How Can We Predict a Successful Outcome after Varicocelectomy in Painful Varicocele Patients? An Updated Meta-Analysis

Effect of physical activity level and occupation on resolution of pain after varicocelectomy: A prospective clinical study

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.

Increased intraoperative vein ligation in microsurgical varicocelectomy is associated with pain improvement

Varicocele is a major cause of male infertility. However, few studies have discussed the potential associations between the pain caused by varicocele and preoperative and intraoperative factors. The aim of this study was to evaluate factors potentially associated with changes in pain score after microsurgical varicocelectomy. This retrospective study was conducted between August 2020 and August 2022 at China Medical University Hospital in Taichung, Taiwan. Patient characteristics including age, body mass index, semen analysis, testicular volume, and the number of veins ligated were collected. Preoperative and intraoperative factors were analyzed to determine if they were correlated with changes in numeric rating scale (NRS) after microsurgical varicocelectomy. A total of 44 patients with clinical varicocele underwent subinguinal microsurgical varicocelectomy and were analyzed. The overall pain resolution rate was 91%, and the average satisfaction score after surgery was 9.2 according to their subjective feelings. Multivariate analysis revealed that severe varicocele grade (odds ratio [OR] 16.5, 95% confidence interval [CI] 3.01-90.47; P = .018) and the number of veins ligated (OR 6, 95% CI 1.6-22.48; P = .013), were significantly associated with changes in NRS after surgery. In addition, the area under the receiver operating characteristic curve for changes in NRS and the total number of veins ligated was 0.869. Microsurgical varicocelectomy had a high success rate for scrotal pain and satisfaction. Severe varicocele grade and the number of veins ligated in microsurgical varicocelectomy were associated with postoperative pain improvement.

Scrotal Pain after Varicocelectomy: A Narrative Review

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.

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

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.