ORIGINAL ARTICLE Long-term effects of microsurgical varicocelectomy on pain and sperm parameters in clinical varicocele patients with scrotal pain complaints A. Armag ˘ an 1 , O. Ergu ¨n 2 , E. Bas ¸ 2 , T. Oksay 2 & A. Kos ¸ ar 2 1 Department of Urology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey; 2 Department of Urology, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey Introduction Varicocele, the most common reversible cause of infertil- ity in men, is defined as venous dilatation and reflux occurring in the pampiniform plexus as a result of vari- ous aetiologic causes (Nagler et al., 1997). Its prevalence among healthy and infertile men is 15–22% and 30–40% respectively (Nagler et al., 1997). Treatment indications include infertility, pain and cosmetic reasons. Although it is generally asymptomatic in adults, scrotal pain and dis- comfort are detected in 2–10% of varicocele patients. The ideal treatment method of varicocele is still controversial. Several methods including open surgical ligation of spermatic vein, retrograde or anterograde sclerotherapy, microsurgery and laparoscopic varicocelectomy, have been used. Each technique has advantages and disadvantages, and controversial results have been obtained from different studies (Enquist et al., 1994; Ulker et al., 1997; Cayan et al., 2000; Pintus et al., 2001; Ghanem et al., 2004, Grober et al., 2004, Schiff et al., 2005; Cayan et al., 2005, May et al., 2006; Zini et al., 2006). Treatment for a pain- ful varicocele traditionally consists of conservative man- agement, followed by surgery if unsuccessful. We previously reported the short-term effects of microsurgical varicocelectomy on pain in patients with varicocele (Soyupek et al., 2006). In the present study, we aimed to examine the long-term effect of microsurgical varicocelec- tomy on testicular pain in patients with varicocele. Methods A total of 72 patients who had undergone microsurgical subinguinal varicocelectomy because of scrotal pain between 2004 and 2009 were included in the study. Local Keywords Microsurgical—pain—spermia parameters—subinguinal varicocelectomy Correspondence Abdullah Armag ˘ an, MD, Department of Urology, Faculty of Medicine, Bezmialem Vakif University, 34100 Istanbul, Turkey. Tel.: +90 2124531700 1706; Fax: +90 212621 7580; E-mail: aarmagantr@gmail.com Accepted: August 19, 2011 doi: 10.1111/j.1439-0272.2011.01238.x Summary We aimed to investigate the long-term effects of microsurgical varicocelectomy on pain improvement and sperm parameters in patients with varicocele-related pain. A total of 72 patients who had undergone microsurgical subinguinal varicocelectomy because of varicocele with scrotal pain between 2004 and 2009 were included in the study. The patients were grouped according to the pres- ence or absence of pain following surgical treatment. The patients expressing a decrease in frequency and severity of pain or minimal fullness sense were included in the pain-positive group. The mean follow-up period was 54.4 ± 18.06 months. There was left-sided varicocele in 80.3% of patients, while 19.7% had bilateral varicocele. In our study, complete success rate (Visual Analog Scale: 0–1) was found to be 79.2% (57/72), while failure (com- plete and partial failure) rate was 20.8% (15/72), and a significant difference was found (P < 0.05). Microsurgical subinguinal varicocelectomy is a reliable approach for clinically varicocele patients with scrotal pain complaints. Regard- less of the type of pain, varicocelectomy significantly decreases pain. The suc- cess of the treatment is not related to the degree of varicocele. ª 2011 Blackwell Verlag GmbH Andrologia 2012, 44, 611–614 611