Painful varicoceles: Role of varicocelectomy

Abstract

The incidence of varicocele in the general population is up to 15%. It is estimated that the prevalence of pain with varicoceles is around 2-10%. Till the year 2000, only two studies evaluated efficacy of varicocelectomy in painful varicoceles with conflicting results. Over the past decade many other studies have addressed this issue and reported on the treatment outcome and predictors of success. We critically appraised studies published from March 2000 to May 2013 evaluating surgical management in painful varicoceles to provide an evidence based review of effectiveness of varicocelectomy in relieving pain in patients with symptomatic painful varicoceles. The association between varicoceles and pain is not clearly established. Conservative treatment is warranted as the first line of treatment in men with painful clinical varicoceles. In carefully selected men with clinically palpable varicoceles and associated characteristic chronic dull ache, dragging or throbbing pain who do not respond to conservative therapy, varicocelectomy is warranted and is associated with approximately 80% success. However, surgical success does not always translate into resolution of pain and pain might persist even when no varicoceles are detected postoperatively.

The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired?

“…We have outlined how varicoceles may be toxic to the testis, which could result in size difference, abnormal SA, or infertility Although it has been hypothesized that the varicocele adds weight to the scrotum causing tension on the spermatic cord leading to chronic, dull, aching testicular pain, the mechanism linking varicocele and testicular pain has yet to be elucidated 21 .…”

How Can We Predict a Successful Outcome after Varicocelectomy in Painful Varicocele Patients? An Updated Meta-Analysis

“…Although one study grouped dull and dragging pain [13], and another study grouped dull and throbbing pain in the same category [15], most studies have shown www.wjmh.org a higher likelihood of pain resolution after surgery in varicocele patients complaining of preoperative dull pain than in those with other qualities of pain [7,14,16,17]. In line with these studies, some reviews and meta-analysis reported that the postoperative pain resolution rate was significantly higher when dull pain was experienced preoperatively [3,9,13]. The reason for the higher likelihood of postoperative pain resolution in patients with dull pain remains unclear.…”

The association between varicocoeles and vascular disease: an analysis of U.S. claims data

“…The current surgical management of varicocoeles is largely focused on preventing or treating male infertility (Schlegel, 2012;Choi & Kim, 2013), with treatment of refractory orchialgia as a less common indication (Abrol et al, 2014). However for men without future reproductive intent, the absence of pain often leads to expectant management of varicocoeles rather than surgical repair although varicocoeles are recognized as progressive lesions (World Health Organization, 1992;Witt & Lipshultz, 1993).…”