Laparoscopic varicocelectomy for painful varicoceles: merits and outcomes

PURPOSE: To evaluate the effectiveness of laparoscopic ligation as an option offered to patients with painful varicocele. Laparoscopy has been an established technique for varicocelectomy in infertile patients, but little objective data exist addressing its effectiveness in the control of pain. PATIENTS AND METHODS: We reviewed records of 68 patients who underwent laparoscopic varicocelectomy for pain from March 1988 through March 2000. We documented patient age at operation, grade and side of the varicocele, duration and quality of the pain, and response to conservative treatment and laparoscopic ligation. RESULTS: Follow-up data were available for 58 patients. Their average age was 21.5 years (range 14-39 years). The varicocele was left sided in 51 patients and bilateral in 7. Forty patients described their pain as dull or throbbing ache and 13 as a dragging sensation, while 5 patients were unable to characterize their pain. Initial conservative treatment failed in all patients. Varicocele was grade III in 29 patients, grade II in 27, and grade I in 2. In 49 patients (84.5%), there was complete postoperative resolution of pain, while 6 (10.3%) had partial resolution. Only three patients had persistent symptoms. Hydrocele formation occurred in 3 patients (5.2%), and varicocele persisted in 2 (3.4%). CONCLUSIONS: This retrospective review supports varicocele ligation for the relief of pain. Laparoscopic ligation is an effective and safe approach to achieve this outcome.