Managing Recurrence of Varicocele: Pain Relief and Surgical Options

Recurrence of varicocele?

Hello Dr.
Hsu,
I underwent a high ligation surgery for left-sided varicocele above the abdomen in 2004.
Unfortunately, at the end of 2015, I developed right-sided epididymitis, and my nightmare officially began.
From 2016 to the first half of 2017, I visited the urology department multiple times and consulted with no less than six doctors.
I took many antibiotics and painkillers, but my scrotal pain did not show significant improvement.
In August 2016, I had a second ultrasound examination, and two doctors stated that I no longer showed signs of inflammation; they suggested that my pain might be due to neuropathic pain triggered by lifestyle or stress.

I then consulted a traditional Chinese medicine practitioner, who claimed that Western medicine could not resolve my condition, attributing it to insufficient Qi in the bladder meridian and damp-heat in the bladder.
I took traditional Chinese medicine for nearly six months, but it did not significantly affect my condition.
In 2017, I underwent a B-scan examination at the hospital, and the report indicated that I had varicocele on both sides of the scrotum, with the left side being more severe (0.29 cm on the left, 0.24 cm on the right).
The doctor informed me that my varicocele had recurred and that I could undergo surgery, including laparoscopic and microscopic options, but he did not seem very confident that surgery would improve my condition.
Soon after, I visited another hospital's urology department.
The doctor there suggested microscopic surgery, stating that the chance of not recurring was about 80%.
I hesitated and went to another private clinic, where the doctor first mentioned that my bacteria had not been completely eradicated.
He advised me to have a urinalysis and semen culture, which revealed the presence of Group D Streptococcus in my semen.
I was prescribed a 28-day course of antibiotics, and after completing it, the pain in my right testicle significantly decreased, but the left testicle continued to hurt persistently.
Regarding the recurrence of my varicocele, that doctor did not strongly recommend surgery, as he could not guarantee that my condition would improve post-surgery, estimating the chance of not recurring to be only around 60-70%.
Feeling quite helpless after receiving such differing opinions, I sought advice from another traditional Chinese medicine clinic at the end of last year.
The practitioner attributed my condition to insufficient kidney Qi and prescribed some traditional Chinese medicine containing pangolin.
After taking it, my pain level indeed decreased by more than half, although the pain became more frequent.
I have been taking traditional Chinese medicine for six months, but my condition remains fluctuating.
He advised me to avoid certain foods and to eat as lightly as possible.
Therefore, I would like to ask the doctor:
1.
Is my pain caused by the varicocele?
2.
From your perspective, should I undergo surgery again?
3.
If I have the surgery, what is the likelihood of not recurring?
4.
If I do not have surgery, what other methods can help alleviate my pain? For example, is ice therapy effective?
I am currently very confused and troubled by this pain every day, which severely affects my normal life.
I look forward to your advice and response.
Thank you!

Xiao Cheng, 30~39 year old female. Ask Date: 2018/07/30

Dr. Xu Wencang reply Urology

Return to the outpatient clinic for follow-up examination and discussion with the physician.

Reply Date: 2018/07/30

More Info

Managing the recurrence of varicocele and associated pain can be quite challenging, especially when previous treatments have not yielded satisfactory results. Your situation involves a complex interplay of physical symptoms and emotional distress, which is not uncommon in chronic pain conditions. Let’s break down your concerns and explore potential avenues for relief and management.

1. Is the pain caused by varicocele?
Varicocele can indeed be a source of pain, particularly if there is a recurrence after surgical intervention. The condition is characterized by enlarged veins within the scrotum, which can lead to discomfort, a feeling of heaviness, and sometimes even fertility issues. However, your symptoms could also be exacerbated by other factors, such as nerve pain or psychological stress, particularly since you mentioned that some doctors suggested your pain might be related to lifestyle or stress. It’s essential to consider that chronic pain can have multiple contributing factors, and isolating the cause may require a comprehensive evaluation.

2. Should you undergo surgery again?
The decision to pursue further surgical intervention should be made after careful consideration of the potential benefits and risks. Given that you have received mixed opinions from various healthcare providers, it may be beneficial to seek a second opinion from a urologist who specializes in male reproductive health and varicocele treatment. They can provide a thorough assessment of your current condition, including imaging studies, and help you weigh the likelihood of success against the risks of surgery. If the recurrence rate is a concern, discussing minimally invasive options, such as laparoscopic or microsurgical techniques, may be worthwhile, as these often have lower complication rates and quicker recovery times.

3. What is the likelihood of recurrence after surgery?
The recurrence rate of varicocele after surgical treatment can vary widely depending on the technique used and the individual’s anatomy. Generally, microsurgical techniques have reported lower recurrence rates, often cited between 5% to 10%. However, if your previous surgeries did not alleviate your symptoms, it’s crucial to discuss with your surgeon the specific reasons for your pain and the expected outcomes of another procedure.

4. What non-surgical options are available for pain relief?
If you decide against surgery, there are several non-invasive strategies that may help alleviate your symptoms. These include:
- Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage discomfort. However, consult your doctor before starting any new medication regimen.

- Physical Therapy: Engaging in physical therapy may help strengthen pelvic floor muscles and improve blood flow, potentially alleviating some pain.

- Ice Therapy: Applying ice packs to the affected area can reduce inflammation and numb the pain temporarily. It’s generally recommended to apply ice for 15-20 minutes at a time, several times a day.

- Lifestyle Modifications: Maintaining a healthy weight, avoiding heavy lifting, and managing stress through relaxation techniques or counseling can also be beneficial.

- Alternative Therapies: Some patients find relief through acupuncture or chiropractic care, although these should be approached with caution and discussed with your healthcare provider.

In conclusion, your situation is multifaceted, and it’s essential to approach it holistically. Engaging in open discussions with your healthcare providers about your symptoms, treatment options, and personal preferences will empower you to make informed decisions. Remember, chronic pain management often requires a combination of strategies tailored to your specific needs. Don’t hesitate to seek support from mental health professionals if you find the emotional toll of your condition overwhelming. Your well-being is paramount, and there are pathways to improve your quality of life.

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