永尾光一(東邦大学泌尿器科教授 リプロダクションセンター長)

Supervising doctor on this page

Koichi Nagao
(Professor, Department of Urology, Toho University, Director of Reproduction Center)


At our clinic, we perform about 1,000 cases of varicocele surgery annually. In addition, Dr. Nagao, who is the main operator at this clinic, has been operating on varicocele for more than 20 years by the Nagao method, and the number of operations is more than 9,000.

Please also check the special page for One-day microsurgical low ligation varicocelectomy surgery.

At our clinic, we perform varicocele surgery by the Nagao method (own expence).

Varicocelesurgery has been covered by insurance since 2018, and the number of patients undergoing surgery is increasing.
Since the Nagao method leaves everything necessary, there are almost no functional deterioration or complications compared to general surgery, and the improvement of semen findings is as high as 87% (* 1).
If you are suffering from male infertility, please consider varicocele surgery using the Nagao method developed by Professor Nagao of Toho University.

(* 1 Data source: Nagao K, Nakajima K: One day microsurgical varicocelectomy under local anesthesia. International Federation of Fertility (IFFS) / Japan Society for Reproductive Medicine (JSRM) International Meeting 2015 * (Symposium) *, Yokohama, 2015 4)

Microsurgical low ligation varicocelectomy requires advanced microsurgery techniques.
Professor Nagao of Toho University, who developed the Nagao Method, has been performing microsurgery ever since he became a doctor.

The Nagao method carefully separates and confirms blood vessels, lymph vessels, and nerves from spermatic cord and external spermatic cord one by one, and ligates only the reflux vein.

Surgery depends on the skill of the surgeon, so there are many places where it is easier to perform.
For example, some surgeons secure one vas deferens and one artery and ligate the other tissues at once.
Some surgeons are hoping that the testicles will not be necrotic.

However, it is not good to perform surgery for the purpose of improving testicular function because it ligates the remaining arteries, nerves, and lymph vessels.

High-level ligation under the microscope is recommended for medical interns who are not microsurgeons that are not well trained in microsurgery.
The high position means the high position of the body, and the veins are thicker and smaller in number as they go up the body, so the procedure is gentle and there is a bypass artery even if the artery is damaged.

Surgical Overview

Introducing the overview of one-day microsurgical low ligation varicocelectomy・Nagao method.

Before Surgery

At the time of examination

We will ask you about your wife’s age and history of fertility treatment.
We will ask you about your medical history, oral medication, and whether you have any allergies.

The size of the scrotum, the presence of vas deferens, and the presence of inflammation of the epididymis are examined.

Echo examination
Check the condition in the testicles. (Presence of calcification and testicular cancer, etc.)
Measure the diameter of the vein on each side.
It also measures the presence and degree of regurgitation in the veins.

Day of Surgery

Please shave and come to the clinic.
Meals must be completed at least 3 hours before the appointment for your visit.

After Surgery

You can take a shower from the next day. In gynecological treatment, if you want to match your wife’s timing, you can also collect semen. (*)
After a week, you can have light exercise and sexual intercourse.
After 2 weeks, muscle training is also possible.
Gynecological treatment is also available after 2 months.

* If there is a varicocele, sperm genes (chromosomes / DNA) will be damaged, so gynecological treatment is recommended from the second month. When semen improves, the pregnancy rate and childbirth rate increase and the number of miscarriage and malformed children decreases by all methods such as microinsemination, in vitro fertilization, artificial insemination, and natural (timing). Also, during this time, it is okay to go if it is natural (timing).

Pain during and after surgery

Pain during surgery

With anesthesia, there is pain only on the first stab of the needle. The Nagao method anesthesia method is a uniquely developed 7-step anesthesia method that combines two types of anesthesia, one with a long action time and the other with a short action time. Add an anesthetic little by little to the area where pain is expected, and perform surgery with a narrower range of peeling.
From the age of 13, it has become possible to perform surgery with this method with almost no pain.

Pain after surgery

There are individual differences in postoperative pain. We prescribe loxonin in case of pain, but from those who did not feel any pain and did not take a single tablet says, it hurt for 2 to 3 days, but it was not unbearable after the operation. Each patient has their own pain.

Is Nagao Method operable within insurance coverage?

