High ligation to treat pain in varicocele

There are limited data about the effectiveness of surgery in patients with painful varicocele. We report a retrospective study done for the follow up on all varicocele high ligations performed for pain to evaluate the effectiveness of the operations.

The patients who were all physically active workers and who underwent high inguinal ligation of varicocele for pain from January 1995 to January 2000, were invited for interviews. Their charts were reviewed to document patient age, grade and location of varicocele, duration and quality of pain, response to conservative treatment. All patients who could be contacted were interviewed for resolution of pain and complications, their physical examinations were made.

87 of 140 (62.1%) patients were available for the follow up. Median patient age was 26 (15 to 34) years old. The varicocele was on the left side in 82 patients and bilateral in 5. The pain was dull in 42, throbbing in 25, sharp in 6 and as a pulling sensation in 14. The longest conservative therapy given in the literature failed in all patients. Varicocele grades were as follows: Grade I in 17, Grade II in 34 and Grade III in 36 patients. High inguinal ligation was used in all patients. 72 (82.8%) patients reported complete resolution, 8 (9.2%) patients reported partial response, 7 (8%) patients had persistant pain.

High inguinal ligation is effective in the treatment of painful varicocele in highly selected patients. Prospective randomized studies are needed comparing surgical and conservative treatments.