Outcome of loupe assisted sub-inguinal varicocelectomy in infertile men

ABSTRACT

Sub-inguinal varicocelectomy has gained wide reputation among surgeons. The aim of this study was to evaluate outcome of varicocelectomy using a modified microsurgical method, specifically a loupe assisted one, and its effects on sperm parameters in infertile men. This study was carried out in 40 patients who presented with varicocele. All patients had at least a 1-year history of infertility with abnormal semen parameters and varicocele proven by physical examination and confirmed with color Doppler ultrasound. Routine investigations as required preoperatively were done. Semen analysis and hormonal profile was also done and repeated postoperatively for follow up. Half of the patients [20 patients] were treated by subinguinal approach assisted with loupe magnification [Group-A] and the other half was treated by the same approach but without magnification [Group-B]. To facilitate the procedure, an x3.0 loupe was used during the spermatic cord dissection at the level of the external inguinal ring. During dissection, the dilated veins were ligated and divided including vassal veins and external spermatic veins. A total of 40 patients were followed up for more than 6 months. Age of the patients varied from 25 to 38 years [mean 32.5]. No intra-operative complications occurred in both groups. As regard post-operative complications, group [A] [loupe assisted] showed only one patient [5%] who developed scrotal hematoma and two [10%] developed wound infection, while in group [B] complication rate was higher, two cases [10%] developed scrotal hematoma, two cases [10%] developed wound infection, three cases [15%] developed hydrocele, two cases [10%] developed recurrence and two cases [10%] developed scrotal edema. As regard to seminal parameters there was much improvement in sperm count, sperm motility and decrease in abnormal forms after surgery with significant differences in Group A [patients treated with a modified microsurgical method] but in Group B [patients treated with sub-inguinal approach without loupe assistant] there was improvement in sperm count, sperm motility and decrease in abnormal forms but without significant differences. Loupe-assisted sub- inguinal varicocelectomy is a safe, simple, and effective method for the treatment of sub-fertile men, especially in medical facilities without microscopic equipment and has significant improvement in sperm parameters