Microsurgical Subinguinal Varicocelectomy

Park, Kwanjin; Kim, Soo Woong; Paick, Jae Seung

Abstract

PURPOSE: Varicocelectomy is a commonly performed procedure for the treatment of uncomfortable scrotal swelling as well as for infertile males. It is well known that conventional varicocelectomy is often associated with substantial risks of hydrocele formation, varicocele recurrence, and ligation of testicular artery. In 1992, Goldstein et al described the microsurgical technique of varicocelectomy. For this study we have performed 32 cases of microsurgical subinguinal varicocelectomies and analysed the results to verify their efficacy and safety. MATERIALS AND METHODS: For this study we performed microscopic varicocelectomies in 32 patients, and the follow-up period extended from 11 months to 56 months(mean 27 months). Preoperative and regular postoperative semen analyses were obtained on patients who underwent varicocelectomy for the treatment of infertility. During the operation the testicle is delivered through a small subinguinal incision, and all external spermatic and gubernacular veins are ligated. Then the testis is returned to the scrotum, and the spermatic cord is dissected under the operating microscopy. The testicular artery, vas deference, and lymphatics are identified and preserved, and all internal spermatic veins are ligated. RESULTS: During the follow-up there was no hydrocele and no clinical recurrence. One testicular artery was cut accidently during operation and immediately reanastomosized. And one case of hematoma and two cases of mild testicular discomfort were observed. The changes in sperm count, percent of motility, and percent of normal forms were highly significant. The pregnancy rate was 39%. CONCLUSIONS: Delivery of testis through a small inguinal incision provides direct visual access to all possible avenues of testicular venous drainage. The operating microscope allows identification of the testicular artery, lymphatics and small venous channels. This minimally invasive technique results in a significant decrease in the incidence of hydrocele formation, testicular arterial injury and recurrence.