Painful scrotum can be a bothersome symptom in men and in many cases despite extensive investigation, the cause of the pain can be a mystery to the treating doctor.
There are many causes of painful scrotum and the presence of a varicocele is one such cause. Varicoceles are abnormal enlargements or dilations of veins within the scrotum that surround the male spermatic cord. These are diagnosed either clinically or by an ultrasound. Sometimes surgery if performed for varicoceles will give relief from pain. However this is not the rule as there are instances where the pain never goes away despite the surgery. Not many studies have been done to look at this issue
AdvertisementTo address the above issue an interesting study has been published in the Indian Journal of Urology entitled, "Painful varicoceles: Role of varicocelectomy," authored by Nitin Abrol, Arabind Panda and Nitin S. Kekre. The article discusses the combined result gathered by various research groups on varicoceles and the role of surgical treatments for varicoceles for painful scortum.
Effectiveness of Surgery for Painful Scortum due to Varicocele
Varicocele is a benign condition but can cause pain and sometimes affect the fertility of men as it can lead to low sperm count. It is estimated that the prevalence of varicoceles pain is around 2-10 percent. Currently, surgical varicocelectomy is one of the options available for the treatment of varicocele that is causing symptom.
In all of the scientific studies conservative treatment is advocated for varicoceles if they cause pain. This includes scrotal support, oral non-steroidal anti-inflammatory drugs and limitation of physical activity like lifting weights and strenuous activities. If this fails to resolve the problem surgery maybe advised.
The current reviewed article mentions that only 5 of the 119 men responded well to conservative treatment. It also emphasizes that factors such as duration, type and intensity of pain are to be considered by the physician before advising any treatment. Research has revealed that the success rate of surgery is much more when the duration of pain exceeds 3 months.
Varicocelectomy is found to be most effective for pain when the patient involved is carefully selected. The success rate in such cases is about 80 percent. Overall, there are many studies suggesting that surgical varicoceletomy has fewer complications and recurrences of the disease have also been reported to be low. However, a lot more continued research and randomised studies with longer follow up have to be carried out to answer the question as to how effective varicocelectomy is, in treating painful scrotum with varicoceles.
What is Surgical Varicocelectomy?
Treatment of varicocele using surgery is known as varicocelectomy. Surgical varicocelectomy is a minimally invasive surgery and also an effective one. It is divided into subtypes such as laparoscopic, transvenous percutaneous embolization, retroperitoneal, inguinal and sub-inguinal varicocelectomy.
Currently the best method advised to treat varicoceles is by using an operating microscope and taking the sub-inguinal route. The surgery is performed through a small incision made below the pubic hairline. The spermatic cord is elevated and the magnification of the operating microscope is used to identify the abnormal veins, which are then litigated. This is done while testicular arteries, lymphatic channels and nerves are preserved. Finally the incision is closed. This approach gives the best results especially when varicoceles cause low sperm count.
Varicocele is estimated to be responsible for approximately 40 percent cases of primary male infertility (where a couple has not conceived a child after at least one year of trying) and 80 percent cases of secondary male infertility (where a couple has conceived at least once but are not able to again).
Optimum temperature, which is essential for sperm production, is maintained by the venous plexus called pampiniform plexus as they cool down blood in the testicular artery before it enters the testicles. This results in the scrotal temperature being 2 to 3 degrees lower than the body temperature. Once the veins are dilated as in varicoceles they fail to regulate the scrotal temperature.
4. Painful varicoceles: Role of varicocelectomy by Nitin Abrol, Arabind Panda, Nitin S. Kekre, Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India.