The microsurgical low ligation varicocelectomy ・Nagao method is different from normal surgery and require very advanced techniques. It is an operation called Supermicro Surgery, which can be performed only by doctors who have skills in the field of ultramicrosurgery and have further training. Currently, there are only a few doctors who can perform this operation in our clinic. Due to the extremely advanced procedure, the number of doctors who can perform this operation is limited, so we perform this operation at your own expense.

About one-day microsurgical low ligation varicocelectomy・Nagao method

Superiority of Nagao Method

The Nagao method performed at this clinic checks the vas deferens, arteries, lymph vessels, nerves, and bad regurgitation veins one by one, and the most important arteries are checked with a Doppler blood flow meter, and the important ones are left. It is a technically advanced operation that leaves everything and ligates only the bad regurgitation veins. It stops all bad regurgitation veins and leaves everything important, so there is no blood flow obstruction or lymphedema. The risk of recurrence is also the lowest at 0.5%.
These records are kept in detail during the operation and given to the patient.

In addition, the 6-step local anesthesia method that predicts the pain site in advance causes almost no pain other than injection pain.
Furthermore, since the spermatic cord reaches under the microscope, the peeling range (scratch range) is narrow, there is less postoperative pain, and you can return to normal life from the next day.
If you wish, you can watch the surgery on the monitor.

View the surgery on a monitor.
* These are images of the affected area during surgery, so please view them with care.

Differences from commonly performed surgery (lump-sum ligation method / time saving method)

Surgery that is commonly performed is surgery that leaves one or two vas deferens and arteries then connects all others together. Among the tied things are several important arteries, lymph vessels and nerves.

For example, if the commonly used bundled ligation method is applied to this case, 6 out of 7 arteries will be ligated and blood flow may deteriorate. It also ligates 9 lymphatic vessels, causing swelling. Furthermore, simply stopping all the regurgitation veins with strong regurgitation pressure with a single thread will easily loosen and increase the risk of recurrence.

View the pattern of the affected area after surgery.
*This is an image of the affected area after surgery, so please view it with caution.

Effect of one-day microsurgical low ligation varicocelectomy・Nagao method



Surgery fee
US$11,000(one side)
Medical certificate

(tax included)


Frequently Asked Questions about One-day Microsurgical low ligation Varicocelectomy Surgery・Nagao method

  • Is the one-day microsurgical low ligation varicocelectomy・Nagao method painful?

    Local anesthesia uses a fine needle (intradermal needle) and there will some pain in the injection, but long-acting and short-acting local anesthetics are used, and the 7-step local anesthesia method causes almost no pain.
    Since establishing this anesthesia method, even junior high school students have been performing day surgery without pain.
    Some patients are listening to music or emailing on their smartphones during surgery.
    You can walk home immediately after surgery.
    Postoperative pain can be controlled by taking painkillers.

  • Is Varicocele Related to Male Infertility?

    It is stated in the guidelines of the world including Europe and the United States that it is closely related to male infertility.
    The testicles function when the temperature of the testicles is 2-3 degrees lower than the body temperature. If the varicocele is left untreated, the testicular function (the function of making sperm and androgens) will deteriorate.

  • How to prepare for surgery and manage after surgery?

    Infectious disease blood sampling is performed as a preoperative examination.
    Shave your pubic hair yourself with an electric shaver the day before surgery.
    * When shaving in the clinic, an electric shaver with a disposable head is used, so an additional cost will be charged.
    The skin is sewn from the back side of the skin with a meltable thread, so the thread will not be removed.
    On the day of surgery, gauze is used to press the wound to prevent internal bleeding, so wipe the genital area. Hair wash is okay.
    Since the medical vinyl tape is attached to the wound, you can use the shower from the next day.
    Semen collection starts the next day, sexual intercourse starts one week later, and bathing and drinking starts after the wound is completely dry.
    Wear briefs and a towel inside for a week to prevent the scrotum from moving around (preventing internal bleeding).


永尾 光一 先生

永尾 光一 先生

東邦大学 医学部教授(泌尿器科学講座)
東邦大学医療センター大森病院 リプロダクションセンター
東邦大学医療センター大森病院 尿路再建(泌尿器科・形成外科)センター長