requires general anaesthesia, carries a potential risk of abdominal organ damage, requires 2-3 days of hospitalisation and has a varicocele relapse rate of 17 to 30% based on various data sources
- Ok I see…
- The only reason for laparoscopic surgery for varicocele is doing it together with another operation. For example if the patient presents with a hernia or gallbladder stones and varicocele is a co-existing condition. In cases like this the risks are justified.
Marmar surgery as Varicocele treatment
The point of the Marmar operation is to tighten up the pathologically widened veins of the testicle. Why it needs to be done is explained in detail in this article “Varicocele”
Technically the Marmar method demands that the surgeon performing the procedure has mastered microsurgical procedures and have at their disposal a good pair of magnifying 4x or 5x glasses.
Usually the operation is performed under spinal anaesthesia but the patient can opt for general anaesthesia. In any case the patient can go home the following day and go back to work the day after.
Minimal incision size of 1,0 – 1,5 cm guarantees no pain after surgery.
Although the main advantage of Marmar surgery is the highest number of pregnancies occurring following the operation compared to other types of surgeries.
THE HIGHEST NUMBER OF PREGNANCIES HAS BEEN NOTED SPECIFICALLY FOLLOWING MARMAR SURGERY
Confessions of a medical heretic.

Marmar Surgery Complications
Marmar Surgery Complications
MARMAR SURGERY IS VIRTUALLY PAIN FREE
Recovery after Marmar surgery happens almost unnoticed. The patient is admitted for no longer than 24 hours. They may be discharge on the day following the operation and can go back to work the day after that. They may resume usual physical activity after 7 to 10 days after nearly invisible cosmetic stitches have been removed. 6 months after the surgery a second consultation with semen analysis takes place to assess the effectiveness of the surgery.
- We guarantee your safety by using modern and highest quality anaesthesia manufactured in Austria or France.
-We DO NOT USE low quality equivalents of any drug which significantly lowers the risk of any complications.
-Use of Karl Storz microsurgery microscope guarantees the integrity of the testicular artery for all my patients.
- Andrology surgical work placements in Austria and Italy together with over 500 Marmar operations ensure absence of complications.
- We DO NOT REFER our patients to unknown clinics for follow up and further treatment and provide outpatient follow up as well as inpatient treatment.
Professional approach: up to date diagnostic methods of male infertility causes.
Our Team: Specialised science based clinical andrology team.
Board of doctors specializing in infertility: Urologist/andrologist, thyroid specialist, reproductive health gynaecologist.
Our equipment: Karl Storz surgical microscope and KLS Martin microsurgery kits.
Comfort: no queueing or waiting for a consultation and premium inpatient facility.
Safety: Use of methods recommended by professional associations such as EAU and AAU.
Result: Elimination of testicular varicose veins and its complications.
We are also GCP certified, which confirms we provide the highest standards of diagnosis and treatment