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
To 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
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
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.