Post-Surgery Recovery for Varicocele: Persistent Symptoms

Q: Post-Surgery Recovery for Varicocele: Persistent Symptoms

Hello, A-Jie：<br>Q1： Is it still not recovered or a failure? <br>A： Based on your description, the condition has significantly improved, but it is still not as satisfactory as expected. <br>If you continue to experience discomfort, you may consider undergoing a low ligation proc

Varicocele six months post-surgery has not recovered?

I have undergone laparoscopic surgery for varicocele six months ago.
Although I have noticed significant improvement (the effects were felt only after six months), the lumps have decreased, but I am still not fully recovered.
After a period of activity, I still experience noticeable swelling, especially on the left side, which becomes more pronounced after sitting on public transport for a long time or walking for a while, and it can also become red.
I still wear tight-fitting underwear; if I wear loose boxers, the swelling occurs more quickly.

Q1: Is this still part of the recovery process or a sign of failure?
Q2: When I went for a follow-up examination six months later (with a different doctor at another hospital), the ultrasound showed that the blood vessels were still somewhat enlarged.
However, unlike the previous ultrasound, this doctor did not ask me to exert pressure on my abdomen to observe the changes in the colored patterns.
When I asked if this indicated a failure of the surgery, he said that improvement signifies success.
So does this enlarged blood vessel indicate a recurrence, or is it still part of the healing process? I have been very careful with that area over the past six months, except for rare occasions when work requires me to be active for a couple of hours.
Otherwise, I have been very cautious in my care.
Q3: Can varicocele cause fatigue and ankle pain? Most doctors have said that these symptoms are unrelated to different blood vessels.
However, I have come across some news articles and information from doctors online that do correlate with my symptoms: since my varicocele became severe, I have experienced increased fatigue and occasional pain in the ankle veins.
The severity is moderate to severe.

A Jie, 20~29 year old female. Ask Date: 2020/05/11

Dr. Cai Zhuorong reply Urology

Hello, A-Jie:
Q1: Is it still not recovered or a failure?
A: Based on your description, the condition has significantly improved, but it is still not as satisfactory as expected.
If you continue to experience discomfort, you may consider undergoing a low ligation procedure.
Q2: When I go for a follow-up examination in six months (with a different doctor at another hospital), the ultrasound indeed shows that the blood vessels are still enlarged.
However, the doctor did not ask me to exert pressure on my abdomen like the previous ultrasound technician did, which would show the changes in blue and red patterns.
I asked that doctor if this indicates a surgical failure, and he said that improvement signifies success.
So does this enlarged blood vessel mean a recurrence, or is it still in the process of recovery?
A: As mentioned in the response to Q1.
Q3: Can varicocele cause fatigue and ankle pain?
A: No, it does not.

Reply Date: 2020/05/11

More Info

Post-surgery recovery from varicocele surgery can be a complex process, and it's not uncommon for patients to experience lingering symptoms even months after the procedure. Let's address your questions one by one, while also providing some context regarding the condition and recovery.

Q1: Is it still recovering or a failure?
It’s important to understand that recovery from varicocele surgery, particularly high ligation or microsurgical techniques, can take time. The fact that you have noticed improvements, such as a reduction in the size of the varicocele, is a positive sign. However, the persistence of symptoms like swelling or discomfort, especially after prolonged activity, can be part of the normal healing process.
In some cases, patients may experience what is known as "post-operative edema," where fluid accumulation can cause swelling in the affected area. This can be exacerbated by activities that increase intra-abdominal pressure, such as prolonged standing or heavy lifting. If the symptoms do not improve over time or worsen, it would be advisable to consult your surgeon for a thorough evaluation.

Q2: Is the presence of a thicker vein on ultrasound indicative of recurrence or ongoing recovery?
The presence of a thicker vein on ultrasound can be concerning, but it does not automatically indicate a surgical failure or recurrence of the varicocele. Post-surgical changes can include the formation of scar tissue or changes in blood flow dynamics, which may result in altered ultrasound findings.
If the ultrasound shows a thicker vein but you are experiencing improvement in symptoms, it may suggest that the surgery was partially successful, and the body is still in the process of healing. It’s essential to have a detailed discussion with your healthcare provider about the ultrasound findings and what they mean in the context of your recovery. They may recommend follow-up imaging or additional assessments to monitor the situation.

Q3: Can varicocele cause fatigue and ankle pain?
Varicocele is primarily associated with localized symptoms, such as discomfort or pain in the scrotal area, but it can also have systemic effects. Some patients report feelings of fatigue or generalized discomfort, which can be attributed to the body’s response to chronic venous insufficiency.
While most physicians may attribute ankle pain to unrelated vascular issues, there is some evidence to suggest that varicocele can impact overall venous return and circulation, potentially leading to symptoms in the lower extremities. If you are experiencing persistent fatigue and ankle pain, it’s important to discuss these symptoms with your healthcare provider. They may consider evaluating other potential causes, including vascular issues or even hormonal imbalances that could be contributing to your overall symptoms.

Additional Considerations:
1. Lifestyle Modifications: Continue to protect the surgical area and avoid heavy lifting or strenuous activities until you receive clearance from your doctor. Wearing supportive undergarments can help manage symptoms.

2. Follow-Up Care: Regular follow-up appointments are crucial to monitor your recovery. If you have concerns about your symptoms or the results of your ultrasound, don’t hesitate to seek a second opinion or ask for further evaluations.

3. Physical Therapy: If you continue to experience discomfort or limitations in activity, consider discussing physical therapy options with your healthcare provider. A physical therapist can help design a program tailored to your recovery needs.

4. Patient Education: Stay informed about your condition and recovery process. Understanding what to expect can help alleviate anxiety and empower you to take an active role in your recovery.

In conclusion, while it’s normal to have lingering symptoms after varicocele surgery, it’s essential to maintain open communication with your healthcare provider to ensure that your recovery is on track and to address any new or concerning symptoms that may arise.

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