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Influence of Preoperative Pain Duration on Microsurgical Varicocelectomy Outcomes

DOI: 10.1155/2013/370969

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Abstract:

Objective. To investigate the question of whether duration of pain before surgery ultimately affects sperm parameters after varicocelectomy. Methods. Fifty patients with painful grade-3 varicocele were investigated prospectively. The patients were divided into two groups according to their symptom period. The patients having had grade-3 varicocele for less than 1 year were included in Group-1 (Ge, ). Twenty-five patients who had painful grade-3 varicocele for more than 1 year (Gs, ) were classified in Group-2. Semen analysis was performed after 3 days of sexual abstinence twice a month. Total sperm concentration (TSC), rapidly progressive motility (SPa), and slow or sluggish motility (SPb) rates were noted. Pain was evaluated by using 10?cm visual analogue scale (VAS). Results. Postoperative TSC and %SPb were significantly higher in both groups ( ). There was no difference between two groups for preoperative and postoperative TSC, %SPa, % and SPb values. VAS significantly declined in both groups ( ). This postoperative decline was not significant for intergroup comparison. Conclusions. Our results show that increase in semen quality and decrease in the pain after microsurgery varicocelectomy do not depend on the duration of the preoperative pain. 1. Introduction Varicocele is the dilatation and tortuosity of plexus pampiniformis leading to a retrograde reflux. It is estimated in 15–22% of adult male population and 30–40% of men presenting with infertility to the urology clinics [1]. Varicocele is detected on the left in 75–95% of the cases. The etiology of varicocele is controversial. There are some theories such as anatomical differences between left and right testicular veins, the lack of venous valves, and nutcracker phenomenon [2–5]. Varicose veins may cause pain. The etiology of varicocele is similar to peripheral varicose veins. It is not enlightened yet whether varicocele may cause pain because of testicular damage. Our hypothesis is that if the pain was due to testicular damage, the longer duration of pain before surgery would negatively influence varicocelectomy outcomes. 2. Materials and Methods After being approved by the Ankara Mevki Military Hospital Local Ethical Committee (2008), 50 patients with painful grade-3 varicocele were investigated between 2008 and 2012, prospectively. The patients were divided into two groups according to their pain duration. Before randomising patients, one year was accepted as a cut-off value for preoperative pain duration. The patients who had grade-3 painful varicocele for less than one year were included in

References

[1]  J. I. Gorelick and M. Goldstein, “Loss of fertility in men with varicocele,” Fertility and Sterility, vol. 59, no. 3, pp. 613–616, 1993.
[2]  S. Karazincir, A. Balci, S. G?rür, H. Sumbas, and A. N. Kiper, “Incidence of the retroaortic left renal vein in patients with varicocele,” Journal of Ultrasound in Medicine, vol. 26, no. 5, pp. 601–604, 2007.
[3]  M. Karcaaltincaba, “Demonstration of normal and dilated testicular veins by multidetector computed tomography,” Japanese Journal of Radiology, vol. 29, no. 3, pp. 161–165, 2011.
[4]  A. Shafik, A. Moftah, S. Olfat, M. Mohi-el-Din, and A. El-Sayed, “Testicular veins: anatomy and role in varicocelogenesis and other pathologic conditions,” Urology, vol. 35, no. 2, pp. 175–182, 1990.
[5]  M. M. Wishahi, “Anatomy of the spermatic venous plexus (pampiniform plexus) in men with and without varicocele: intraoperative venographic study,” The Journal of Urology, vol. 147, no. 5, pp. 1285–1289, 1992.
[6]  J. L. Marmar and Y. Kim, “Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data,” The Journal of Urology, vol. 152, no. 4, pp. 1127–1132, 1994.
[7]  A. C. Peterson, R. S. Lance, and H. E. Ruiz, “Outcomes of varicocele ligation done for pain,” The Journal of Urology, vol. 159, no. 5, pp. 1565–1567, 1998.
[8]  T. A. Abdel-Meguid, A. Al-Sayyad, A. Tayib, and H. M. Farsi, “Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial,” European Urology, vol. 59, no. 3, pp. 455–461, 2011.
[9]  T. A. Abdel-Meguid, “Predictors of sperm recovery and azoospermia relapse in men with nonobstructive azoospermia after varicocele repair,” The Journal of Urology, vol. 187, no. 1, pp. 222–226, 2012.
[10]  A. Shridharani, G. Lockwood, and J. Sandlow, “Varicocelectomy in the treatment of testicular pain: a review,” Current Opinion in Urology, vol. 22, no. 6, pp. 499–506, 2012.
[11]  ?. Yaman, E. ?zdiler, K. Anafarta, and O. G?gü?, “Effect of microsurgical subinguinal varicocele ligation to treat pain,” Urology, vol. 55, no. 1, pp. 107–108, 2000.
[12]  H. T. Kim, P. H. Song, and K. H. Moon, “Microsurgical ligation for painful varicocele: effectiveness and predictors of pain resolution,” Yonsei Medical Journal, vol. 53, no. 1, pp. 145–150, 2012.
[13]  S. S. Chen, “Factors predicting symptomatic relief by varicocelectomy in patients with normospermia and painful varicocele nonresponsive to conservative treatment,” Urology, vol. 80, no. 3, pp. 585–589, 2012.
[14]  S. Z. Al-Buheissi, H. R. Patel, H. D. Wazait, R. A. Miller, and S. Nathan, “Predictors of success in surgical ligation of painful varicocele,” Urologia Internationalis, vol. 79, no. 1, pp. 33–36, 2007.
[15]  K. Karademir, T. ?enkul, K. Baykal, F. Ate?, C. I?eri, and D. Erden, “Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain,” International Journal of Urology, vol. 12, no. 5, pp. 484–488, 2005.
[16]  A. Armagan, O. Ergun, E. Bas, T. Oksay, and A. Kosar, “Long-term effects of microsurgical varicocelectomy on pain and sperm parameters in clinical varicocele patients with scrotal pain complaints,” Andrologia, supplement 1, pp. 611–614, 2012.
[17]  B. Altunoluk, H. Soylemez, E. Efe, and O. Malkoc, “Duration of preoperative scrotal pain may predict the success of microsurgical varicocelectomy,” International Brazilian Journal of Urology, vol. 36, no. 1, pp. 55–59, 2010.
[18]  H. J. Park, S. S. Lee, and N. C. Park, “Predictors of pain resolution after varicocelectomy for painful varicocele,” Asian Journal of Andrology, vol. 13, no. 5, pp. 754–758, 2011.
[19]  Y. W. Park and J. H. Lee, “Preoperative predictors of varicocelectomy success in the treatment of testicular pain,” The Journal of Men's Health, vol. 31, no. 1, pp. 58–63, 2013.

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