Microsurgical varicocelectomy for recurrent or persistent varicoceles associated with orchalgia

Chawla, Ashis; Kulkarni, Girish S.; Kamal, Khaled; Zini, Armand

doi:10.1016/j.urology.2005.05.052

Cited by 38 publications

(23 citation statements)

References 12 publications

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“…The discomfort resolved completely after varicocelectomy. This relief was reported by other investigators [40–42]. However, we do not think that such discomfort could affect sexual activity.…”

Section: Discussionsupporting

confidence: 84%

Does Varicocelectomy Improve Gonadal Function in Men with Hypogonadism and Infertility? Analysis of a Prospective Study

Srini

Veerachari

2011

International Journal of Endocrinology

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Varicocele in infertile males is associated with Leydig cell dysfunction and hypogonadism. The effect of varicocelectomy on serum testosterone level is not yet established. We analysed 200 heterosexual infertile men diagnosed to have clinical varicocele they were divided into two groups: group 1 (100 men) had microsurgical varicocelectomy, and group 2 (100 patients) underwent assisted reproduction procedures. All participants had semen analysis, serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and total testosterone (TT), measured both at recruitment time and 6 months later. In group 1, the mean TT level increased significantly after varicocelectomy (1.644 ± 0.029 to 2.461 ± 0.0198 ng/dL, P < 0.0001) and testicular size correlated with the mean change in TT (P = 0.001). No similar change was found in group 2. Out of the 100 patients in group 1, 78 had postoperative normalization of TT unlike only 16 men in group 2.

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Section: Discussionsupporting

confidence: 84%

Does Varicocelectomy Improve Gonadal Function in Men with Hypogonadism and Infertility? Analysis of a Prospective Study

Srini

Veerachari

2011

International Journal of Endocrinology

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“…In attempt to improve the surgical outcome, several factors have been investigated in the literature to predict success in pain relief after surgery. These included varicocele grade (8-13), pain quality and intensity (8,10-13), duration of pain (8,10-13), varicocele recurrence (11,12,14), external spermatic vein ligation (5,15), method of varicocele ligation (11,15-17), body mass index (8,10,12), and semen quality, pH and volume (10). While the extent of intraoperative vein ligation was sparsely evaluated in terms of its influence on semen parameter results postoperatively, this study is the first of its kind to explore the influence of the number of veins ligated during microsurgical subinguinal varicocelectomy on pain relief.…”

Section: Introductionmentioning

confidence: 99%

Does the number of veins ligated during microsurgical subinguinal varicocelectomy impact improvement in pain post-surgery?

Elbardisi

Agarwal

Majzoub

et al. 2017

Transl. Androl. Urol.

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BackgroundWe examined the impact of the number of veins ligated during varicocelectomy on post-surgical improvement of pain in a group of men presenting with clinical varicocele and pain as an indication for surgery.MethodsThis is a retrospective study of patients presenting with clinical left varicocele to the male infertility unit at a teaching hospital in Qatar. Files of all patients who underwent sub-inguinal microsurgical varicocelectomy were retrieved and categorized into three groups indicating the number of spermatic veins ligated during varicocelectomy. The presence of pain was assessed during pre- and post-operation (at 3 and 6 months). Statistical analysis was performed using Kruskal-Wallis test (K) and Chi-square test (C).ResultsOut of 675 records, 207 (30.7%) patients did left varicocelectomy for pain. Their mean age was 35.3±9.2 years. Pain was assessed in 106/207 (51.2%) patients post operatively, of whom 89 (84%) reported complete resolution of symptoms. This improvement was maintained irrespective of the number of veins ligated during surgery (<5 veins: 90.0%, 5–10 veins: 81.5%, and >10 veins: 85.7%).ConclusionsMicrosurgical subinguinal varicocelectomy is a valid treatment method for patients with a symptomatic clinical varicocele. While a significant post-surgical (at 6 months) reduction of pain was detected, the number of veins ligated intraoperatively was not predictive of post-operative improvement of pain in this study population.

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“…It has been reported that varicocele recurrence generally results from incomplete ligation of collateral veins,2 and that magnification of the spermatic vessels by operating microscope reduces the possibility of such complications 15. Levine, et al16 also reported that complete dissection of the spermatic cord using operative microscope might be effective for chronic scrotal pain because that procedure might result in partial denervation of the testis.…”

Section: Discussionmentioning

confidence: 99%

“…Also, varicocele is associated with chronic scrotal pain, but this relationship has been less widely investigated 2. It is evaluated that the prevalence of painful varicoceles is 2-10%.…”

Section: Introductionmentioning

confidence: 99%

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

2012

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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.

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Microsurgical varicocelectomy for recurrent or persistent varicoceles associated with orchalgia

Cited by 38 publications

References 12 publications

Does Varicocelectomy Improve Gonadal Function in Men with Hypogonadism and Infertility? Analysis of a Prospective Study

Does Varicocelectomy Improve Gonadal Function in Men with Hypogonadism and Infertility? Analysis of a Prospective Study

Does the number of veins ligated during microsurgical subinguinal varicocelectomy impact improvement in pain post-surgery?

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

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