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Purpose:
To determine the efficacy of different surgical approaches and techniques for resolving varicocele-related pain and factors that predict surgical outcomes.
Methods:
The PubMed and Embase databases were searched with the terms "varicocele", "varicocelectomy" and "pain". Manual searches by reviewing the references of included studies were...
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The prevalence of idiopathic male infertility is high, up to 75% of patients with abnormal sperm parameters. Hence, the research of its causes is mandatory. Oxidative stress (OS) can be responsible for male infertility in 30–80% of cases. In recent years, seminal plasma (SP) proteomics has developed as a useful tool to provide biomarkers of specifi...
Objectives: To evaluate the effect of acupuncture on the semen quality of patients with clinical varicocele and their fertility outcomes. Methods: A total of 158 men, with the primary infertility and clinical varicocele were randomized into two groups. The study group underwent a subinguinal microscopic varicocelectomy, and control group without op...
Citations
... Varicocele is a well-recognized cause of decreased testicular function and affects approximately 15%-20% of all males and up to 40% of infertile males. [1] It is the most common cause of reversible infertility, yet the majority are asymptomatic and fertile. [2] Varicocele-related scrotal pain accounts for 2%-10% of all varicocele cases. ...
... [2] Varicocele-related scrotal pain accounts for 2%-10% of all varicocele cases. [1] Varicocele-related pain is usually described as dull aching pain and scrotal heaviness that may be aggravated by standing or exercising . [3] Varicocelectomy is recommended to patients who present with testicular pain. ...
... Painful varicocele accounts for 2%-10% of all varicocele cases. [1] Painful varicocele used to be debatable for surgical repair as varicocelectomy was preserved for male factor infertility, semen analysis abnormality, and testicular atrophy. ...
Introduction
Varicocelectomy is the prevailing management of scrotal pain secondary to varicocele. However, the literature is controversial on this topic. Some data showed that pain may persist after the surgery even if the varicocele is not detected postoperatively.
Objectives
The objectives of the study were to identify the effect of varicocelectomy in patients with chronic scrotal pain, to report the association between the clinical grade and postoperative pain resolution, and to identify the need for a secondary procedure after varicocelectomy to control the pain.
Materials and Methods
This was a retrospective study of 47 patients who underwent varicocelectomy between March 2016 and December 2018.
Results
Postoperatively, the pain totally resolved after surgery in 64.3% of patients with scrotal pain; it improved in 21.4%, 11.9% have persistent pain, and the pain got worse in only 2.4%. Our study showed 100% complete resolution or improvement with Grade I, 85.7% in Grade II, and 81.3% in Grade III. In addition, all patients who underwent bilateral varicocelectomy had pain that either completely resolved or improved postoperatively. On the other hand, all patients who had persistent pain or pain worsening postoperatively had unilateral varicocelectomy. An additional intervention for postoperative pain control was needed in only 14% of patients, 7% of them underwent embolization, 4.7% had a cord block, and 2.3% were sent to a pain clinic.
Conclusion
Varicocelectomy offers good outcomes in most patients with varicocele-related scrotal pain. The most significant predictor for success was low grade and bilaterality. However, there is a subset of patients whose symptoms will not improve postoperatively. Careful preoperative counseling and expectation management are crucial when discussing surgical options for those patients.
... На эффективность устранения болей также может оказывать влияние метод оперативного лечения [10]. ...
... Частота устранения болевой симптоматики была выше после выполнения субингвинальной варикоцелэктомии. Также было показано, что микрохирургическая варикоцелэктомия предпочтительней лапароскопической [10]. ...
Surgical treatment of clinically significant varicocele in infertile men with pathospermia is a common practice. However, the question of the role of this disease in the pathogenesis of such conditions as hypogonadism and orchalgia, as well as the role of varicocelectomy in eliminating pain symptoms in the scrotum and increasing testosterone levels, has remained ambiguous for a long time. The expediency of surgical treatment of varicocele in patients with azoospermia also remains a subject of discussion.
