Post-Varicocele Surgery: Common Concerns and Recovery Insights

Varicocele surgery

Dear Dr.
Hsu,
Last month, I underwent varicocele surgery (left side) using microsurgery.
The incision is located about two centimeters above the base of the penis on the left side.
It has been about a month and a half since the surgery, and the wound has scabbed over; externally, it appears healed.
I have a few questions for you:
1.
Although the wound has healed, I sometimes experience a dull pain (not at the incision site) near the base of the penis.
Is this normal?
2.
There are white threads at the surgical site.
Last week, I thought they were tissue from the healing process and tried to pull them off.
However, I ended up pulling some of the threads out, leaving a small segment exposed while the ends are still inside my body.
I am now hesitant to touch it.
Is this a concern?
3.
I have heard that the internal sutures will be absorbed by the body.
Does this mean that the sutures used to ligate the blood vessels will disappear, potentially allowing blood to flow back and cause a recurrence of the varicocele?
4.
How long after surgery can I engage in sexual activity? If certain positions involve more vigorous contact, could this negatively affect the surgical site, such as impacting healing or increasing the risk of recurrence?
5.
Recently, during sexual activity, I have noticed that the left side of my scrotum collides with my partner's body and causes pain.
Is this normal?
6.
Lastly, after showering today, I suddenly noticed that my left scrotum hangs significantly lower than the right, almost by double! Previously, the left side was lower, but not by much.
Seeing it like this today was alarming, as it looks like it might fall off.
Is there a problem with this? Should I get any further examinations?
Thank you, Dr.
Hsu, for taking the time to answer my questions.
Thank you!

Lao K, 20~29 year old female. Ask Date: 2009/02/25

Dr. Xu Weikai reply Urology

1.
The sensation of dull pain near the base of the penis (not at the wound site) is likely a result of fibrosis after surgery, which is a normal tissue response.
Local heat application may help alleviate this discomfort.

2.
There are white threads at the surgical site.
Last week, I thought they were tissue from skin healing and tried to pull them off, but ended up pulling some of the threads out, with both ends still inside the body and a small segment exposed.
I'm afraid to touch it now.
Is this a concern? It’s best to see a doctor quickly, as exposed thread ends can allow bacteria to enter the body and cause an infection.
3.
I’ve heard that the threads inside the body can be absorbed by the body.
Does this mean that the threads used to tie the blood vessels will disappear, potentially allowing blood to flow again and causing a recurrence of varicocele? Generally, non-absorbable sutures are used for tying blood vessels in such surgeries.
4.
How long after surgery can I engage in sexual activity? If certain positions involve more vigorous contact, could that negatively affect the surgical site, such as impairing healing or increasing the risk of recurrence? It should be fine as long as there is no pain at the wound.
Some people resume sexual activity the same day without issues.
However, avoid overly vigorous movements, as they may cause the wound to reopen.
5.
Recently, during sexual activity, I’ve experienced pain in the left scrotum when it collides with my partner's body.
Is this normal? This is likely due to fibrosis or swelling in the scrotum following surgery, which can be improved with local heat application.
It should gradually recover over time.
If it persists beyond three months, it’s best to consult a doctor.
6.
Lastly, after showering today, I suddenly noticed that my left scrotum hangs much lower than the right, almost doubling in length! Previously, the left scrotum was lower than the right, but not by much.
Seeing this today startled me, as it looks like it might fall to the ground.
Is there a problem with this? Should I get any further examinations? It’s advisable to see a doctor for a proper diagnosis.

Reply Date: 2009/02/25

More Info

Post-varicocele surgery recovery can raise several concerns, especially regarding pain, healing, and changes in anatomy. Here’s a comprehensive overview addressing your questions and providing insights into the recovery process after varicocele surgery.

1. Postoperative Pain: It is not uncommon to experience some discomfort or pain in the area surrounding the surgical site even after the wound has healed. This can be attributed to nerve irritation or inflammation in the surrounding tissues. If the pain is mild and intermittent, it may be part of the normal healing process. However, if the pain persists or worsens, it is advisable to consult your surgeon to rule out any complications such as infection or nerve entrapment.

2. Surgical Sutures: The presence of white threads you mentioned could be remnants of sutures. If these are absorbable sutures, they typically dissolve on their own over time. However, if you have pulled on them and they are now partially exposed, it’s best to avoid manipulating them further. If you notice any signs of infection (increased redness, swelling, or discharge), or if you are concerned about the sutures, please reach out to your healthcare provider for an evaluation.

3. Absorbable Sutures and Recurrence: Absorbable sutures are designed to dissolve and be absorbed by the body over time. This does not mean that the ligation of the blood vessels is ineffective; the surgical technique aims to permanently occlude the veins responsible for the varicocele. If the surgery was performed correctly, the risk of recurrence should be low. However, factors such as anatomical variations or incomplete ligation can potentially lead to recurrence, so it’s important to follow up with your surgeon for any concerns.

4. Resuming Sexual Activity: Generally, patients are advised to wait at least 2 to 4 weeks post-surgery before resuming sexual activity. This allows adequate time for healing. Engaging in vigorous sexual activity or positions that may cause excessive pressure on the surgical site could potentially lead to discomfort or complications. It’s best to discuss this with your surgeon, who can provide personalized recommendations based on your recovery progress.

5. Pain During Sexual Activity: Experiencing pain in the left scrotum during sexual activity can be concerning. This could be due to several factors, including swelling, sensitivity in the surgical area, or even referred pain from the surgical site. If this pain continues or intensifies, it’s important to consult your doctor to ensure there are no underlying issues.

6. Changes in Scrotal Position: Noticing a significant difference in the height of your left scrotum compared to the right can be alarming. Post-surgery, it is not uncommon for the scrotum to appear asymmetrical due to swelling or changes in the tissue. However, if the difference is pronounced and accompanied by pain, discomfort, or other symptoms, it is advisable to seek medical evaluation. Your surgeon may perform a physical examination or imaging studies to ensure there are no complications such as hydrocele or recurrence of varicocele.

In summary, while some discomfort and changes are expected after varicocele surgery, persistent or severe symptoms warrant further evaluation. Regular follow-ups with your surgeon are crucial to ensure a smooth recovery and address any concerns that may arise. Always prioritize communication with your healthcare provider regarding your recovery process and any symptoms you experience.

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