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2017 ; 6
(Suppl 1
): S20-S29
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A review of varicocele repair for pain
#MMPMID28725614
Owen RC
; McCormick BJ
; Figler BD
; Coward RM
Transl Androl Urol
2017[May]; 6
(Suppl 1
): S20-S29
PMID28725614
show ga
A dilation of the pampiniform venous plexus in the scrotum above the testicle,
called a varicocele, affects approximately 15% of the general male population.
While the majority is asymptomatic, pain results in up to 10% of cases of
varicoceles. The pain associated with varicoceles is typically mild and is
described as heavy, achy, or dull-and is usually isolated to the testicle or
spermatic cord. Guidelines clearly recommend varicocele repair in males with
varicoceles, infertility, and an abnormal semen analysis. While chronic, severe
pain is an additional indication for repair, a careful evaluation to rule out
other etiologies in addition to a period of conservative management are necessary
prior to surgical treatment because of the high incidental prevalence of
varicoceles in the general population. Several techniques for varicocele repair
have been described, including retroperitoneal, laparoscopic, inguinal, and
subinguinal. Additionally, recent adjuncts to improve visualization and
identification of critical structures including the operating microscope and
microvascular Doppler ultrasound have improved success and complication rates.
With careful patient selection, outcomes of varicocele repair with regard to pain
are excellent, with over 90% of patients experiencing symptomatic relief. After
failure of conservative treatments, a varicocele associated with pain should be
considered for repair, and the microsurgical subinguinal approach is the gold
standard surgical treatment, offering excellent outcomes while minimizing risk of
complications.