Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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Fig. 26.7. Hydrodissection of residual nerve fibers on perivasal tissue (From
Brahmbhatt et al. [ 3 ], with kind permission Springer Science + Business Media).
Varicocelectomy for Chronic Scrotal Content Pain
Introduction
Varicoceles are an abnormal enlargement of the pampiniform venous
plexus veins within the scrotum. This abnormal enlargement is linked to
low sperm counts, decreased sperm quality, infertility, testicle atrophy,
and pain. Varicocelectomy (ligation of the enlarged veins) is often performed
on its own for fertility, hypogonadism, or in extreme cases, for
management of chronic pain. It is performed alongside a targeted denervation
if varicoceles are clinically present.
From June 2008 to September 2014, 264 robotic-assisted varicocelectomies
were performed in 220 patients. Indications for the procedure
were the presence of a grade two or three varicocele and the following
conditions: azoospermia in 20 patients, oligospermia in 63 patients, and
chronic orchialgia with or without oligospermia in 137 patients. The
median duration per side was 25 min (10–80). Median follow-up was 36
months (1–76). 80 % with oligospermia had a significant improvement
in sperm count or motility and 30 % with azoospermia converted to