Microsurgical varicocelectomy preferred over conservative treatment

Men who experience painful recurrent varicoceles after undergoing conservative treatment and failed surgical repair are best served by microsurgical varicocelectomy, according to Canadian researchers.

Of 11 men who had failed standard varicocelectomy and experienced pain before and after surgery, 10 experienced a favorable response following microsurgical repair, according to investigators.

"In my mind, microsurgical varicocelectomy is the gold standard, and non-microsurgical repair is sub-standard," said lead author Armand Zini, MD, associate professor of urology at McGill University, Montreal. "However, few urologists are able to perform this procedure, since they have not been trained properly."

Dr. Zini noted that microsurgical repair greatly reduces the rate of varicocele recurrence (

Dr. Zini and colleagues evaluated patients who had been referred for consideration of microsurgical varicocelectomy after conservative treatment and previous varicocele repair had failed. "Conservative treatment" in this case included analgesics, loose-fitting underwear, and reduced physical activity.

At mean follow-up of 12 months (range, 3 to 32 months), orchalgia in six of 11 patients was completely resolved, and four patients reported reduced severity of pain.

Postoperative analgesic requirements during convalescence, consisting of acetaminophen with codeine, ranged from 0 to 60 tablets total (mean, 25.9 tablets). Days required before returning to work ranged from 7 to 60 days, with a mean of 17.2 days. Return to physical activity also ranged from 7 to 60 days, with a mean of 28.3 days.