Varicocele Recurrence: Symptoms and Treatment Options

Varicocele

Hello Dr.
Hsu,
I underwent varicocele surgery about a year and a half ago, where both the left and right sides were ligated at a high abdominal position similar to a hernia repair.
After the surgery, I experienced pain at the incision site for over six months, and it gradually improved to the point where I could walk normally.
However, more than a year later, I have noticed that the varicocele on the left side, which was more severe, seems to show no signs of regression.
The veins still feel very prominent and worm-like.
Recently, after exercising, I have started to feel significant soreness, heaviness, and even some pain, along with increased swelling.
Does this indicate a possible recurrence? How can recurrence be determined? If there is a recurrence, can laparoscopic techniques be used to avoid adhesions from reoperation? Thank you for your response.

Xiao Bai, 20~29 year old female. Ask Date: 2011/11/28

Dr. Xu Weikai reply Urology

Hello, first of all, the high ligation surgery has the advantages of a small incision (approximately 2-3 centimeters) and quick recovery.
However, compared to low ligation surgery, it requires a higher level of surgical skill, and the recurrence and failure rates are slightly higher, which are the disadvantages of high ligation surgery.
If there has never been atrophy, it is possible that there are other vascular supplies, and high ligation surgery may not effectively correct the issue.
As for the possibility of recurrence, it is uncertain.
Laparoscopic surgery can be considered (which is also a type of high ligation surgery), as well as low ligation surgery.
Note: It is still best to discuss in detail with your outpatient physician.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses should only serve as a reference; if necessary, you should seek medical attention at a healthcare facility.
This response is provided by Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2011/11/28

More Info

Dear Patient,
Thank you for your inquiry regarding the recurrence of varicocele after surgery. It’s understandable to have concerns about your symptoms and the effectiveness of the surgical intervention you underwent. Let’s break down your situation and explore the potential implications and treatment options.

Understanding Varicocele and Its Recurrence
Varicocele is a condition characterized by the enlargement of veins within the scrotum, similar to varicose veins in the legs. Surgical treatment, often through techniques like laparoscopic high ligation, aims to alleviate symptoms and prevent complications such as infertility. However, recurrence can occur in some cases, and it’s essential to recognize the signs and symptoms that may indicate this.

Symptoms of Recurrence
From your description, it seems you are experiencing discomfort, swelling, and a sensation of heaviness or pain in the left side, which could suggest a recurrence of varicocele. Common signs of recurrence include:
1. Visible Veins: If the veins remain prominent and do not show signs of regression post-surgery, this could indicate that the varicocele has not resolved or has recurred.

2. Pain or Discomfort: Increased discomfort, especially after physical activity, can be a sign of recurrence. Pain may be dull or sharp and can be accompanied by a feeling of heaviness.

3. Swelling: Any noticeable swelling in the scrotum or surrounding areas post-surgery should be evaluated.

Diagnosis of Recurrence
To determine if you have a recurrence, a thorough evaluation is necessary. This typically involves:
- Physical Examination: A healthcare provider will assess the scrotum for any abnormalities.

- Ultrasound: A Doppler ultrasound can help visualize blood flow in the veins and confirm the presence of a varicocele.

- Symptom Review: Discussing your symptoms in detail with your physician will provide context for your physical findings.

Treatment Options for Recurrence
If a recurrence is confirmed, there are several treatment options available:
1. Surgical Intervention: If the varicocele is significant and causing symptoms, a repeat surgical procedure may be necessary. Laparoscopic techniques can minimize recovery time and reduce the risk of adhesions compared to open surgery.

2. Endovenous Laser Treatment (EVLT): This is a minimally invasive procedure that uses laser energy to close off the affected veins. It may be an option if traditional surgery is not preferred.

3. Sclerotherapy: This involves injecting a solution into the affected veins to cause them to collapse and close. It is less invasive than traditional surgery.

4. Observation: If the symptoms are mild and not affecting your quality of life, your doctor may recommend monitoring the condition without immediate intervention.

Conclusion
It’s crucial to follow up with your healthcare provider regarding your symptoms. They can perform the necessary evaluations to determine if you are experiencing a recurrence of varicocele and discuss the most appropriate treatment options based on your specific situation.
Remember, each case is unique, and your healthcare provider will consider your overall health, the severity of your symptoms, and your personal preferences when recommending a treatment plan.
Thank you for reaching out, and I hope this information helps clarify your concerns. Please do not hesitate to seek further medical advice for your condition.

Best regards.

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