Microsurgical Ligation for Painful Varicocele: Effectiveness and Predictors of Pain Resolution

Abstract

PurposeWe evaluated the effectiveness of microsurgical ligation for painful varicocele and predictive factors of pain resolution.Materials and MethodsBetween January 2006 and March 2009, a total of 114 patients (mean age, 30.2±8.9 years), who underwent microsurgical inguinal varicocelectomy for painful varicocele, were included and followed up for 1 year after the surgery. The quantity of preoperative and postoperative pain was assessed by means of 11-point numeric rating scale (NRS). We retrospectively analyzed the outcome of surgical ligation and predictive factors of pain resolution using patient age, height, weight, body mass index, grade and location of varicocele, duration, quantity and quality (dull, dragging, aching) of pain, and postoperative pain resolution.ResultsIn 104 patients (91.2%), complete or marked resolution of pain was reported at follow-up 1 year after surgery. Only 10 patients (8.8%) had recurrent or persistent pain (≥3 points in NRS scores). On multivariate analysis, low quantity (≤6 points in NRS scores) and dull or dragging natured preoperative pain were independent factors associated with surgical success rates (p=0.004; odds ratio=1.62, p=0.012; odds ratio=1.76, respectively).ConclusionMicrosurgical ligation is an effective treatment of painful varicocele. The quantity and quality of preoperative pain are independent predictive factors of pain resolution after surgery.

Scrotal pain: Evaluation and management

“…The study showed resolution of pain postoperatively in 86% and partial resolution in 1 patient, whereas 4 patients (11%) had persistent or worsened symptoms [ 50 ]. A more recent study conducted by Kim et al [ 55 ] reported that 91.2% had complete or marked resolution of pain at a 1-year follow-up. The authors used microsurgical inguinal varicocelectomy, with 8.8% of patients having recurrent pain and 0.8% having recurrence.…”

Preoperative Predictors of Varicocelectomy Success in the Treatment of Testicular Pain

“…To better elucidate their relationship, follow-up studies including a larger patient population are needed. Additionally, dull pain has been reported to have a significant association with the successful resolution of pain compared with sharp pain 3,7,13. However, another study did not show a significant difference with respect to the type of pain 6,8.…”

Microsurgical varicocelectomy: a review

“…Reported success rates vary between 50% and 90%, depending on the definition used. [46][47][48][49] Varicocele grade, 47 preoperative duration of pain 49 and quality of pain 46 have been found to be predictors of postvaricocelectomy pain resolution in different series.…”