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Huyghe E, Methorst C, Faix A. [Varicocele and male infertility]. Prog Urol 2023; 33:624-635. [PMID: 38012908 DOI: 10.1016/j.purol.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association française d'urologie (AFU) Comité d'andrologie et de médecine sexuelle (CAMS) recommendations. Since then, the literature has provided additional information. This review will comprehensively reassess current indications for the treatment of varicocele, and revisit contemporary issues in the light of current advances. METHODS Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023. RESULTS Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery. CONCLUSION Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.
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Affiliation(s)
- E Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; UMR DEFE, Inserm 1203, université de Toulouse, université de Montpellier, Toulouse, France.
| | - C Methorst
- Service de médecine de la reproduction, hôpital des Quatre Villes, Saint-Cloud, France
| | - A Faix
- Clinique Saint-Roch, 560, avenue du Colonel-Pavelet-dit-Villars, 34000 Montpellier, France
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2
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Kandemir E, Sezer A, Bozkurt M. Effect of physical activity level and occupation on resolution of pain after varicocelectomy: A prospective clinical study. Rev Int Androl 2023; 21:100372. [PMID: 37406593 DOI: 10.1016/j.androl.2023.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/22/2023] [Accepted: 02/09/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES Persistent scrotal pain after varicocelectomy is stressful for both surgeon and patient. The number of researches focusing on which patient will benefit more from the operation is increasing in the literature. In this prospective study, we aimed to investigate whether the patient's physical activity levels and occupations affect the success of varicocelectomy in terms of pain relief. MATERIALS AND METHODS The data of 176 patients who underwent subinguinal microscopic varicocelectomy were analyzed according to BMI, age, varicocele grade, laterality, duration of pain, testicular volume difference, quality of pain, level of physical activity, and profession. The International Physical Activity Questionnaire was used to evaluate the level of physical activity. Patients were grouped as inactive, moderately active, and active according to this scale. Visual analog scale (VAS) scores of the patients were recorded before and after the procedure. RESULTS 135 patients (76.7%) reported complete resolution of their pain. Partial resolution of pain was observed in 34 patients (19.3%). Seven patients (4%) complained of the same pain level. Univariate analysis showed that patient occupations and physical activity levels significantly affected the pain level (p=0.041, p=0.032, respectively). In the multivariate analysis, only physical activity levels of the patients were statistically significant in predicting the resolution of pain (p=0.024). CONCLUSIONS Patients with low physical activity levels who underwent microscopic varicocelectomy surgery are less likely to have postoperative pain.
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Affiliation(s)
- Emre Kandemir
- Karamanoglu Mehmetbey University, Faculty of Medicine, Department of Urology, İbrahim Oktem Str., 70100 Merkez/Karaman, Turkey.
| | - Ali Sezer
- Konya City Hospital, Clinic of Urology and Pediatric Urology, Adana Str. No: 135/1, 42020 Karatay/Konya, Turkey
| | - Muammer Bozkurt
- Basaksehir Cam and Sakura City Hospital, Clinic of Urology, Basaksehir Olympic Str., 34480 Basaksehir/İstanbul, Turkey
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3
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Lai CZ, Chen SJ, Huang CP, Chen HY, Tsai MY, Liu PL, Chen YH, Chen WC. Scrotal Pain after Varicocelectomy: A Narrative Review. Biomedicines 2023; 11:biomedicines11041070. [PMID: 37189688 DOI: 10.3390/biomedicines11041070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Varicocele is a frequently encountered urological disorder, which has a prevalence rate of 8 to 15% among healthy men. However, the incidence is higher in male patients with primary or secondary infertility, with up to 35 to 80% of varicocele cases occurring in this population. The clinical manifestations of varicocele typically include the presence of an asymptomatic mass that feels like a “bag of worms”, chronic scrotal pain, and infertility. Most patients with varicocele only undergo varicocelectomy after conservative treatments have failed. Unfortunately, some patients may still experience persistent scrotal pain due to a recurrence of varicocele, the development of hydrocele, neuralgia, referred pain, ureteral lesions, or nutcracker syndrome. Therefore, clinicians should consider these conditions as potential causes of postoperative scrotal pain, and take measures to address them. Several factors can assist in predicting surgical outcomes for patients with varicocele. Clinicians should consider these factors when deciding whether to perform surgery and what type of surgical intervention to use. By doing so, they can increase the likelihood of a successful surgical outcome and minimize the risk of complications such as postoperative scrotal pain.
