Duration of preoperative scrotal pain may predict the success of microsurgical varicocelectomy

Abstract

Purpose: Varicocelectomy is used in the treatment of scrotal pain. We report our results with microsurgical subinguinal varicocele ligation to treat pain. Materials and Methods: A total of 284 men underwent subinguinal microsurgical varicocele ligation for scrotal pain. All patients were asked to return for a follow-up evaluation 3 months after surgery, which included a physical examination, as well as questions on pain severity, number of days required before their return to work and development of any postoperative complications. Results: Median patient age at the time of varicocele ligation was 23.7 years (range 16-38 years). The average duration of pain before presentation was 11.2 months (range 1 month to 40 months). In 85.6% patients there was complete resolution of pain and 6.3% had partial resolution. Pain persisted postoperatively in 19 cases (8.1%). There were statistically nonsignificant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had long period and those who had short period of pain. Conclusions: Sub-inguinal microsurgical varicocele ligation is an effective treatment for painful varicocele. The duration of pain preoperatively may predict outcomes in selected patients.

The Evaluation of the Effect of TENS Therapy on Reducing Acute and Chronic Pain Following Varicocelectomy

“…Varicocelectomy is one of the effective approaches for the treatment of varicocele and is associated with significant implication on sperm parameters, but after surgery, pain is the most important concern due to somatic and emotional effects on human life [1] [2]. There are several pharmacologic and non-pharmacologic methods to control of postoperative pain.…”

“…Concluded that using TENS acts as an index of important and efficient postoperative pain after inguinal hernia operation without side effects and continuation of pain reduction until one month [2]. Matthew et al demonstrated that TENS may reduce postoperative phantom pain on movement and at rest [10].…”

“…It can entail limited movement, problems in working, patient dissatisfaction and unnecessary consumption of treatment resources and long stay in the hospital. Overall, history and prevalence of pain are unknown [2]. The prevalence of varicocele in normal population is 15% to 20% and in infertile men is 68% to 81% with 2% to 10% prevalence of pain.…”

Painful varicoceles: Role of varicocelectomy

“…Others did not find significant difference in varicocele grade between responders and non-responders. [7101116] In study by Chen et al . percentage of responders vs. non-responders in grade I, II, and III was 21.8% vs. 23.8%, 50.9% vs. 47.6%, and 27.3% vs. 28.6%, respectively.…”

Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction

“…Some studies have suggested that relief of pain after varicocele repair is independent of the type of pain (25), however, nearly all patients who had varicocele repair in this study had ''dull'' or ''throbbing'' pain prior to varicocelectomy. Other studies have related the relief of pain to the duration of pain; men with more chronic scrotal pain associated with varicocele are more likely to respond to surgical correction (25,26). Nearly every study recommends conservative measures (scrotal support, rest, etc) prior to consideration of varcicocelectomy.…”