Magnified and non magnified subinguinal varicocelectomy in infertile and/or symptomatic men: A comparative study of the outcome

Abstract

Objective: To compare the outcome of magnified and non magnified varicocelectomy for infertile and/or symptomatic men.
Patients and methods: One hundred and sixteen patients with 2nd and 3rd degree varicocele were treated in a university based hospital between January 2006 and July 2008. Sixty patients were randomly allocated to be operated upon by conventional subinguinal technique and this is the 1st group (9 patients of them with bilateral varicocele). Other 56 patients were operated upon by microsurgical subinguinal technique and this is the 2nd group (11 of them with bilateral varicocele). All patients were followed up at regular intervals, every 3 months for 3 years, 7 patients were lost during follow-up period, all of them with unilateral varicocele (3 patients from 1st group and 4 patients from 2nd group).
Results: Sixty-six varicocelectomies in the 1st group were done by conventional subinguinal technique (57 unilateral and 9 bilateral). Their results had been shown; 8 unilateral hydroceles (12.1%), 7 unilateral recurrences (10.7%) and one scrotal hematoma (1.5%). In the 2nd group total varicocelectomies were 63 (52 unilateral and 11 bilateral) had been done by microsurgical subinguinal technique resulting in no hydroceles and no scrotal hematomas but there were two unilateral recurrence (3%). The differences between the two techniques in the incidence of hydrocele formation and varicocele recurrence are significant (P < 0.001) and (P < 0.03) respectively.
Conclusion: Approaching the testis via a small subinguinal incision gives direct access to all testicular venous drainage. Furthermore, using the operating loupes helps to ease the recognition of the small venous channel, the testicular artery and the lymphatics, thus resulting in significant decrease of the incidence of varicocele recurrence, persistence, hydrocele formation and testicular artery injury. It is considered safe, effective and less morbid method for varicocelectomy.