What Causes Varicocele Recurrence in Men?
If you have a varicocele or if you’ve had one in the past, you probably won’t be happy to learn that they can reappear after treatment. But recurrence is one of the most common complications associated with varicocele repair.
Varicocele basics: a quick review
As a quick review, veins carry blood from the testicles back to the heart. These veins have valves that keep the blood from flowing backward. If any of these valves fail, some of the blood flows in reverse. This causes the veins to swell. These swollen veins are called varicoceles, and they occur for about 15% to 20% of all men.
Varicoceles are a problem for some men because they can cause pain, a sagging scrotum, fertility issues and other problems. In fact, it’s been estimated that more than one third of all infertile men have a varicocele.
Varicoceles are usually treated surgically through a procedure called a varicocelectomy. For about 5% to 10% of all men who have this procedure done, the varicoceles return afterward. One study found that, for a group of men whose varicoceles reappeared, the average time it took for new varicoceles to form was about five months.
Why do varicoceles come back after treatment?
According to another study that was published in 2016, the most common reason for varicocele recurrence is that the procedure didn’t treat all of the veins that were most likely to generate varicoceles.
The main thing to understand here is that there are a lot of different ways to conduct a varicocelectomy. In these studies and others, researchers concluded that a procedure called a microscope-assisted subinguinal varicocelectomy may be the best overall treatment for patients with recurring varicoceles. This approach uses incisions in the pubic region rather than in the testicles. It’s the technique I prefer to use because it allows the physician to directly see the veins that take blood away from the testicles, and to treat not only the existing varicoceles, but also the veins that appear most likely to cause varicoceles. This approach also tends to cause less discomfort after the procedure.
I’ve been involved in refining this technique over the years using an approach called artery and lymphatic isolation. Many other urologists have adopted this approach, which minimizes complications — including recurrence.
The bottom line: avoiding varicocele recurrence
So what’s the bottom line here? Well, if you have a varicocele — whether it’s the first time or not — be sure to find out what varicocelectomy approach your urologist uses. Because unfortunately, not all varicocelectomy approaches are created equal.