From the Guidelines
Varicocele treatment should be individualized based on symptoms and fertility concerns, with microsurgical subinguinal varicocelectomy being the gold standard for treatment due to its low recurrence rates and fewer complications, as supported by recent studies 1.
Treatment Options
When treatment is needed, the following options are available:
- Microsurgical subinguinal varicocelectomy: This is the preferred method for treating varicoceles, especially in cases of infertility or testicular size discrepancy, due to its high success rates and low complication rates 1.
- Laparoscopic varicocelectomy: This is a minimally invasive alternative to open surgery, but it may have higher recurrence rates compared to microsurgical subinguinal varicocelectomy.
- Radiological embolization: This is a less invasive option that can be used to embolize the affected spermatic vein, and it has been shown to be effective in relieving orchialgia, with 87% of patients experiencing complete pain relief at 39 months in one review 1.
Considerations for Treatment
The decision to proceed with treatment and the choice of treatment should be based on symptoms, patient preferences, and fertility concerns. Other considerations include:
- Cost and availability of resources
- Potential for complications
- Insurance reimbursement
- Physician training and expertise
Post-Treatment Care
After varicocele treatment, patients should:
- Avoid heavy lifting for 2-3 weeks
- Use scrotal support as needed
- Take over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) for discomfort Most patients experience significant pain relief after repair, and approximately 60-70% of infertile men show improved semen parameters within 3-6 months following successful varicocele treatment.
From the Research
Treatment Options for Varicocele
- Surgical repair: either by open or microsurgical approach, or laparoscopy 2
- Percutaneous embolization of the internal spermatic vein: offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts, but demands interventional radiologic expertise and has potential serious complications 2
- Percutaneous retrograde sclerotherapy: successful in 82.8% of left varicoceles and 51% of right varicoceles, with a lower cost compared to surgery 3
- Laparoscopic varicocelectomy: a safe and efficient approach, especially for bilateral varicoceles, with a low recurrence rate and minimal adverse outcomes 3, 4, 5
- Open surgery: still has a role in isolated right-sided varicoceles and in left-sided cases with failed sclerotherapy, with a higher risk of postoperative complications 3
Outcomes and Complications
- Recurrence rates: vary depending on the treatment approach, with laparoscopic Palomo varicocelectomy showing a lower recurrence rate compared to embolization and open surgery 4, 5
- Postoperative hydrocele: a common complication, especially after laparoscopic varicocelectomy, with a reported incidence of up to 24.5% 4, 5
- Other complications: include vascular perforation, coil migration, thrombosis of pampiniform plexus, genitofemoral nerve damage, infection, and bleeding 2, 4, 5
Comparison of Treatment Approaches
- Laparoscopic varicocelectomy vs. embolization: laparoscopy may have a lower recurrence rate, but a higher risk of secondary hydrocele 5
- Open surgery vs. laparoscopy: open surgery may have a higher risk of postoperative complications, but is still a viable option for certain cases 3
- Embolization vs. sclerotherapy: embolization may have a higher success rate, but sclerotherapy is a less invasive and less expensive option 3