Varicocele: Recurrence, Symptoms, and Treatment Options

Varicocele

Hello, Dr.
Hsu: I have varicocele on both sides, with the left side being particularly severe.
I initially underwent traditional varicocele surgery on both sides, but it did not improve.
I then had two microsurgical procedures on the left side, which had small incisions.
I recovered quickly after the first microsurgery, but the varicocele did not significantly decrease in size.
About six months later, I experienced discomfort and swelling again, and my semen analysis worsened.
The doctor recommended a second microsurgery, but after this surgery, the soreness and swelling did not subside.
It is especially noticeable in the afternoons.
Although the varicocele does not seem to have enlarged, the left side feels very sore and uncomfortable.
It has been over three months since the third surgery, and the soreness and swelling return every afternoon.
Taking pain medication helps a lot.
Is this considered a recurrence, or is it simply poor blood circulation? Why has the soreness and swelling not improved after my surgeries? Is it related to my exercise? Should I continue to observe for another six months, or should I consult a doctor? The surgeon who performed my surgery said I do not need to return for a follow-up...
What should I do?

Xiao Chen, 30~39 year old female. Ask Date: 2012/11/07

Dr. Xu Weikai reply Urology

Hello, I recommend seeking medical attention for a scrotal Doppler ultrasound, which can objectively diagnose whether it is truly caused by varicocele.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Answers from the internet should only serve as a reference; it is essential to visit a healthcare facility for proper evaluation.
This message is from Dr.
Hsu Wei-Kai, Director of the Urology Department at Taitung Hospital, Department of Health, Executive Yuan, who cares about your well-being.

Reply Date: 2012/11/07

More Info

Understanding varicocele is crucial for managing symptoms and treatment options effectively. Varicocele is a condition characterized by the enlargement of veins within the scrotum, similar to varicose veins in the legs. It is often associated with discomfort, pain, and potential fertility issues.
In your case, it appears that you have undergone multiple surgical interventions, including traditional varicocele surgery and microsurgical techniques, yet you continue to experience discomfort and symptoms. This raises several important considerations regarding recurrence, symptoms, and treatment options.

Recurrence and Symptoms
1. Recurrence: Varicocele can recur after surgical treatment, particularly if the underlying anatomical issues are not fully addressed. The recurrence rate varies depending on the surgical technique used, with microsurgical techniques generally having lower rates of recurrence compared to traditional methods. However, even with microsurgery, recurrence can occur, especially if there are additional contributing factors such as anatomical variations or underlying venous insufficiency.

2. Symptoms: The symptoms you describe, including a persistent dull ache or heaviness in the scrotum, particularly in the afternoon, are common in individuals with varicocele. The discomfort may not necessarily indicate a recurrence but could be related to blood flow dynamics or residual venous congestion. The fact that pain improves with analgesics suggests that it may be related to inflammation or irritation rather than a structural issue.

Treatment Options
1. Observation: Given that your symptoms have persisted for three months post-surgery, it may be prudent to continue monitoring your condition. If the discomfort does not improve or worsens, further evaluation may be necessary.
2. Follow-Up Consultation: While your surgeon indicated that follow-up visits are not necessary, it is essential to advocate for your health. If you are experiencing significant discomfort, seeking a second opinion or consulting with a urologist or a specialist in male reproductive health may provide further insights. They can perform a physical examination and possibly recommend imaging studies, such as Doppler ultrasound, to assess blood flow and identify any underlying issues.

3. Lifestyle Modifications: Engaging in regular physical activity can improve circulation and potentially alleviate some symptoms. However, it is essential to avoid activities that may exacerbate discomfort, such as heavy lifting or high-impact exercises. Wearing supportive undergarments may also help reduce discomfort.

4. Pain Management: If pain persists, discussing pain management strategies with your healthcare provider is advisable. This may include non-steroidal anti-inflammatory drugs (NSAIDs) or other analgesics, as well as exploring alternative therapies such as physical therapy or acupuncture.

5. Surgical Options: If symptoms continue to be bothersome and significantly impact your quality of life, revisiting the option of surgical intervention may be warranted. A thorough discussion with a specialist about the potential benefits and risks of additional surgery is essential.

Conclusion
In summary, while your symptoms may not necessarily indicate a recurrence of varicocele, they warrant further investigation and management. It is crucial to communicate openly with your healthcare provider about your ongoing discomfort and explore all available options. Whether through observation, lifestyle changes, pain management, or further surgical intervention, taking proactive steps can help you achieve relief and improve your overall well-being.

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