... 2017 yılında yapılan başka bir çalışmada ağrılı varikoseli olan hastaların yaklaşık %90'ının varikosel onarımından sonra semptomatik rahatlama yaşayacağı sonucuna varmıştır (34). On iki çalışmanın meta-analizi sonucu mikrocerrahi tekniği ile yapılan subinguinal yaklaşımın ağrı iyileşmesinde daha etkili olduğu sonucuna varılmıştır (35). Künt ağrının keskin ağrıya nazaran daha iyi çözüldüğü sonucuna varılırken, varikosel derecesi ile ağrı iyileşmesi arasında anlamlı bir ilişki bulunamamıştır (35). ...
... On iki çalışmanın meta-analizi sonucu mikrocerrahi tekniği ile yapılan subinguinal yaklaşımın ağrı iyileşmesinde daha etkili olduğu sonucuna varılmıştır (35). Künt ağrının keskin ağrıya nazaran daha iyi çözüldüğü sonucuna varılırken, varikosel derecesi ile ağrı iyileşmesi arasında anlamlı bir ilişki bulunamamıştır (35). Bizim hastalarımızda ise en sık başvuru yakınması skrotal ağrı olmakla beraber, operasyon sonrası poliklinik kontrollerinde hiçbir hastanın ağrı yakınması olmamıştır. ...
... Pijn of ongemak worden beschreven door 2-10% van de mannen met een varicocele. Scherpe pijn geeft een slechtere resolutie na behandeling dan doffe pijn [27]. Na varicocelectomie verdwijnt de pijn bij 48-90% van de patiënten [28]. ...
Samenvatting
In dit overzichtsartikel wordt de relatie besproken tussen een varicocele, mannelijke subfertiliteit, kans op een kind met en zonder behandeling van de varicocele na natuurlijke conceptie of geassisteerde voortplanting. Er wordt kort ingegaan op de verschillende theorieën over de pathofysiologie van de varicocele. Daarnaast worden de klinische diagnose en de overwegingen besproken rond de selectie en indicatiestelling bij subfertiele mannen, kinderen en adolescenten met een varicocele, en bij mannen met klachten en hypogonadisme. Tot slot worden de verschillende behandeltypen, uitkomst, recidief en evaluatie van het effect van interventies doorgenomen.
... P<.00001 and RR =0.92; 95% CI: 0.86-0.99; P=0.02) (19). In our current study, the postoperative pain resolution rate was 95.5% for those who underwent MSV for testicular pain only, which was higher than the average pain resolution rate reported in the literature, which may be explained by the surgical procedure and the small sample size (3). ...
Background:
Varicocele (VC) is one of the most common causes of infertility in men, and microscopic varicocelectomy is currently the major surgical procedure for VC. We assessed the clinical effectiveness of microsurgical subinguinal varicocelectomy (MSV) with enhanced recovery after surgery (ERAS) in the treatment of VC in terms of semen quality improvement rate, pregnancy rate, pain relief rate, recurrence rate, and complication rate after MSV and explored the indications for VC surgery.
Methods:
In total, 216 patients undergoing MSV in our center between June 2019 and July 2020 were enrolled in this study. All patients received the surgery under local anesthesia and were admitted and discharged within 24 hours. All patients were followed up for more than 6 months, and the rates of semen quality improvement, pregnancy, pain relief, recurrence, and postoperative complications were recorded. We can evaluate the pain degree of patients through the numerical rating scale (NRS). (I) 0 points for painless; (II) 1-3: mild pain; (III) 4-6: moderate pain; (IV) 7-10 points are severe pain. 0 is the most slightly, indicating comfort, and 10 is the most painful and unbearable.
