pain and paraesthesia leg after varicocoele

[vijar]

Dear doctor,
               I am a doctor.One fine morning I suddenly had a loin to groin pain during walking.Pain subsided when I lied down.Then I noticed a left sided scrotal swelling which I didnt know which was present earlier or not.Gradually left sided groin pain increased.I himself diagnosed my problem has varococoele and confirmed by a doppler study.I beared my pain in the scrotum while standing for almost one year.During this time my pain in the scrotum progressed to L hip and L knee.A slight compression in the scrotum can cause pain and paraesthesia over the posterior aspect of L Lowerlimb.As per the urologists and surgeons opinion undergone a varicocoelectomy operation.After the surgery pain in the scrotum was subsided by nearly 50%.But pain and parasthesia in the leg worsens.Even I cant sit on a chair for sometime.It causes pain and parasthesia over the ventral aspect of both legs.I consulted a lot of specialist doctors .But they couldnt explain the cause of pain.Radiological and sonographic examinations were normal.But I felt like my left hip is inflamed.Diagnosis by different doctors were schiatica,neuropathic pain,pyriformis syndrome,even as depressive disorder.I have already taken several medications.But no improvement with any medication.Now I am under treatment from a psychiatrist for depression.But even now no improvement for my pain.As I am a doctor and a patient I want to know whether anybody in the world got similar type of pain.Please help me from this worse pain.I asking help from doctors all over the world.

[vijar]

Dear Doctor,
                 Frankly speaking,sorry I am not satisfied with your answer.Anyway Thank you for your immediate response.Because this pain was present even before varicocoelectomy.If it is meralgia parasthetica pain usually occur in the lateral cutaneous nerve of thigh distribution that is in the upper outer lateral aspect of thigh as you clearly said.But my pain and burning sensation is only in the posterior aspect of thigh and posterior aspect of calf and it is bilateral.This problem aggravates by scrotal compression and  posterior thigh compression.I know as a doctor nobody can relate this type of pain after varicocoele anatomically.But I am very sure this pain has got some relation with varicocoele.I am expecting more studies in this field.MRI shows no nerve compression.Nerve conduction study was normal.Routine blood tests and blood glucose study was normal.I am expecting further response from you sir.
                                                                                        Thank you
                                                                                         vijar

[Dr. A. Srivastava]

Hi, Thank you for your question. Pain, numbness or tingling sensation in any part of body is considered nerve related in origin. This burning sensation you are having can occur due to impingement, irritation or compression of nerve of thigh. Most frequently involved nerve is lateral cutaneous nerve of thigh (which is branch of femoral nerve). This condition is called meralgia paraesthetica which manifests itself as pain, tingling or burning sensation of outer thigh. It may occur due to injury to nerve either due to spinal deformity or along its path to thigh by any ligament or tendon stretch, excessive tight clothing (therefore it is also called "jeans disease"), diabetic neuropathy or damage to nerve after varicocele repair etc. Another nerve which may cause pain in legs is sciatic nerve compression. I would advice a CT scan of spine and thigh, blood sugar levels, and EMG to check out abnormal muscle responses.  Hope this helps.