From the Guidelines
Treatment for varicocele should be individualized, considering the severity of symptoms, fertility concerns, and the presence of testicular atrophy, with surgical intervention such as microsurgical subinguinal varicocelectomy or percutaneous embolization being recommended for men with significant symptoms or fertility issues, as evidenced by a study published in the American Family Physician in 2019 1. When considering treatment options, it's essential to weigh the potential benefits against the risks and consider the patient's overall health and fertility goals.
- For men with mild varicoceles and no symptoms, observation with regular monitoring may be sufficient.
- For those with significant symptoms, such as pain or testicular atrophy, or fertility concerns, surgical intervention may be necessary.
- The primary surgical approaches include open surgery (varicocelectomy), laparoscopic varicocelectomy, and percutaneous embolization, with microsurgical subinguinal varicocelectomy being a common technique due to its low recurrence and complication rates.
- According to a study published in Human Reproduction Update in 2017 1, treatment of a clinically palpable varicocele may be offered to the male partner of an infertile couple when there is evidence of abnormal semen parameters and minimal/no identified female factor. The decision to treat varicocele should be made on a case-by-case basis, taking into account the individual's specific circumstances and the potential impact on fertility and quality of life.
- Pain management is also crucial, with over-the-counter anti-inflammatory drugs being effective in managing post-operative discomfort or pain associated with varicocele.
- Additionally, compression underwear may help reduce swelling, and patients should be advised to avoid heavy lifting for about 2 weeks post-surgery.
From the Research
Treatment Options for Varicocele
- Varicocele treatment options include percutaneous embolization, open surgery, laparoscopy, and sclerotherapy 2, 3, 4, 5, 6
- Percutaneous embolization is a minimally invasive treatment with low morbidity, minimal pain, and rapid recovery, and has been shown to be effective in resolving varicocele in 91% of patients with no evidence of hydrocele formation 2
- Sclerotherapy is best used for isolated left-sided varicoceles, while laparoscopy is the treatment of choice for bilateral varicoceles, and open surgery still has a role in isolated right-sided varicoceles and in left-sided cases with failed sclerotherapy 3
- Laparoscopic surgery and antegrade scrotal sclerotherapy are also effective treatment options, with laparoscopic surgery being more effective in correcting varicoceles, but with a higher incidence of postoperative hydrocele formation 6
- Occluding balloon embolization has been shown to have a slight advantage over conventional laparoscopic ligation in terms of hospital stay and full recovery to normal activity of patients 5
Comparison of Treatment Options
- A comparative study of conventional open surgery, percutaneous retrograde sclerotherapy, and laparoscopy found that sclerotherapy was successful in 82.8% of left varicoceles and 51% of right varicoceles, while laparoscopy had a higher success rate for bilateral varicoceles 3
- A study comparing laparoscopic surgery and antegrade scrotal sclerotherapy found that laparoscopic surgery had a lower failure rate and fewer complications, but a higher incidence of postoperative hydrocele formation 6
- Percutaneous embolization has been shown to be a safe and effective procedure, with a success rate of approximately 90% 4
Indications and Contraindications
- Indications for varicocele treatment include pain, varicocele size, and persistent testicular asymmetry 2
- Relative contraindications for percutaneous embolization include vascular perforation, coil migration, and thrombosis of pampiniform plexus 4
- Patients with previous inguinal surgery may be at higher risk of postoperative hydrocele formation after laparoscopic varicocelectomy 6