Results:
The sperm concentration, total sperm count, progressive motility rate, sperm viability, and morphology were significantly improved after the surgery (all P values <0.05). The rate of semen quality improvement was 88.2%, and the semen indicators returned to normal in 26.6% of the patients. Among the patients who were followed up for 1 year, the natural conception rate reached 27.1% and was accompanied by a 95.5% pain relief rate, a 0.5% VC recurrence rate, and a 2.3% postoperative complication rate.We obtained data through laboratory examination of semen DNA fragments index (DFI). Compared with preoperative and postoperative DFI, postoperative DFI was improved, and the pregnancy outcome was improved.
Conclusions:
MSV under local anesthesia increases the rates of semen quality improvement, pregnancy, and pain relief while lowering the rates of recurrence and postoperative complications. MSV may also help to improve the pregnancy outcomes in patients with VC accompanied by sperm DNA fragmentation or nonobstructive azoospermia, but this should be verified by further investigation.
... Therefore, studies on the effects of varico-celectomy in the treatment of painful varicocele continue to be conducted [9]. However, for each study, the indicators used in the analysis are different, and the numbers of patients corresponding to each indicator are unequal [10]. From the perspective of research design, high-quality research is rare because it is difficult to conduct research into this issue with a prospective design as a randomized controlled trial. ...
... In the present study, no significant association was observed between the preoperative varicocele grade and postoperative pain resolution. In this regard, our study is consistent with the meta-analysis of Han et al [10]. Although there was no statistically significant difference in the pain resolution rate between patients with varicocele grades II and III, the pain resolution rate was higher in patients with grade III varicocele [11]. ...
... In our study, subinguinal ligation showed a significantly higher pain resolution rate than high ligation, but not inguinal ligation. The present study is inconsistent with the meta-analysis of Han et al [10], in which subinguinal ligation was associated with a higher pain resolution rate than inguinal ligation. The prospective study of Abd Ellatif et al [20] compared high and subinguinal ligation, but in the meta-analysis performed by Han et al [10], the data from the study of Abd Ellatif et al [20] were entered into the comparison between inguinal and subinguinal ligation. ...
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.
... In a meta-analysis, it was observed that subinguinal varicocelectomy and microsurgical varicocelectomy are effective techniques for resolving varicocele-related pain compared with other approaches. 37 In this study, 33.4% of patients in terazosin group and 30.3% in baclofen group underwent varicocelectomy; however, there was no significant difference between the groups with or without varicocelectomy. In other words, the results obtained in the study did not show the combination therapy is more effective than a single treatment. ...
Purpose
We aimed to investigate the comparative efficacy of terazosin and baclofen in young men with chronic orchialgia using National Institutes of Health Chronic Prostatitis Symptom Index measurement.
Patients and methods
Of 499 young men with chronic orchialgia, 255 received a daily 2 mg terazosin at bedtime and 244 received 10 mg baclofen during a period of 3 months. A daily 10-min hot-tub hip-bath rest was administered for all patients. Moreover, all patients with grade 3 and 18 patients with grade 2 varicocele underwent varicocelectomy. The National Institutes of Health Chronic Prostatitis Symptom Index score was assessed at baseline and 3 months later.
Results
Both terazosin and baclofen groups experienced a significant reduction in mean National Institutes of Health Chronic Prostatitis Symptom Index score (24.78 and 24.81 at baseline to 19.68 and 19.60 after the treatment for terazosin and baclofen groups, respectively). However, there was no significant difference between the groups with regard to post-treatment National Institutes of Health Chronic Prostatitis Symptom Index score after adjustment for the pre-treatment score ( p = 0.987). A total of 85 patients (33.4%) in terazosin group and 74 patients (30.3%) in baclofen group underwent varicocelectomy. Addition of the varicocelectomy to the treatment as a multimodal approach had no further improvement in the National Institutes of Health Chronic Prostatitis Symptom Index score.
