Recurring Pain After Varicocele Surgery: Causes and Concerns

Regarding varicocele?

I had surgery for bilateral varicocele in November last year.
However, in early January, I started experiencing pain on the left side after sitting for too long, lasting about two hours.
My daily life was still relatively normal.
By the end of March this year, I noticed that the right side would also hurt after prolonged activity, approximately after 40 minutes.
Therefore, I underwent another surgery on the right side in early April.
However, recently I have still been experiencing pain on the right side, although it occurs less frequently.
It is still quite uncomfortable, and I feel psychological pressure during exercise.
Could you please explain why this is happening? The surgeon mentioned that theoretically, the chance of recurrence after one surgery is low, but I have already had two surgeries.
When the pain occurs, it can be unbearable, and I am really worried.
Additionally, I am unsure if this is related to my involvement in a mountaineering club, where I carry weight and engage in intense physical activity.
Thank you.

Fanrao de ren, 20~29 year old female. Ask Date: 2005/04/23

Dr. Lai Ronghao reply Urology

You have varicocele, with two surgeries on the right side and one on the left side.
Theoretically, the recurrence rate is not high.
It is recommended that you check again to see if there is any recurrence.
If not, it may be neuropathic pain! In that case, it's best to avoid sitting or standing for too long.
If you engage in vigorous exercise, you should take a break for a few minutes every 30 to 60 minutes.
Additionally, applying heat or taking a warm bath can help improve blood circulation.

Reply Date: 2005/04/23

More Info

After undergoing varicocele surgery, it is not uncommon for patients to experience recurring pain, even after what is considered a successful procedure. Your situation, where you have had surgery on both sides and are still experiencing pain, can be frustrating and concerning. Let’s delve into the potential causes of your ongoing discomfort and discuss some management strategies.

Potential Causes of Recurring Pain
1. Postoperative Adhesions: After any surgery, including varicocele repair, scar tissue can form. This scar tissue can lead to adhesions, which may cause pain by pulling on surrounding tissues or organs. Adhesions can develop even if the surgery was performed laparoscopically, as in your case.

2. Nerve Irritation or Damage: During surgery, nerves in the area may be irritated or inadvertently damaged. This can lead to chronic pain or neuropathic pain, which may not respond well to typical pain management strategies.

3. Incomplete Repair or Recurrence: Although your surgeon indicated that the likelihood of recurrence is low, it is still possible for varicoceles to recur, especially if the initial surgery did not completely address the issue. This can happen if the veins were not fully ligated or if new veins develop over time.

4. Muscle Strain or Overuse: Given that you are active in a hiking club and engage in strenuous activities, it’s possible that the pain you are experiencing is related to muscle strain or overuse rather than the varicocele itself. The physical demands of hiking, especially with added weight, can lead to discomfort in the groin or lower abdomen.

5. Psychological Factors: Chronic pain can also have psychological components. Anxiety about the pain or fear of recurrence can amplify your perception of pain, making it feel more intense during activities.

Management Strategies
1. Physical Therapy: Engaging in physical therapy can help strengthen the muscles in the pelvic area and improve flexibility. A physical therapist can provide exercises tailored to your needs and help you learn proper body mechanics to avoid strain during activities.

2. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), can help manage pain during flare-ups. If the pain persists, discussing prescription options with your doctor may be beneficial.

3. Activity Modification: While staying active is important, it may be necessary to modify your activities to avoid exacerbating the pain. This could include reducing the weight you carry while hiking or taking more frequent breaks during strenuous activities.

4. Follow-Up with Your Surgeon: If the pain continues or worsens, it is crucial to follow up with your surgeon or a specialist. They may recommend imaging studies, such as an ultrasound or MRI, to assess for any anatomical issues or complications from the surgery.

5. Psychological Support: If anxiety or stress about the pain is affecting your quality of life, consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective in managing chronic pain.

Conclusion
Recurring pain after varicocele surgery can stem from various factors, including postoperative complications, nerve issues, or even lifestyle factors related to your activities. It’s essential to approach this issue holistically, considering both physical and psychological aspects. Open communication with your healthcare provider will be key in finding an effective management plan tailored to your specific situation. Remember, while it can be disheartening to experience ongoing pain, there are strategies and resources available to help you manage it effectively.

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