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Affiliation(s)
- Chien-Zhi Lai
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Szu-Ju Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Chi-Ping Huang
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Huey-Yi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Ming-Yen Tsai
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan
- Kaohsiung Municipal Feng Shan Hospital (Under the Management of Chang Gung Medical Foundation), Kaohsiung 830025, Taiwan
| | - Po-Len Liu
- Department of Respiratory Therapy, College of Medicine, Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 404327, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
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4
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Al-Gadheeb A, El-Tholoth HS, Albalawi A, Althobity A, AlNumi M, Alafraa T, Jad A. Microscopic subinguinal varicocelectomy for testicular pain: a retrospective study on outcomes and predictors of pain relief. Basic Clin Androl 2021; 31:1. [PMID: 33413080 PMCID: PMC7788765 DOI: 10.1186/s12610-020-00119-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 2–10% of patients with varicocele complain of pain. Varicocelectomy for testicular pain is a surgical choice when conservative therapy fails to relieve the pain. Different variables have been reported as prognostic factors for pain relief following varicocele ligation. Moreover, the success rate of varicocelectomy for testicular pain has varied among studies. This retrospective study aimed to investigate the predictors and success rate of microscopic subinguinal varicocelectomy performed for the treatment of painful varicocele. Results Among the 132 patients, 83.3% reported pain relief. A significant association was identified between varicocelectomy for unilateral testicular pain and pain resolution (P < 0.0001); no other factors were predictors of pain relief. Conclusions Microscopic subinguinal varicocelectomy for testicular pain is an effective surgical alternative. Varicocelectomy for unilateral testicular pain may predict postoperative pain relief in appropriately selected patients.
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Affiliation(s)
- Abdullah Al-Gadheeb
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Hossam S El-Tholoth
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Albalawi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Mussa AlNumi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Tala Alafraa
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Amr Jad
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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5
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Methorst C, Akakpo W, Graziana JP, Ferretti L, Yiou R, Morel-Journel N, Terrier JE, Beley S, Carnicelli D, Hupertan V, Madec FX, Faix A, Marcelli F, Huyghe E. [Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Varicocele]. Prog Urol 2020; 31:119-130. [PMID: 33308982 DOI: 10.1016/j.purol.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022]
Abstract
The diagnosis of varicocele is clinical, carried out in supine and standing position and in Valsalva maneuver. Only clinical varicoceles have to be treated. A scrotal ultrasound with Doppler is generally performed as part of the infertile man's evaluation or in case of examination difficulties. The main indication for varicocele treatment is the adult man with clinical varicocele and abnormalities of sperm parameters, in a context of infertility of couple, with a partner having a satisfactory ovarian reserve and no cause of female infertility or a curable infertility cause. The decision to treat varicocele must therefore be taken after evaluation of the two partners of the couple. Adults with symptomatic varicocele and those with spermogram abnormalities may also be offered a cure for their varicocele even in the absence of a paternity plan, as well as adolescents with reduced testicular growth, an ipsilateral decrease testicular volume, or a size gradient between the 2 testes. The cure of varicocele can be carried out by surgery or by percutaneous embolization. Microsurgery (inguinal or subinguinal) offers lower rates of recurrence and complications than high surgical approaches (laparoscopic or not) and surgeries without magnification. It is therefore the reference surgical technique. Percutaneous retrograde embolization is a minimally invasive alternative to microsurgery offering satisfactory outcomes with rare and often benign complications. The cure for varicocele results in an improvement in sperm parameters and recent data seem to confirm that it increases the natural pregnancy rate. These results appear after a delay of 3 to 9 months (at least 1 to 2 cycles of spermatogenesis). When the sperm involvement was severe (azoospermia, severe oligospermia), the improvement of the spermogram allow (1) to avoid surgery testicular sperm extraction or (2) perform intrauterine insemination rather than ICSI.