Conclusion
Although a significant reduction was observed in mean National Institutes of Health Chronic Prostatitis Symptom Index score for both terazosin and baclofen groups, there was no significant difference between the treatments. Moreover, addition of varicocelectomy to terazosin or baclofen could not significantly decrease National Institutes of Health Chronic Prostatitis Symptom Index score; thus, varicocelectomy may not be appropriate for men who have some success with medical management. Further randomized studies are warranted.
... dull pain responded better to intervention compared to sharp pain, while varicocele grade did not predict success of intervention. 47 However, it is worthwhile to note that most of the studies were uncontrolled. decrease in scrotal pain has been reported after spermatic cord dissection alone 48 and the possible bias due to placebo effect of surgical intervention are of concern. ...
Varicoceles exert deleterious effect on testicular function. The condition has been associated with male infertility, testicular hypotrophy and pain. These comprises the common indications for varicocele repair currently. Significant improvement in semen parameters and pregnancy outcomes had been suggested by reports decades ago. However, selection of the best candidates remains an issue since not all patients respond
positively to treatment. Consensus has been reached in recent decade after the publication of a series of meta-analyses. Significant improvement in pregnancy outcomes were reported in patients with clinical varicocele and abnormal semen parameters. Varicocelectomy in adolescents with testicular hypotrophy was supported by the positive implication on catch-up growth and semen parameters. However, little is known about the treatment effect of adolescence varicocelectomy on long term fertility and paternity rate. Recent studies on outcome of varicocele repair for pain consistently demonstrated a resolution rate of approximately 90% and support varicocele-associated pain as an indication for surgery. Alternate indications for varicocele repair have been proposed in recent decade. Despite the encouraging preliminary data, most studies were uncontrolled retrospective series. Although varicocelectomy may not obviate the need for assisted reproductive techniques in patients with non-obstructive azoospermia, it potentially increases sperm retrieval rate. The significant increase in serum testosterone after varicocelectomy in patients with
androgen deficiency may open an alternative treatment for hypogonadism. The adjunctive role of varicocelectomy before assisted reproduction and the significant decrease in sperm DNA fragmentation after varicocele repair deserve further well-designed controlled studies.
... On the other hand, contemporary series generally stated that complete and partial resolution of pain were expected in around 90% and 5% of patients, respectively, after inguinal or subinguinal varicocelectomy (Lundy & Sabanegh, 2018). A recent meta-analysis including 12 studies concluded that subinguinal approach and microsurgery were associated with higher pain resolution rate (Han et al., 2016). Although correlation between treatment failure and varicocele recurrence was not reported by most studies, the lower recurrence rate of microsurgical subinguinal varicocelectomy (MSV) may account for the higher rate of pain resolution in contemporary series. ...
... Usually is greater with the patient standing, and can be eased with the patient lying down. Those who present with pain are more likely to have a higher grade varicocele 31 . ...
O manejo da varicocele em adolescentes continua sendo um dos tópicos mais interessantes e debatidos. Embora a crescente conscientização do comprometimento testicular induzido por varicocele tenha motivado diversos estudos, algumas das controvérsias na varicocele em adultos, em relação à fisiopatologia, tratamento e problemas de fertilidade, também podem ser transpostas para a população adolescente. Além disso, os adolescentes representam um grupo heterogêneo com desafios no diagnóstico, parâmetros clínicos e preditores de desfecho limitados. O desenvolvimento físico e puberal reflete-se em dificuldades para condutas padronizadas. O objetivo deste artigo é revisar os dados disponíveis da literatura sobre a apresentação, epidemiologia e patogênese da varicocele em crianças e adolescentes. Também abordamos as principais limitações e desafios da avaliação clínica e fornecemos evidências atuais sobre o dilema do tratamento com varicocele nesse subconjunto específico de pacientes. Opções de intervenção e resultados também são discutidos. A presente revisão baseia-se em uma busca eletrônica utilizando as bases de dados Pubmed / MEDLINE e referências dos artigos identificados realizadas entre março e maio de 2018.
