Clinical follow-up after subinguinal varicocele ligation to treat pain.

OBJECTIVE

To evaluate the usefulness of surgical treatment in patients with chronic orchialgia associated with varicocele and those for whom conservative treatment (jockstrap, non-steroidal anti-inflammatory drugs (NSAIDs) and restricted physical activity) was not effective. The response to spermatic vein ligation performed subinguinally with local anaesthesia was assessed in 25 patients with chronic testicular pain and varicocele as the only associated causal factor. Patient age, grade (according to Doppler study) and location of the varicocele, duration and degree of pain, response to treatment using an analogous pain scale pre- and post-surgery and complications pre- and post-surgery were recorded. Mean patient age was 28 years (range: 17-57) and time of pain evolution 14 months (range: 3-72). The varicocele was left-sided in 19 patients, bilateral in 4 and right-sided in 2, and grade III in 14 cases, grade II in 6 and grade I in 5. Subinguinal ligation of the spermatic vein was performed under local anaesthesia on an ambulatory basis in all cases.

RESULTS

Twenty-two of the 25 patients (88%) reported resolution or evident improvement in their pain. The mean value on the pre-surgical pain scale was 64 (30-80). After a mean postoperative follow-up period of three months, the pain was reduced to a mean of 12. No perioperative complications were recorded; a post-operative hydrocele appeared in one case and the varicocele persisted in another.

CONCLUSIONS

Ligation of the spermatic vein performed on an outpatient basis using a subinguinal approach and local anaesthesia is an effective treatment for chronic varicocele-associated testicular pain for patients in whom other therapeutic measures have failed.