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Affiliation(s)
- C Methorst
- Service d'urologie, CH des quatre villes, Saint-Cloud, France
| | - W Akakpo
- Service d'urologie, Hôpital universitaire de la Pitié Salpêtrière, Paris, France
| | - J P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - L Ferretti
- Service d'urologie, Hôpital d'instruction des armées Robert Picqué, Villenave-d'Ornon, France
| | - R Yiou
- Service d'urologie, CHU Henri Mondor, Créteil, France
| | | | - J E Terrier
- Hôpital privé de La Châtaignerie, Beaumont, France
| | - S Beley
- Service d'urologie, Hôpital américain, Paris, France
| | - D Carnicelli
- Service d'urologie, CHU Henri Mondor, Créteil, France
| | - V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - F X Madec
- Service d'urologie, Hôpital Foch, Suresnes, France
| | - A Faix
- 265, avenue des États du Languedoc, Montpellier
| | - F Marcelli
- Service d'urologie, CHRU de Lille, France
| | - E Huyghe
- Département d'urologie, Transplantation Rénale et Andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France.
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6
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Park JH, Pak K, Park NC, Park HJ. How Can We Predict a Successful Outcome after Varicocelectomy in Painful Varicocele Patients? An Updated Meta-Analysis. World J Mens Health 2019; 39:645-653. [PMID: 32009313 PMCID: PMC8443985 DOI: 10.5534/wjmh.190112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 11/15/2022] Open
Abstract
Purpose This study evaluated the relationships of varicocele characteristics and surgical methods with the pain resolution rate post-varicocelectomy. Materials and Methods A literature search was conducted using PubMed (MEDLINE) and Embase (1980 to December 2018). The keywords used for the search were “varicocele,” “varicocelectomy OR ligation OR repair,” and “pain OR painful.” Two authors independently reviewed the titles and abstracts of the retrieved articles. Studies were evaluated for eligibility, and those that fulfilled all of the inclusion criteria and none of the exclusion criteria were selected for full-text review. Results Fourteen studies were included in the analysis. There were no significant differences in the postoperative pain resolution rate with respect to varicocele grades I, II, and III. The resolution rate was significantly higher for dull pain than for dragging and sharp pain (odds ratio [OR], 5.73; 95% confidence interval [CI], 1.78–18.41; p=0.003 and OR, 8.72; 95% CI, 2.91–26.08; p=0.0001, respectively). In terms of the surgical approach, subinguinal ligation was significantly more effective in terms of pain resolution than high ligation (OR, 2.73; 95% CI, 1.54–4.85; p=0.0006). Microsurgical varicocelectomy showed a significantly higher likelihood of pain resolution than laparoscopic varicocelectomy (OR, 7.12; 95% CI, 3.78–13.44; p<0.0001). Conclusions Patients with varicocele complaining of dull pain preoperatively had a higher likelihood of postoperative pain resolution than those complaining of dragging or sharp pain. Furthermore, subinguinal ligation was more effective for pain resolution than high ligation, and microsurgical varicocelectomy showed better surgical outcomes than laparoscopic varicocelectomy.
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Affiliation(s)
- Jih Hoon Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.,Pusan National University Hospital Biomedical Research Institute, Busan, Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine, Pusan National University School of Medicine, Busan, Korea.,Pusan National University Hospital Biomedical Research Institute, Busan, Korea
| | - Nam Cheol Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.,Pusan National University Hospital Biomedical Research Institute, Busan, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.,Pusan National University Hospital Biomedical Research Institute, Busan, Korea.
