Varicocelectomy with primary gubernaculum veins closure: A randomised clinical trial

Abstract

To evaluate the effect of microsurgical inguinal varicocelectomy with testicular delivery on semen parameters. A total of 416 patients, diagnosed with grade III varicocele, were randomised into two groups. One group underwent microsurgical inguinal varicocelectomy without testicular delivery. For the other group, testicular delivery and ligation of gubernacular and all collateral veins were performed. A semen analysis was performed before and 6 months after the procedure. Mean age of the patients in the case and control groups was 27.3 ± 6.1 years and 25.9 ± 4.6 years respectively (p = .1). The total number of recurrence after 6 months in the conventional and testicular delivery groups was 13 (6.5%) and 3 (1.5%) (p < .05). No case of hydrocele formation was observed in any of the groups. All sperm parameters were improved 6 months after the surgery in both groups. But comparing the mean improved difference between the two groups revealed a significant difference in improvement in sperm motility for patients who had undergone varicocelectomy with testicular delivery (p = .05). Microsurgical inguinal varicocelectomy is a safe and efficient technique with a minimum chance of post-operative complications and recurrence and also may have role in improvement of sperm motility compared with conventional techniques.

Comparison between microsurgical varicocelectomy with and without testicular delivery for treatment of varicocele: A systematic review and meta‐analysis

“…The remaining 15 studies were analysed for their full texts. After these analyses, seven studies were removed and eight articles containing five RCTs (Allameh et al, ; Hou et al, ; Li et al, ; Nie et al, ; Spinelli et al, ) and three cohort studies (Choi et al, ; Ramasamy & Schlegel, ; Yang et al, ) remained. Detailed literature searching and screening steps process were listed in Figure .…”

“…Three studies (Allameh et al, ; Li et al, ; Yang et al, ) reporting grade II and III varicocele were enrolled in this study. In comparison with microsurgical varicocelectomy without TD, total sperm count (SMD = 0.23, 95% CI = 0.07–0.39, p = 0.258) was significantly increased in microsurgical varicocelectomy with TD, while sperm viability, sperm concentration and progressively motile spermatozoa had no difference between the two varicocelectomy approaches ( p > 0.05) (Figure and Table ).…”

“…However, Spinelli et al () found MIV with TD and ligation of all collateral and gubernacular veins obviously increased the left testicular volume than MIV without TD. On the other hand, Allameh et al () performed a RCT comparing the two approaches in MIV in patients with grade III varicocele. Neither of the two methods resulted in recurrence or scrotal oedema and the main distinction was that sperm motility was markedly increased in men with TD in MIV.…”

“…For the past few years, many studies on the effect of TD in microsurgical varicocelectomy have been carried out (Allameh et al, ; Choi, Park, Lee, & Hong, ; Hou, Zhang, Zhang, Huo, & Li, ; Li et al, ; Nie, Gao, Chen, & Wang, ; Ramasamy & Schlegel, ; Spinelli et al, ; Yang et al, ). However, these studies reported inconsistent and conflicting results and the deficient sample capacity in studies weakens the strength of evidence.…”

Evaluation of clinical effects of microsurgical subinguinal varicocelectomy with and without testicular delivery

“…And Ramasamy and Schlegel (2006) found MSV without testicular delivery offered more beneficial effect for semen quality without reducing the incidence of recurrence. However, Allameh et al (2018) found that MSV with testicular delivery could improve the sperm motility and per cent of normal morphology compared with that without testicular delivery. In a meta‐analysis published recently, it is found that MSV with testicular delivery could increase total sperm count in patients with grade II and III varicocele, while taking no benefits to sperm viability, sperm concentration and progressively motile spermatozoa (Song, Lu, Xu, Yang, & Liu, 2019).…”