What is the treatment for a painful varicocele?

From the Guidelines

Treatment for a painful varicocele should prioritize endovascular therapy, such as gonadal vein embolization, which has been shown to be effective in relieving orchialgia, with 87% of patients experiencing complete pain relief at 39 months. This approach is supported by recent studies, including one published in the American Family Physician in 2019 1. The use of endovascular therapy embolizes the affected spermatic vein using coils or sclerosants, addressing the underlying cause of the pain.

Some key points to consider when treating a painful varicocele include:

• The condition affects up to 15% of males and is the most common diagnosis in infertile men 1
• Varicoceles are most often treated in cases of orchialgia, infertility, or reduced testicular size in adolescents 1
• Gonadal vein embolization is a minimally invasive procedure that can provide significant pain relief, with a success rate of 87% at 39 months 1
• Alternative treatments, such as varicocelectomy, may also be effective, but endovascular therapy is a viable option for patients who prefer a less invasive approach

In terms of specific treatment protocols, the use of coils or sclerosants to embolize the affected spermatic vein has been shown to be effective in relieving pain associated with varicoceles 1. It is essential to consult with a healthcare professional to determine the best course of treatment for each individual patient, taking into account their specific symptoms, medical history, and preferences.

From the Research

Treatment Options for Painful Varicocele

• Varicocele embolization is an effective and minimally invasive method to occlude the varicocele and is known to improve testicular size and function 2
• Microsurgical varicocelectomy demonstrates the best results, but a relapse is subsequently detected in 1-3% of cases 3
• Laparoscopic varicocelectomy is a surgical option for symptomatic patients with clinical varicocele, including those with chronic scrotal pain 4
• Antegrade scrotal sclerotherapy is also an effective treatment option, although it has a higher failure rate compared to laparoscopic surgery 5
• Occluding balloon embolization is a percutaneous interventional procedure that has been shown to be safe and effective in the treatment of varicocele, with a slight advantage in terms of hospital stay and full recovery to normal activity of patients 6

Comparison of Treatment Outcomes

• Laparoscopic varicocelectomy has been shown to be more effective than antegrade sclerotherapy in correcting varicoceles, with a lower failure rate 5
• Occluding balloon embolization has been shown to have a slight advantage over conventional laparoscopic ligation in terms of operative time, hospitalization, and patient's postoperative recovery time 6
• Microsurgical varicocelectomy has been shown to have a high success rate in relieving scrotal pain syndrome and improving sperm parameters, with a low recurrence rate 3

Considerations for Treatment Choice

• The choice of treatment for painful varicocele should be based on the individual patient's needs and medical history 2
• The method of primary treatment should be taken into account when choosing a surgical treatment option for patients with recurrent varicocele 3
• The use of microsurgical techniques and a thorough revision of the spermatic cord components during the primary operation can help minimize the risk of recurrence 3