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7
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Paick S, Choi WS. Varicocele and Testicular Pain: A Review. World J Mens Health 2019; 37:4-11. [PMID: 29774668 PMCID: PMC6305863 DOI: 10.5534/wjmh.170010] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/28/2018] [Accepted: 04/11/2018] [Indexed: 11/24/2022] Open
Abstract
Varicocele is the dilatation of the scrotal portion of pampiniform plexus and the internal spermatic venous system. About 15% of men suffer from scrotal varicocele and 2% to 10% of them complain of pain. The probable mechanisms for pain include compression of the surrounding neural fibers by the dilated venous complex, elevated testicular temperature, increased venous pressure, hypoxia, oxidative stress, hormonal imbalances, and the reflux of toxic metabolites of adrenal or renal origin. Testicular pain associated with varicoceles is typically described as a dull, aching, or throbbing pain in the testicle, scrotum, or groin; rarely, it can be acute, sharp, or stabbing. The management of testicular pain associated with varicocele starts with a conservative, non-surgical approach and a period of observation. Varicocelectomy in carefully selected candidates with clinically palpable varicocele resolves nearly 80% of all cases of testicular pain. Microsurgical techniques for varicocelectomy have gained popularity with minimal complication rates and favorable outcomes. The grade of varicocele, the nature and duration of pain, body mass index, prior conservative management, and the type of surgical method used, are predictors for the success of varicocelectomy.
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Affiliation(s)
- Sunghyun Paick
- Department of Urology, Konkuk University School of Medicine, Seoul, Korea
| | - Woo Suk Choi
- Department of Urology, Konkuk University School of Medicine, Seoul, Korea.
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8
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Çift A, Yucel MO. Outcomes of microsurgical subinguinal varicocelectomy to treat painful recurrent varicocele. Andrologia 2018; 50:e13105. [DOI: 10.1111/and.13105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ali Çift
- Department of Urology, Faculty of Medicine; Adiyaman University; Adiyaman Turkey
| | - Mehmet Ozgur Yucel
- Department of Urology, Faculty of Medicine; Adiyaman University; Adiyaman Turkey
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9
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Tomita K, Kageyama S, Hanada E, Yoshida T, Okinaka Y, Kubota S, Nagasawa M, Johnin K, Narita M, Kawauchi A. Indocyanine Green Angiography-assisted Laparoendoscopic Single-site Varicocelectomy. Urology 2017; 106:221-225. [DOI: 10.1016/j.urology.2017.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/17/2017] [Accepted: 04/04/2017] [Indexed: 12/01/2022]
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10
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Sack BS, Schäfer M, Kurtz MP. The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired? Curr Urol Rep 2017; 18:38. [PMID: 28315171 DOI: 10.1007/s11934-017-0686-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The primary indication for varicocele repair in adults, that of failed paternity, must be substituted in the adolescent population with surrogate parameters of testicular size differential and semen analysis. Making recommendations based on these two parameters is incredibly difficult because studies often have contradictory findings, different patient populations, and lack of long-term follow up of the key endpoint, paternity. Therefore, it is not a surprise that recommendations for adolescent varicocele repair are general (with some exceptions) and necessarily so because of limitations in quality of evidence. Apart from pain, all indications for varicocele repair in adolescence remain controversial. This highlights the most important task for future studies: to prevent pediatric urologists from allowing a potentially damaging process to go untreated, while at the same time avoiding unnecessary intervention on a highly prevalent condition.
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Affiliation(s)
- Bryan S Sack
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Mattias Schäfer
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatric Surgery and Pediatric Urology, Cnopf'sche Kinderklinik, St. Johannis-Muehlgasse 19, 90419, Nuremberg, Germany
| | - Michael P Kurtz
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
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11
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Elbardisi H, Agarwal A, Majzoub A, Al Said S, Alnawasra H, Khalafalla K, Al Rumaihi K, Al Ansari A, Durairaganayagam D, Arafa M. Does the number of veins ligated during microsurgical subinguinal varicocelectomy impact improvement in pain post-surgery? Transl Androl Urol 2017; 6:264-270. [PMID: 28540234 PMCID: PMC5422682 DOI: 10.21037/tau.2017.03.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background We 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. Methods This 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). Results Out 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%). Conclusions Microsurgical 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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Affiliation(s)
| | - Ashok Agarwal
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmad Majzoub
- Department of Urology, Hamad General Hospital, Doha, Qatar
| | - Sami Al Said
- Department of Urology, Hamad General Hospital, Doha, Qatar
