Microsurgical Ligation for Painful Varicocele: Effectiveness and Predictors of Pain Resolution

PURPOSE We evaluated the effectiveness of microsurgical ligation for painful varicocele and predictive factors of pain resolution. MATERIALS AND METHODS Between January 2006 and March 2009, a total of 114 patients (mean age, 30.2 ± 8.9 years), who underwent microsurgical inguinal varicocelectomy for painful varicocele, were included and followed up for 1 year after the surgery. The quantity of preoperative and postoperative pain was assessed by means of 11-point numeric rating scale (NRS). We retrospectively analyzed the outcome of surgical ligation and predictive factors of pain resolution using patient age, height, weight, body mass index, grade and location of varicocele, duration, quantity and quality (dull, dragging, aching) of pain, and postoperative pain resolution. RESULTS In 104 patients (91.2%), complete or marked resolution of pain was reported at follow-up 1 year after surgery. Only 10 patients (8.8%) had recurrent or persistent pain (≥ 3 points in NRS scores). On multivariate analysis, low quantity (≤ 6 points in NRS scores) and dull or dragging natured preoperative pain were independent factors associated with surgical success rates (p=0.004; odds ratio=1.62, p=0.012; odds ratio=1.76, respectively). CONCLUSION Microsurgical ligation is an effective treatment of painful varicocele. The quantity and quality of preoperative pain are independent predictive factors of pain resolution after surgery.