Varicocelectomy to Treat Pain, and Predictors of Success: A Prospective Study

Abstract

Objective: We attempted to examine the success rate of varicocele ligation when performed for the treatment of pain and to evaluate all the predictor factors that may affect the resolution of pain. Patients and Methods: From January 2008 to January 2011, a total 152 patients presented with painful varicocele to our out-patient clinic. While waiting for surgery, 7 patients (4.6%) resolved their pain with conservative management and 145 patients underwent varicocelectomy due to failure. The first follow-up visit was after 1 week to check the wounds and 130 patients attended the second visit after 3 months. Follow-up evaluation included physical examination, questioning of pain severity (compared with preoperative pain severity), development of any postoperative complications, and color Doppler to study recurrence reflux. Results: During the study period, 145/397 (36.5%) patients underwent varicocelectomy for pain. Of the 145 men operated on for pain 130 (89.6%) were available for follow-up. A subinguinal approach was used in 93 patients (71.5%) and high ligation in 37(28.5%). Of the 130 patients contacted after surgery, 109 (83.8%) reported complete resolution of pain, 7 (5.4%) had partial resolution of pain and 14 did not show benefit from surgery. There was no association between varicocele grade, quality of pain, type of varicocele ligation, or recurrence and pain resolution after surgery, only the duration of pain seems to be a factor that is considerably associated with pain resolution. Conclusion: Varicocelectomy is a successful option for treatment of painful varicocele in selected patients. The duration of pain may predict outcomes in these patients.

Varicocele management for infertility and pain: A systematic review

“…In stratifying these collective data by surgical approach, the highest pain-free rates to date have been reported with the subinguinal microscopic approach ( Table 3 ). The inguinal and retroperitoneal approaches appear to be slightly less effective, with 75% and 76% of men reporting improvement in pain, respectively ( Table 3 [61] , [62] , [63] , [64] , [102] , [103] , [104] , [105] , [106] , [107] , [108] , [109] , [110] , [111] , [112] ). In summary, the data seem to suggest a robust improvement in orchidalgia in most carefully selected patients who have previously failed conservative management.…”

Microscopic subinguinal varicocelectomy for testicular pain: a retrospective study on outcomes and predictors of pain relief

“…Most patients (83.3%) reported complete resolution of pain. Only 16.7% experienced persistent pain, and none of them had recurrent varicocele, as examined using Doppler ultrasonography during follow-up, indicating that the primary cause of testicular pain was not varicocele and could be related to chronic orchialgia [ 6 ]. Microsurgical spermatic cord denervation has been described to treat chronic orchialgia; however, this procedure was not performed in the current study [ 15 ].…”

“…Varicocelectomy is usually indicated in patients with infertility, adolescents with testicular hypotrophy, and patients with persistent pain [ 4 ]. Approximately 2–10% of patients with varicocele complain of pain, mainly in the inguinal area or scrotum [ 5 ], which ranges from dull discomfort to sharp pain and may increase after standing, sitting, or physical exertion [ 6 ]. Conservative treatment of varicocele-associated pain, including nonsteroidal anti-inflammatory drugs, scrotal elevation, and limitation of physical activities, can be offered; however, these measures are only successful in a few patients [ 7 ].…”

Varicocele and Testicular Pain: A Review

“…The Scrotal approach had the difficulty of preserving the arterial supply of the testis, because the pampiniform plexus of veins encoils the testicular artery at the level of the scrotum. Various techniques for venous ligation to prevent retrograde flow within the internal spermatic veins have been developed, including retroperitoneal (Palomo), inguinal (Ivanissevich), subinguinal, and scrotal approaches [202122]. Additionally, these techniques have been augmented with laparoscopy, loupe magnification, and operating microscope for enhanced visualization.…”