| | | | | | | | | | | | - Mohamed Arafa
- Department of Urology, Hamad General Hospital, Doha, Qatar.,Department of Andrology, Cairo University, Cairo, Egypt
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12
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Lv KL, Zhang YD, Zhuang JT, Gao Y, Zhao L, Wan Z, Zhou MK, Yu JW, Sun XZ, Zhang YY, Deng CH, Tu XA. Subinguinal microsurgical varicocelectomy with intraoperative microvascular Doppler ultrasound leads to the pain-free outcome after surgery. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2017; 25:839-846. [PMID: 28436412 DOI: 10.3233/xst-17247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine efficacy of intraoperative microvascular Doppler ultrasound in assisting subinguinal microsurgical varicocelectomy for pain relief in the treatment of painful varicoceles, compared to the microsurgery without Doppler ultrasound. METHODS Total 153 patients underwent microsurgical varicocelectomy were randomly allocated to two groups: Groups 1 and 2 included 82 and 71 patients monitored with and without using intraoperative microvascular Doppler ultrasound, respectively. The assessments were compared between two groups, including intraoperative parameters (vessel numbers and operative time) and postoperative outcomes (pain resolution, complications and recurrence). RESULTS The average numbers of internal spermatic veins ligated (13.87±6.43 vs 11.72±5.66) and arteries preserved (1.96±0.87 vs 1.73±0.86) were significantly greater in Group 1 with Doppler ultrasound. Precisely, the smaller size of the internal spermatic veins was ligated and the more encircled arteries were also preserved in Group 1. In two groups with and without using Doppler ultrasound, 56 (68.3%) and 36 (50.7%) patients experienced a complete resolution of pain, 21 (25.6%) and 29 (40.9%) patients experienced partial resolution, whereas 5 (6.1%) and 6 (8.5%) patients experienced no change in the chronic pain, respectively. Thus, patients in Group 1 had a better outcome in chronic pain resolution (P = 0.033). The operative time, complications and recurrence rate were not different between the two groups. CONCLUSIONS Subinguinal microsurgical varicocelectomy is an effective method to treat painful varicoceles. With the assistance of Doppler Ultrasound monitoring, greater numbers of vessels were identified and a better outcome of pain resolution was achieved.
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Affiliation(s)
- Kun-Long Lv
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ya-Dong Zhang
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jin-Tao Zhuang
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yong Gao
- Reproductive Medicine Center, Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Liang Zhao
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zi Wan
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ming-Kuan Zhou
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jing-Wei Yu
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiang-Zhou Sun
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yuan-Yuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Chun-Hua Deng
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiang-An Tu
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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13
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Who will benefit from surgical repair for painful varicocele: a meta-analysis. Int Urol Nephrol 2016; 48:1071-8. [DOI: 10.1007/s11255-016-1246-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
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Tojuola B, Layman J, Kartal I, Gudelogul A, Brahmbhatt J, Parekattil S. Chronic orchialgia: Review of treatments old and new. Indian J Urol 2016; 32:21-6. [PMID: 26941490 PMCID: PMC4756545 DOI: 10.4103/0970-1591.173110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: Chronic orchialgia is historically and currently a challenging disease to treat. It is a diagnostic and therapeutic challenge for physicians. Conservative therapy has served as the first line of treatment. For those who fail conservative therapy, surgical intervention may be required. We aim to provide a review of currently available surgical options and novel surgical treatment options. Methods: A review of current literature was performed using PubMed. Literature discussing treatment options for chronic orchialgia were identified. The following search terms were used to identify literature that was relevant to this review: Chronic orchialgia, testicular pain, scrotal content pain, and microsurgical denervation of the spermatic cord (MDSC). Results: The incidence of chronic orchialgia has been increasing over time. In the USA, it affects up to 100,000 men per year due to varying etiologies. The etiology of chronic orchialgia can be a confounding problem. Conservative therapy should be viewed as the first line therapy. Studies have reported poor success rates. Current surgical options for those who fail conservative options include varicocelectomy, MDSC, epididymectomy, and orchiectomy. Novel treatment options include microcryoablation of the peri-spermatic cord, botox injection, and amniofix injection. Conclusion: Chronic orchialgia has been and will continue to be a challenging disease to treat due to its multiple etiologies and variable treatment outcomes. Further studies are needed to better understand the problem. Treatment options for patients with chronic orchialgia are improving. Additional studies are warranted to better understand the long-term durability of this treatment options.
