ABSTRACT
Varicocele is the dilatation of pampiniform plexuses which can cause infertility. Incidence of varicocele is around 15-80 % and remains the most common treatable cause of infertility in men. The aim of this study was to identify the preferred method of varicocelectomy in patients with infertility, which gives optimal improvement in semen parameters. This study compares laparoscopic varicocelectomy and subinguinal varicocelectomy.METHODSThis is a prospective interventional study carried out in the Department of Urology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai from August 2017 to July 2019. We included patients with documented infertility with clinical varicocele. Only couples with no other attributable causes including female factors for infertility were included. Patients with previous history of surgery for inguinal hernia, testicular pathology were excluded from the study. We included 25 patients who satisfied the inclusion criteria. They were subjected to physical examination, doppler study and semen analysis. The patients were randomised into 2 groups, A & B by random allocation. Group A (12 patients) underwent laparoscopic varicocelectomy and group B (13 patients) underwent subinguinal varicocelectomy. All patients were regularly followed up at 3 months and 6 months period post-surgery.RESULTSReview at immediate post-operative period, follow ups at 3 & 6 months were undertaken. History of conception, clinical examination, semen analysis according to WHO 2010 manual and doppler studies by Sarchetsi scale were performed. Three factors in seminal parameters namely sperm concentration, motility & morphology were assessed. Varicocele recurrence was also assessed. There had been a statistically significant improvement in semen parameters in all the patients who underwent varicocelectomy (p value p< 0.005). On comparing the laparoscopic and sub-inguinal surgical techniques, there was no significant variation in increase in sperm concentration, sperm motility and morphology.CONCLUSIONSVaricocelectomy improves the semen parameters. No significant variation was observed when the different surgical approaches of varicocelectomy were compared.
ABSTRACT
Background: The link between varicocele and infertility was first reported by cessius in 1st century AD but it was not widely acknowledged until TULLOCH and colleagues reported the improvement of sperm parameters in 26 of 30 patients undergoing varicocelectomy. Varicocele is defined as excessive dilatation of pampiniform venous plexus of spermatic cord. varicocele is an important cause infertility which can be corrected by surgery. Several methods have been used for its treatment including open surgical ligation of spermatic veins as well as laparoscopic varicocelectomy. Open varicocelectomy has more risk of recurrence and complications whereas laparoscopic varicocelectomy is simple, has less risk of recurrence and complication in expert hands. Objectives: To compare Laparoscopic varicocelectomy with open varicocelectomy, in terms of postoperative pain, recurrence rate, hospital stay, cost, cosmetic and complication. To prove hospital stay was more in open group than laparoscopic group and also patient of laparoscopic group return to normal activities earlier than open group. To standardize the laparoscopic varicocelectomy procedure for varicocele. Materials and methods: It was a randomized clinical trial done in Department of General Surgery, Vinayaka Mission Medical College, Karaikal. Study was carried out from 1 st March, 2015 to 1st R. Bharathidasan, Reny Jayaprakash, Subith P. Bhaskar, G. Ambujam. Laparoscopic varicocelectomy now the gold standard procedure for varicocele - A comparative study with open technique based on our experience. IAIM, 2017; 4(7): 218-221. Page 219 March, 2016. A total 70 patients was taken in our study of its 36 patient undergone open varicocelectomy and 34 patient undergone laparoscopic varicocelectomy. Results: Recurrence rate 0% in Laparoscopic Varicocelectomy and 5.6% in open varicocelectomy. Wound complication was 0% in Laparoscopic varicocelectomy and 2.5% in open varicocelectomy. Post-operative pain was more in open group as compared to laparoscopic varicocelectomy. Laparoscopic varicocelectomy has less post-operative morbidity and early return to normal activity. Also there was improvement in seminal analysis in both groups. Conclusion: We would like to standardize laparoscopic varicocoelectomy and make it as a gold standard for Varicocele by replacing open technique provided there is good experienced surgical team and good instrumentation. Cost of the procedure is comparatively high.
ABSTRACT
The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy (LESSV) and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design (RCT and non-RCT). The odds ratio (OR) or standardized mean difference (SMD) and their 95% confidence intervals (95% CIs) were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work (overall: SMD = -1.454, 95% CI: -2.502-0.405, P = 0.007; non-RCT: SMD = -2.906, 95% CI: -3.796-2.017, P = 0.000; and RCT: SMD = -0.841, 95% CI: -1.393-0.289, P = 0.003) and less pain experience at 3 h or 6 h (SMD = -0.447, 95% CI: -0.754-0.139, P = 0.004), day 1 (SMD = -0.477, 95% CI: -0.905-0.05, P = 0.029), and day 2 (SMD = -0.612, 95% CI: -1.099-0.125, P = 0.014) postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect (improvement of semen quality and scrotal pain relief), and complications (hydrocele and recurrence) yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.
