A case report on suspicious failure of varicocelectomy and exploration of indication of reoperation

This article reported the management of one patient with suspected failure of varicocelectomy.The patient suffered from bilateral varicocele of III degree in left side and Ⅱ degree in right side,aggravated bearing-down pain in the left scrotum and severe deterioration of semen quality.He accepted bilateral varicocelectomy under peritoneoscope.Two month after operation,he felt that scrotum dropping feeling and pain were relieved significantly but tortuous of bilateral scrotum was more serious.The patient was administrated again due to suspicion of operation failure.Systematic clinical and experimental detections found no evidence for recurrence of varicocele.The reoperation was not considered and the observation and symptomatic treatment were performed.Three month later,clinical symptoms including hydrocele of tunica vaginalis,local pain and discomfort were diminished and semen quality was improved.The blood backflow in bilateral varicocele after Valsalva exercise and hydrocele of tunica vaginalis in both testes were not found by ultrasound detection.All of the evidence indicated that the postoperative transient symptoms were due to imperfective circulation of lateral branch which were quite common in such kind of operation.In summary,after reviewing the case and relative literatures,we suggested that indications for reoperation of varicocele should be strictly cautious,unless there are the evidences of the recurrence of varicocele or original complains are not improved.The observation and symptomatic treatment are only suggested for the patients with difficult to judge in order to avoid unnecessary reoperation.The best choice is to make a comprehensive judgment three to six months follow up after operation.