3 recurrent varicoceles

Hello,
I have had 3 varicocele recurrences and I do not know what to do anymore.  I am 24 years old and I was first diagnosed with a varicocele when I was 15 years old.  I had the varicocele surgery when I was 20 yrs old and the varicocele came back in about a year or so.  I then had a varicocele embolization about a year ago and the varicocele came back in about 6 months.  Then I just recently had again another varicocele embolization done and my urologist believes this did not correct the problem.  My question is, what to do now.  I went to get a second opinion and the other urologist said that he would do the surgery procedure again if I wanted to.  My only concern is more pain due to them going in again and messing with that area.  I am in a lot of pain and my left testicle is again swollen.  My semen analysis has been up and down(one urologist says that it's about normal and the other says it's not where it should be).  Therefore, I am not sure what I should do about this situation.  Would one consider undergoing surgery again knowing my past history with varicoceles and the way they reoccur in my case.  Is varicocele embolization really a great option when one has had reoccurence because it has not helped in my situation at all.  If you can give me any insight/information/direction it would be much appreciated because I feel very confused/lost right now.  I feel like I have been just tossed around from urologist to interventional radiologist back to urologist and so on and so forth.  Thank you for your time in advance and have a great day!

[Kevin Pho, MD]

Unfortunately, 5% of those diagnosed with a varicocele have recurrence despite surgery.  There are normally 3 surgical approaches - including embolization, ligation and laparoscopy.  

The reason why there is so much confusion is because there is no clear course of treatment.  Repeat surgery or repeat embolization would all be reasonable considerations in your case.  I am not aware of data suggesting that one course is better than another in repeat occurances of varicoceles.

If there is no consensus, you may want to inquire about a referral to an academic medical center where presumably they would have more experience with varicoceles.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.