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Affiliation(s)
- Bayo Tojuola
- Department of Urology, South Lake Hospital, Clermont, FL 34711, USA
| | - Jeffrey Layman
- Department of Urology, South Lake Hospital, Clermont, FL 34711, USA
| | - Ibrahim Kartal
- Department of Urology, South Lake Hospital, Clermont, FL 34711, USA
| | - Ahmet Gudelogul
- Department of Urology, South Lake Hospital, Clermont, FL 34711, USA
| | - Jamin Brahmbhatt
- Department of Urology, South Lake Hospital, Clermont, FL 34711, USA
| | - Sijo Parekattil
- Department of Urology, South Lake Hospital, Clermont, FL 34711, USA
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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.
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Affiliation(s)
- Nitin Abrol
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arabind Panda
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin S Kekre
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
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Evaluation of a scrotal mass. Nurse Pract 2014; 39:13-4. [PMID: 24739426 DOI: 10.1097/01.npr.0000441920.64428.9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Influence of preoperative pain duration on microsurgical varicocelectomy outcomes. Adv Urol 2014; 2013:370969. [PMID: 24454350 PMCID: PMC3888677 DOI: 10.1155/2013/370969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/31/2013] [Accepted: 10/08/2013] [Indexed: 11/21/2022] Open
Abstract
Objective. To investigate the question of whether duration of pain before surgery ultimately affects sperm parameters after varicocelectomy. Methods. Fifty patients with painful grade-3 varicocele were investigated prospectively. The patients were divided into two groups according to their symptom period. The patients having had grade-3 varicocele for less than 1 year were included in Group-1 (Ge, n = 25). Twenty-five patients who had painful grade-3 varicocele for more than 1 year (Gs, n = 25) were classified in Group-2. Semen analysis was performed after 3 days of sexual abstinence twice a month. Total sperm concentration (TSC), rapidly progressive motility (SPa), and slow or sluggish motility (SPb) rates were noted. Pain was evaluated by using 10 cm visual analogue scale (VAS). Results. Postoperative TSC and %SPb were significantly higher in both groups (P = 0.01). There was no difference between two groups for preoperative and postoperative TSC, %SPa, % and SPb values. VAS significantly declined in both groups (P = 0.005). This postoperative decline was not significant for intergroup comparison. Conclusions. Our results show that increase in semen quality and decrease in the pain after microsurgery varicocelectomy do not depend on the duration of the preoperative pain.
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Park YW, Lee JH. Preoperative predictors of varicocelectomy success in the treatment of testicular pain. World J Mens Health 2013; 31:58-63. [PMID: 23658867 PMCID: PMC3640154 DOI: 10.5534/wjmh.2013.31.1.58] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 02/22/2013] [Accepted: 02/28/2013] [Indexed: 11/15/2022] Open
Abstract
PURPOSE We performed the present study to evaluate the prognostic factors for the surgical outcome of varicocelectomy in the treatment of a painful varicocele. MATERIALS AND METHODS A total of 77 patients undergoing varicocelectomy were enrolled. All the patients were examined for body mass index (BMI), varicocele grade, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), semen analysis, maximal vein diameter, and discrepancy of testicular volume. At a follow-up visit 3~6 months after the surgery, the patient response was graded as a complete response, partial response, or no response. The resolution of pain was defined as a complete or partial response. We used logistic regression analyses to determine the preoperative factors for predicting a complete response and the resolution of pain. RESULTS Ten subjects were lost to follow-up. The remaining 67 patients were included in this study. The pain was completely resolved in 47.8% of patients, partial resolution was observed in 25.4% of patients, and failure was reported in 26.9% of patients. Among the parameters, only a longer duration of pain (≥3 months) was an independent factor related to the complete response of pain (odds ratio, 7.371; p=0.010) and the resolution of pain (odds ratio, 7.209; p=0.042). The parameters of semen analysis results, testosterone, LH, FSH, BMI, grade, ultrasonography results, and the type of surgical approach did not significantly predict the resolution of pain. CONCLUSIONS The duration of pain (≥3 months) was an independent prognostic factor for the complete response of pain and the resolution of pain.
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Affiliation(s)
- Yeon Won Park
- Department of Urology, National Police Hospital, Seoul, Korea
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