Inguinal optic loupe varicocelectomy

ABSTRACT

Microsurgical loupe inguinal varicocelectomy has been associated with relatively high success rates and minimal postoperative complications. The aim of this study is to analyze the results of a group of patients who underwent inguinal microsurgical varicocelectomy using optic loupe magnifications. From April 2003 to April 2007, 72 patients underwent loupe-assisted inguinal varicocelectomy. In 68 patients [94.3%][the varicoceles were left sided, in 1 patient [1.3%] it was right sided and they were bilateral in 3 patients [4.1%]. The mean age was 26.9 years [range 16.42]. Fifty four patients [75%] were infertile and 18 patients [25%] had painful scrotal sensation, in 6 of them oligoasthenospermia [OAT] was detected. The diagnosis was based on clinical features namely testicular pain and, or scrotal hypersensation and physical examination. Color duplex ultrasonogrphy [CDUS] was performed in persistent cases. The majority of varicoceles were stage II and III, of them 5 [6.9%] were persistent cases. In 10 patients [13.9] OAT was mild [sperm number 10-20 millions], In 30 patients [41.6%] was moderate [5.10 millions] and in 18 [25%] was severe [less than 5 millions]. Azoospermia was detected in 2 patients [2.7%]. Furthermore, 12 patients [16.6%] had normal spermiogram. The loupe-assisted microsurgical inguinal "artery-and lymphatic-sparing" technique of dissection was performed under general anesthesia. All operations were performed as outpatient procedures [postoperative stay 3.7 hours] and the mean operating time was 45 minutes [30.55]. Follow up was performed by physical examination and semen analysis. Color duplex ultrasonogrpahy [CDUS] was done only if persistence was suspected. Immediate and long-term complications were hydrocele in 1 patient [1.3%], palpable persistence in 4 patients [5.2%] and found abscess in 1 patient [1.3%]. Forty four out of sixty [73.3%] patients showed an improvement of semen analysis and from the 30 patients who continued follow up, 14 [47%] have conception. Finally 6 out of 18 patients [33.3%] who presented with scrotal pain have their pain disappeared. Loupe-assisted inguinal varico-celectomy is a safe and effective method. It preserves spermatic artery and lymphatics and minimizes the risk of complications and persistence. In our experience this technique of varicocelectomy showed an improvement of semen analysis and the results are comparable to those obtained by the standard microsurgical technique using the microscope