To assess the factors predicting symptomatic relief by varicocelectomy in patients with normospermia and painful varicocele nonresponsive to conservative treatment.

A total of 76 men with left painful varicocele and normal semen quality were recruited for the present prospective study. The patients who showed complete or partial resolution of pain 6 months after varicocelectomy were designated as responders, and those who did not have improvement were designated as nonresponders. The predictive factors examined included the number of ligated veins, preoperative pain score, duration of pain, body mass index, scrotal temperature, the distance from the renal hilum to the scrotum, the serum concentration of follicle-stimulating hormone, luteinizing hormone, and testosterone, grade of varicocele, peak retrograde flow, and maximal vein diameter on color Doppler ultrasound scans.

Of the 76 patients, 55 (72.4%) were responders and 21 (27.6%) were nonresponders, with a mean age of 31.8 and 32.4 years, respectively. The responders had a significantly greater number of ligated veins, preoperative pain score, and longer duration of pain than the nonresponders. No significant differences were found in body mass index, scrotal temperature, distance from the renal hilum to the scrotum, peak retrograde flow, follicle-stimulating hormone, luteinizing hormone, testosterone, and maximal vein diameter between the responders and nonresponders.

The findings of the present study suggest that the factors predicting symptomatic relief by varicocelectomy in patients with normospermia and painful varicocele nonresponsive to conservative treatment are a greater number of ligated veins (>7), greater preoperative pain score (>6), and longer duration of pain (>9 months).