Clinical follow-up after subinguinal varicocele ligation to treat pain.

OBJECTIVE: To evaluate the usefulness of surgical treatment in patients with chronic orchialgia associated with varicocele and those for whom conservative treatment (jockstrap, non-steroidal anti-inflammatory drugs (NSAIDs) and restricted physical activity) was not effective. The response to spermatic vein ligation performed subinguinally with local anaesthesia was assessed in 25 patients with chronic testicular pain and varicocele as the only associated causal factor. Patient age, grade (according to Doppler study) and location of the varicocele, duration and degree of pain, response to treatment using an analogous pain scale pre- and post-surgery and complications pre- and post-surgery were recorded. Mean patient age was 28 years (range: 17-57) and time of pain evolution 14 months (range: 3-72). The varicocele was left-sided in 19 patients, bilateral in 4 and right-sided in 2, and grade III in 14 cases, grade II in 6 and grade I in 5. Subinguinal ligation of the spermatic vein was performed under local anaesthesia on an ambulatory basis in all cases. RESULTS: Twenty-two of the 25 patients (88%) reported resolution or evident improvement in their pain. The mean value on the pre-surgical pain scale was 64 (30-80). After a mean postoperative follow-up period of three months, the pain was reduced to a mean of 12. No perioperative complications were recorded; a post-operative hydrocele appeared in one case and the varicocele persisted in another. CONCLUSIONS: Ligation of the spermatic vein performed on an outpatient basis using a subinguinal approach and local anaesthesia is an effective treatment for chronic varicocele-associated testicular pain for patients in whom other therapeutic measures have failed.

Regulation of human penile smooth muscle tone by prostanoid receptors.

We have characterized the prostanoid receptors involved in the regulation of human penile arterial and trabecular smooth muscle tone. Arachidonic acid induced relaxation of human corpus cavernosum strips (HCCS) that was blocked by the cyclo-oxygenase inhibitor, indomethacin, and augmented by the thromboxane receptor (TP) antagonist, SQ29548, suggesting that endogenous production of prostanoids regulates penile smooth muscle tone. TP-receptors mediate contraction of HCCS and penile resistance arteries (HPRA), since the agonist of these receptors, U46619, potently contracted HCCS (EC50 8.3+/-2.8 nM) and HPRA (EC50 6.2+/-2.2 nM), and the contractions produced by prostaglandin F(2alpha) at high concentrations (EC50 6460+/-3220 nM in HCCS and 8900+/-6700 nM in HPRA) were inhibited by the selective TP-receptor antagonist, SQ29548 (0.02 microM). EP-receptors are responsible for prostanoid-induced relaxant effects in HCCS because only prostaglandin E1 (PGE1), prostaglandin E2 and the EP2/EP4-receptor agonist, butaprost, produced consistent relaxation of this tissue (EC50 93.8+/-31.5, 16.3+/-3.8 and 1820+/-1284 nM, respectively). In HPRA, both prostacyclin and PGE1 (EC50 60.1+/-18.4 and 109.0+/-30.9 nM, respectively) as well as the selective IP receptor agonist, cicaprost, and butaprost (EC50 25.2+/-15.2 and 7050+/-6020 nM, respectively) caused relaxation, suggesting co-existence of IP- and EP-receptors (EP2 and/or EP4). In summary, endogenous production of prostanoids may regulate penile smooth muscle contractility by way of specific receptors. TP-receptors mediate contraction in HCCS and HPRA, while the relaxant effects of prostanoids are mediated by EP2- and/or EP4-receptors in HCCS and by EP- and IP-receptors in HPRA.