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Urology (Expert Forum)
Varicocele surgery complications?
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Varicocele surgery complications?
by Grant, Dec 09, 1999 12:00AM
I had bi-lateral varicocele surgery in April '99. Since that time, I've been experiencing a lot of pain in my right testicle. THe epididymis really hurts. Subsequent ultrasound was normal. My urologist said everything looks normal. Tried Elavil to no avail. No infection, etc. I do have a herniated disc at L4/5. Would this cause the pain? The testicle seems to be riding higher than before the surgery. Could the surgery have caused this and the pain? Could the testicle be put back wrong?
Doctor's Answer
by hfhs M.D.-AK, Dec 09, 1999 12:00AM
Dear Grant,
Yes, the surgery could have caused the pain, but I don’t think it was secondary to the placement of the testicle after the procedure or a bad operation from your doctor. The ultrasound would tell you if there was any obvious recurrence, infection, or hydrocele. If your testicle was descended as a child, the testicle itself will seek a dependent position in the scrotum. If you had a large varicocele, the blood vessels that you once thought were the testicle, may now be reduced, and make you believe that the testicle is in a different position or smaller. A varicocele is an abnormal dilation of the pampiniform plexus of veins surrounding the testis. They are more common on the left but can occur bilaterally. The prevalence of varicoceles in the general population is estimated to range between 13-15%. Varicoceles are usually asymptomatic however as they become larger, they can cause pain. Prophylactic varicocelectomy in an adolescents and adults with grossly normal testes has not been shown to have a positive effect upon either future testicular development or fertility.
There are three commonly used surgical approaches to perform a varicocelectomy, an extraperitoneal approach, the inguinal approach and the subinguinal approach. The later two procedures allow for both ligation of the internal and external spermatic veins to prevent recurrence. A fourth option which has gained some popularity as an alternative to surgery is the percutaneous approach. This involves catheterization of the femoral vein. The internal spermatic vein is approached and occluded using a variety of materials. Initially there were many failures but with more experience, success is similar to the retroperitoneal approach. This is due to the fact that the external spermatic veins are not occluded.
All of these procedures are relatively short in terms of operating room time. They should last less than an hour. The recovery time from this procedure is similar to a hernia repair lasting several weeks.
Over all the success of these operations are all very good. The complications are rare and usually minor. Some patients get a post-operative hydrocele(3% fluid around the testicle) and less than one percent have wound infections, recurrences, or postoperative pain. The later problems, particularly pain, may be caused by shunting the blood flow to new veins which may develop into a varicolcele recurrence. I don’t see any connection though, between your disk problem and your current pain.
I don’t know what the indications were for your surgery in the first place, but I would not have operated on a varicocele for pain without fist exploiting more conservative options. I would first encourage the use of anti-inflammatory medication and scrotal support. I can’t tell you much more without a physical exam, so I would return to your doctor for further care. I don’t think your doctor did anything wrong and he or she may have some suggestions to help you.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Varicocele
Yes, the surgery could have caused the pain, but I don’t think it was secondary to the placement of the testicle after the procedure or a bad operation from your doctor. The ultrasound would tell you if there was any obvious recurrence, infection, or hydrocele. If your testicle was descended as a child, the testicle itself will seek a dependent position in the scrotum. If you had a large varicocele, the blood vessels that you once thought were the testicle, may now be reduced, and make you believe that the testicle is in a different position or smaller. A varicocele is an abnormal dilation of the pampiniform plexus of veins surrounding the testis. They are more common on the left but can occur bilaterally. The prevalence of varicoceles in the general population is estimated to range between 13-15%. Varicoceles are usually asymptomatic however as they become larger, they can cause pain. Prophylactic varicocelectomy in an adolescents and adults with grossly normal testes has not been shown to have a positive effect upon either future testicular development or fertility.
There are three commonly used surgical approaches to perform a varicocelectomy, an extraperitoneal approach, the inguinal approach and the subinguinal approach. The later two procedures allow for both ligation of the internal and external spermatic veins to prevent recurrence. A fourth option which has gained some popularity as an alternative to surgery is the percutaneous approach. This involves catheterization of the femoral vein. The internal spermatic vein is approached and occluded using a variety of materials. Initially there were many failures but with more experience, success is similar to the retroperitoneal approach. This is due to the fact that the external spermatic veins are not occluded.
All of these procedures are relatively short in terms of operating room time. They should last less than an hour. The recovery time from this procedure is similar to a hernia repair lasting several weeks.
Over all the success of these operations are all very good. The complications are rare and usually minor. Some patients get a post-operative hydrocele(3% fluid around the testicle) and less than one percent have wound infections, recurrences, or postoperative pain. The later problems, particularly pain, may be caused by shunting the blood flow to new veins which may develop into a varicolcele recurrence. I don’t see any connection though, between your disk problem and your current pain.
I don’t know what the indications were for your surgery in the first place, but I would not have operated on a varicocele for pain without fist exploiting more conservative options. I would first encourage the use of anti-inflammatory medication and scrotal support. I can’t tell you much more without a physical exam, so I would return to your doctor for further care. I don’t think your doctor did anything wrong and he or she may have some suggestions to help you.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Varicocele
Member Comments (6)
by harry, Dec 09, 1999 12:00AM
To: Misc.
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by Grant, Dec 09, 1999 12:00AM
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by joel, Apr 28, 2000 12:00AM
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by sirio2@tin.it, May 03, 2000 12:00AM
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by William, May 08, 2000 12:00AM
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by david, Jul 18, 2000 12:00AM
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