ABSTRACT
The aim of this study is to evaluate the benefits of laparoscopic Doppler ultrasound (LDU) application during laparoscopic varicocelectomy (LV), and to compare the surgical outcomes and complications between LDU-assisted LV (LDU-LV) and conventional LV for infertile patients with varicoceles; 147 infertile patients were randomly divided into two groups. Operative and postoperative parameters, semen parameters, and the pregnancy rate were compared. There were no differences in baseline demographics. The operative time was significantly longer in LDU-LV group than LV group. The incidence of postoperative hydrocele was 1.4% (1/72) in LDU-LV group versus 10.7% (8/75) in LV group, which showed a significant difference (P 0.05). In conclusion, compared with LV, LDU-LV could safely and effectively ligate all spermatic veins and preserve spermatic arteries without leading to high varicocele recurrence and postoperative hydrocele. Given the benefits that sperm counts as well as sperm motility favoring LDU-LV, we recommend that LDU should be routinely used as an effective tool to improve outcomes and safety of laparoscopic varicocelectomy.
ABSTRACT
Varicoceles had been recognized in clinical practice for over a century. Originally, these procedures were utilized for the management of pain but, since 1952, the repairs had been mostly for the treatment of male infertility. However, the diagnosis and treatment of varicoceles were controversial, because the pathophysiology was not clear, the entry criteria of the studies varied among centers, and there were few randomized clinical trials. Nevertheless, clinicians continued developing techniques for the correction of varicoceles, basic scientists continued investigations on the pathophysiology of varicoceles, and new outcome data from prospective randomized trials have appeared in the world′s literature. Therefore, this special edition of the Asian Journal of Andrology was proposed to report much of the new information related to varicoceles and, as a specific part of this project, the present article was developed as a comprehensive review of the evolution and refinements of the corrective procedures.
ABSTRACT
PURPOSE: Laparoscopic surgery has emerged as an alternative minimally invasive technique as compared to traditional open surgical techniques. We evaluated the efficiency and safety of laparoscopic varicocelectomy for the treatment of varicocele. MATERIALS AND METHODS: Between June 1996 and February 1998, laparoscopic varicocelectomywere performed in 10 patients whose ages ranged from 16 to 43 years at Chosun university hospital. We assessed success rate, hospital stay, operative time, and complications retrospectively. RESULTS: The varicocele was disappeared in all patients after laparoscopic varicocelectomy. The mean operative time was 68 minutes for unilateral varicocelectomy and 110 minutes for bilateral varicocelectomy. The internal spermatic artery was preserved in 9 of 10 patients. The mean hospital stay was 1.9 days. Complications included shoulder pain in 1 patient, cubcutaneous emphysema in 1 patient and pneumoscrotum in 2 patients but resolved with conservative management. CONCLUSIONS: We suggest that laparoscopic varicocelectomy is an effective, safe and a viable alterative to other operative technique with quick full recovery, short hospital stay, minimal analgesic requirement and minimal surgical trauma. But long-term follow up and prospective studies are needed to clarify the clinical effect of laparoscopic varicocelectomy.
Subject(s)
Humans , Arteries , Emphysema , Follow-Up Studies , Laparoscopy , Length of Stay , Operative Time , Retrospective Studies , Shoulder Pain , VaricoceleABSTRACT
PURPOSE: Laparoscopy is a signigicant step forward in the evolution of minimally invasive surgery and laparoscopic varicocelectomy can be an alternative approach to the conventional open surgery or embolization. MATERIALS AND METHODS: Between July, 1994 and July 1995, laparoscopic varicocelectomies were performed in 20 clinical patients whose age ranged 6-29 years. TITLES: Spermatic artery saving was performed successfully in 16 cases. Hospitalization was 1 day and only 1 patient complained of persistent scorotal discomfort and palpable varicocele mass(grade 1). Conclusions : Early return to normal activity, simplicity of spermatic vein dissection, preservation of spermatic artery, access to bilateral veins have do this new technique an alternatives to routine high ligation.