Clinical outcome of microsurgical subinguinal varicocelectomy in infertile men

Jungwirth, A.; Göğüş, Çağatay; Hauser, Goran; Gomahr, A.; Schmeller, N.; Aulitzky, W.; Frick, J.

doi:10.1046/j.1439-0272.2001.00407.x

Cited by 45 publications

(32 citation statements)

References 16 publications

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“…To compare spontaneous pregnancy rates among the techniques used for varicocele repair, the approaches in this review included retroperitoneal high ligation (Palomo technique) with 10 studies (Cockett et al, 1984; Baker et al, 1985; Menchini‐Fabris et al, 1985; Rageth et al, 1992; Hirokawa et al, 1993; Nieschlag et al, 1993; Madgar et al, 1995; Shlansky‐Goldberg et al, 1997; Çayan et al, 2000; Watanabe et al, 2005), microsurgical subinguinal or inguinal technique with 12 studies (subinguinal, 7; inguinal, 5; 1 study to compare both approaches; Goldstein et al, 1992; Ito et al, 1993; Marmar and Kim, 1994; Çayan et al, 2000, 2002; Jungwirth et al, 2001; Kamal et al, 2001; Perimenis et al, 2001; Kumar and Gupta, 2003; Orhan et al, 2005; Watanabe et al, 2005), laparoscopic varicocelectomy with 5 studies (Mehan et al, 1992; Jarow et al, 1993; Enquist et al, 1994; Milad et al, 1996; Watanabe et al, 2005), radiologic embolization with 6 studies (Vermeulen et al, 1986; Yavetz et al, 1992; Nieschlag et al, 1993; Ferguson et al, 1995; Shlansky‐Goldberg et al, 1997; Nabi et al, 2004), and macroscopic inguinal (Ivanissevich) with 3 studies (Newton et al, 1980; Marks et al, 1986; Yavetz et al, 1992). To compare postoperative recurrence and hydrocele formation rates among the techniques used for varicocele repair, the analysis included retroperitoneal high ligation with 4 studies (Yavetz et al, 1992; Çayan et al, 2000; Ghanem et al, 2004; Watanabe et al, 2005), microsurgical technique with 10 studies (subinguinal, 6; inguinal, 4; 1 study to compare both approaches; Goldstein et al, 1992; Ito et al, 1993; Marmar and Kim, 1994; Çayan et al, 2000; Jungwirth et al, 2001; Kamal et al, 2001; Ghanem et al, 2004; Orhan et al, 2005; Watanabe et al, 2005), laparoscopic varicocelectomy with 5 studies (Mehan et al, 1992; Jarow et al, 1993; Enquist et al, 1994; Milad et al, 1996; Watanabe et al, 2005), radiologic embolization with 3 studies (Yavetz et al, 1992; Nabi et al, 2004; Tanahatoe et al, 2004), and macroscopic ...…”

Section: Methodsmentioning

confidence: 99%

Treatment of Palpable Varicocele in Infertile Men: A Meta‐analysis to Define the Best Technique

