Introduction: Sonographic imaging is a frequently used tool in the evaluation for varicoceles. However, the value of scrotal ultrasound (US) in men with scrotal pain and clinically palpable varicoceles remains uncertain. The objective of this study is to examine the role of pre-operative scrotal US prior to treatment of symptomatic palpable varicoceles and evaluate the association between US findings and outcome of varicocele treatment for scrotal pain.
Methods: We performed an IRB-approved, retrospective review of all patients who underwent sub-inguinal microscopic varicocelectomy for scrotal-content pain between July 2017 and June 2021. Only patients presenting with at least a 3-month history of “classic” varicocele pain and diagnosed with a palpable varicocele were offered varicocelectomy. Some men proceeded to varicocele treatment without US imaging. For this study, pre-operative scrotal US images were reviewed, and men were categorized as having “ultrasound-confirmed varicocele” if images demonstrated varicocele on the same side as the symptomatic varicocele. Visual analog pain scale (VAS) score was obtained pre- and post-treatment. Successful treatment of pain was defined as >50% improvement in VAS pain score.
Results: Fifty patients underwent varicocelectomy for scrotal content pain. Fifteen (30%) patients proceeded to surgery without preoperative imaging, and all 15 patients experienced >50% improvement based on VAS pain score, with 13 ( 86.7%) patients experiencing complete pain resolution. Of the 35 patients who had preoperative US imaging, 18 (51%) patients had confirmation of the varicocele.
Post-operative pain outcomes were identical between those who had ultrasound-confirmed varicoceles and those who had an ultrasound that did not demonstrate a varicocele, both in terms of overall success rates (94.4% vs 94.1%, p =1.00) and complete pain resolution (55.6% vs 58.8%, p=0.845).
Conclusions: Most patients with symptomatic palpable varicoceles experience pain relief after varicocelectomy. Men who have a clinically palpable varicocele but no evidence of varicocele on imaging can expect similarly high success rates of pain relief after varicocelectomy. Therefore, preoperative scrotal ultrasounds are not indicated.