Recurrent varicocele

I have had an operation 1.5 years ago (inguinal; microscopic surgery) that failed to correct a left-side varicocele, followed 6 months later by an embolisation with about 5 platinum coils that has helped somewhat.  However, the veins underneath the left testis still get swollen as the day progresses, and they ache.  It has always been veins UNDERNEATH the testis that get distended, less the veins running up from the testis that I see in medical diagrams.  It is a ball of palpable veins slightly smaller than the testis itself and right underneath.  I had a second renal venogram that showed that the spermatic vein is clearly blocked by the embolization.  From my research I understand that the swollen veins may be gubernacular veins.  I am considering have a second surgical procedure (different surgeon) to use a sub-inguinal approach this time to ligate any remaining veins including the gubernacular veins.  What are your thoughts on the advisability of this?  Where do the gubernacular veins drain anyway if not into the spermatic vein?  How do I know whether the testicular artery was cut in the first surgery (I ask because my hormone levels are down further and the testis seems slightly smaller)?  Also can the coils ever be removed, or the now-embolized spermatic vein cut out, since the embolized vein with coils in it causes me some discomfort - I can feel it inside.

Looking forward to your comments

John

[Kevin Pho, MD]

To answer your questions:
1) The subinguinal approach is the most common technique used presently by male infertility specialists. The major advantage of this approach is more direct approach to the spermatic cord, external spermatic veins. The small incision (corresponding to the length of the testis) is more comfortable for the patient with less postoperative pain.  You may want to consider this approach.

2) As I am not a urologist, I do not know where where the gubernacular veins drain after surgery.  

3) You may want to consider an ultrasound which can evaluate the flow of the testicular artery.

4) It may be possible for the coil to be removed if there is discomfort - I would suggest discussing this with your urologist.
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.

[not well 71]

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