Çayan

Shavakhabov

Kadıoğlu

2009

Journal of Andrology

344

261

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To date, there have been no randomized, controlled, prospective clinical studies that compare various techniques to describe the best method for the treatment of varicocele in infertile men. This meta-analysis aims to address the best treatment modality for palpable varicocele in infertile men. A MEDLINE search was performed for articles published between January 1980 and April 2008, and we analyzed 36 studies reporting postoperative spontaneous pregnancy rates and/or complication rates after varicocele repair using various techniques in infertile men with palpable unilateral or bilateral varicocele. Spontaneous pregnancy rates and postoperative complications such as hydrocele formation, recurrence, or persistence were compared among the techniques. In addition, interventional failure with radiologic embolization and reported complications with the laparoscopic approach were reviewed. Overall spontaneous pregnancy rates were 37.69% in the Palomo technique series, 41.97% in the microsurgical varicocelectomy techniques, 30.07% in the laparoscopic varicocelectomy techniques, 33.2% in the radiologic embolization, and 36% in the macroscopic inguinal (Ivanissevich) varicocelectomy series, revealing significant differences among the techniques (P 5 .001). Overall recurrence rates were 14.97% in the Palomo technique series, 1.05% in the microsurgical varicocelectomy techniques, 4.3% in the laparoscopic varicocelectomy techniques, 12.7% in the radiologic embolization, and 2.63% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (P 5 .001). Overall hydrocele formation rates were 8.24% in the Palomo technique series, 0.44% in the microsurgical varicocelectomy techniques, 2.84% in the laparoscopic varicocelectomy, and 7.3% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (P 5 .001). We conclude that the microsurgical varicocelectomy technique has higher spontaneous pregnancy rates and lower postoperative recurrence and hydrocele formation than conventional varicocelectomy techniques in infertile men. However, prospective, randomized, and comparative studies with large number of patients are needed to compare the efficacy of microsurgical varicocelectomy with that of other treatment modalities in infertile men with varicocele.

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Section: Methodsmentioning

confidence: 99%

Treatment of Palpable Varicocele in Infertile Men: A Meta‐analysis to Define the Best Technique

Çayan

Shavakhabov

Kadıoğlu

2009

Journal of Andrology

344

261

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“…One patient with maturation arrest established pregnancy. Jungwirth et al (19) assessed the long-term results in 272 patients who had undergone subinguinal microsurgical varicocelectomy operations for clinical varicoceles. In nearly all the patients, there was a significant improvement in sperm count and sperm motility after 3 and 6 months.…”

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confidence: 99%

Sperm count and sperm motility in incidental high-grade varicocele

Zargooshi

2007

Fertility and Sterility

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“…[16][17][18] Kattan et al 19 reported that the proportion of cases in which preservation of the artery was possible after conventional laparoscopic varicocele ligation was 55%. Although we had tried to preserve the testicular artery and lymphatics in all cases, the testicular artery was spared in just five (26.3%) patients who underwent LESS.…”

Section: Discussionmentioning

confidence: 99%

Umbilical laparoendoscopic single site surgery versus inguinal varicocelectomy for bilateral varicocele: A comparative study

et al. 2011

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Abstract:We aimed to determine the efficacy of umbilical laparoendoscopic single site surgery (LESS) bilateral varicocelectomy on the basis of a comparative study versus open inguinal bilateral varicocelectomy. We enrolled 39 patients who underwent bilateral varicocelectomy with predetermined surgical indications at two hospitals with either the LESS (n = 19) or the open inguinal approach (n = 20). Operative time, operation-related pain (10-point visual analog pain scale), catch-up growth of the testes, semen parameters, and complications after surgery between the LESS group and the open group at 3 months after surgery were compared. Operative times were 46.8 and 72.8 min (P < 0.001) in the LESS and open surgery groups, respectively. Patients in the LESS group reported lower surgery-related pain than those in the open surgery group at 3 months (2.5 vs 1.2, P = 0.029). A significant improvement in terms of semen concentration, motility, catch-up growth of the bilateral testes was observed in both groups, although no significant differences were detected between the groups. Postoperative complications were also similar between the two groups. LESS varicocelectomy required a shorter operative time than inguinal varicocelectomy for bilateral cases. In addition, the LESS procedure showed less postoperative pain and cosmetic benefits with similar seminal outcomes. Thus, LESS for patients undergoing bilateral varicocelectomy represents a promising surgical approach.

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Clinical outcome of microsurgical subinguinal varicocelectomy in infertile men

Cited by 45 publications

References 16 publications

Treatment of Palpable Varicocele in Infertile Men: A Meta‐analysis to Define the Best Technique

Treatment of Palpable Varicocele in Infertile Men: A Meta‐analysis to Define the Best Technique

Sperm count and sperm motility in incidental high-grade varicocele

Umbilical laparoendoscopic single site surgery versus inguinal varicocelectomy for bilateral varicocele: A comparative study

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