Introduction: Varicocele is found in up to 15-20% of young males.
Although asymptomatic in most cases, it can present with pain, infertility,
testicular atrophy, or visible swelling. Despite, some studies supporting the
role of varicocelectomy in pain relief, current guidelines do not mention pain
as an indication for surgery. Therefore, the application of varicocelectomy in
pain relief remains somewhat controversial.
Aim: The aim of the study is to analyze the characteristics of
pain in patients with varicocele and the outcome of varicocelectomy surgeries
on pain perception.
Patient and Methods: In a 14-month period, 36 consecutive patients
with pain secondary to varicocele were prospectively enrolled in this study and
underwent varicocelectomy. History, physical exam, detailed explanation and
scoring of pain, scrotal ultrasound, and semen analysis were evaluated before
and after surgery. Pain details were assessed through a patient questionnaire
which included questions about the type of pain, its location, and exacerbating
and relieving factors. The severity of pain was then scored by patients based
on an analog numerical scale that corresponded to their level of pain.
Varicocele grading was performed based on the World Health Organization (WHO)
grading scale for varicoceles. Patients were followed for one year after
surgery.
Results: Thirty of 36 patients completed the study with
appropriate follow-up visits. Patients were 17- to 34-years-old (mean 24.5±4).
In 57% of patients, pain was the only presenting symptom. Pain was described as
sharp in 11 (36%), burning in 5 (17%), dull in 4 (13%), and vague and hard to
explain in 10 patients (33%). Pain most commonly was experienced in scrotum,
inguinal, and lower abdominal area. After surgery, 12 patients (40%) had
complete relief of pain. Seven patients (23%) had significant relief; seven
patients (23%) had moderate relief. Overall, 26 patients (87%) had moderate
(more than 50%) to complete pain relief (P<0.005). Four patients had minimal
or no improvement in pain after surgery.
Conclusion: Pain related to varicocele is mainly experienced in
the scrotum, inguinal, and lower abdominal area. Varicocelectomy completely or
significantly resolves the pain in up to 86% of patients.
Limitations: This prospective study has some limitations,
including a small sample size and lack of representation across multiple
institutions, both of which limit generalizability. Moreover, the subjective
nature of pain makes analyzing the benefit of varicocelectomy less consistent
among patients. Finally, the association between varicocele grade and severity of
pain was not investigated.
Author
(s) Details
Majid
Mirzazadeh
Department of Urology, Wake Forest School of Medicine,
Winston-Salem, USA.
Rasadokht
Forati
Harvard Medical School, Boston, Massachusetts, USA.
Fernandino
Vilson
Division of Urologic Surgery, Washington University in St. Louis,
Saint Louis, Missouri, USA.
Marc
Colaco
Department of Urology, Wake Forest School of Medicine,
Winston-Salem, USA.
Please see the book here: https://doi.org/10.9734/bpi/mmrnp/v6/1229
