Comparison of Two Different Microsurgical Methods in the Treatment of Varicocele

Abstract

& We reviewed records from patients who underwent two different microsurgical varicocelectomy methods: 147 (high inguinal (MHIV) and 65 sub-inguinal (MSIV) microsurgery) to compare the therapeutic activity and complications. Patients who had 2 different microsurgical varicocelectomies were compared according to preoperative connected vein, number of designated arteries, postoperative semen and improvement degree in hormone parameters, increased ratio related with pregnancy and complications. The ratio of improvement of postoperative semen parameters in patients where MHIV and MSIV were performed was, 42% and 38% (p > 0.05). Pregnancy was achieved in MHIV at a ratio of 41% (34=82) and 33% (22=65) in MSIV (p > 0.05). There was no significant difference according to mean operation periods, the vein connected between the groups. The number of testicular arteries were significantly higher than the ones in MHIV (p < 0.01). However, as a postoperative complication, hydrocele was not seen in any of the patients, while relapses occurred in 1 MHIV and 2 MSIV patients. MHIV and MSIV techniques are effective methods to treat varicocele. However, the excess number of connected veins due to the anatomic feature of MSIV increases the possibility of relapses and the technical difficulty during surgical intervention.

Comparison of Two Approaches in Microsurgical Varicocelectomy in Chinese Infertile Males

“…Nonetheless, the difference between the two groups was not statistically significant. This was identical to the report of Orhan et al in Turkey [19], and was similar to the conclusion of Gontero et al [11] in which they commented that the difference of only 4 min in the duration of two operations was unlikely to be clinically significant. Accordingly, these results remind us that the difficulties of MIV and MSIV are similar regardless of anatomic or vessel differences in the two approaches, while further improvement of techniques with higher magnification is needed.…”

“…From another perspective, the differences between our results and those of Gontero et al [11] might be partly explained by the fact that the patients included in our study were merely infertile males, while patients with other reasons for surgery were also included in their study. The duration of surgery in this study was longer than that reported by some other studies (25-52.36 min) [7,11,19]. This might be explained by the fact that the ocular magnification was only 8 in this study, thus longer surgical time was needed when compared with others using higher magnification techniques.…”

“…To better assess the postoperative fertile status, this study only included infertile men with palpable varicocele who had at least one low semen parameter on three samples, and excluded patients with subclinical varicocele or aspermia, or whose spouse's pregnancy was achieved with assisted reproductive techniques postoperatively. As a result, the two groups were similar (33.9% in MIV and 30.4% in MSIV) in postoperative spontaneous pregnancy rates, and both were a little bit lower than those shown in other studies (33-42.85%) [7,8,9,19]. From another perspective, all the sperm parameters were significantly improved postoperatively in both groups and there were no significant differences between the two groups.…”

Microanatomy of the spermatic cords during microsurgical inguinal varicocelectomy: initial experience in Asian men

“…7,8 Ramasamy and Schlegel 11 found that a varicocelectomy without testicular delivery has equivalent or more beneficial effects on semen parameters without affecting varicocele recurrence rates. Orhan et al 12 thought that both inguinal and subinguinal approach microsurgeries were effective methods to use for varicocelectomy. We chose to perform the inguinal varicocelectomy without testicular delivery.…”

Clinical Outcomes of Varicocele Repair in Infertile Men: A Review

“…Similarly to the subinguinal approach, all of the internal spermatic veins are identified and ligated under microscopy, and the testicular artery and lymphatics are preserved [41]. Several articles have argued that microsurgical inguinal varicocelectomy is the treatment of choice because this approach produces similar outcomes to the subinguinal approach via a simple surgical technique [474849]. One drawback of this approach is that it results in greater intraoperative pain when performed under local anesthesia.…”