Microsurgical subinguinal varicocelectomy-technique and preliminary results

ABSTRACT

INTRODUCTION@#Varicoceles represent the most common attributable cause of primary and secondaryinfertility in the male. A number of studies have established the effect of performing varicocelectomyin order to improve semen parameters. Several techniques of varicocelectomy has been described inliterature, however, the microsurgical technique has been considered as the gold standard in doingthis procedure.@*OBJECTIVES@#The study primarily aims to establish the effect of microsurgical varicocelectomy onpostoperative semenalysis when compared to baseline semenalysis. It also aimed to establish theimpregnation rate and the span at which impregnation occurs following varicocelectomy. Lastly, thestudy also describes the technique and modifications of microsurgical subinguinal varicoelectomyperformed by a single surgeon using an operating microscope and microdoppler throughout theprocedure.@*MATERIALS AND METHODS@#Microsurgical subinguinal varicocelectomy was performed on 37 patients inSLMC from June 2015 to May 2017 by a single microsurgeon (DGL). Patient age, varicocele grade,operative time, intraoperative findings, postoperative complication, and 3-month follow-upsemenalysis results were recorded and compared. Successful impregnation of the partner and thenumber of months from the operation to the successful impregnation were also recorded.@*RESULTS@#Three months postoperative semenalysis parameters were compared to the baselinesemenalysis. The total sperm motility was noted to have increased from 27.95± 15.02 to 50.95±12.60,postoperatively with p-value of 0.010. There was no significant difference observed in the totalcount, concentration, and percent immature forms. Eleven or 30% of patients were able tosuccessfully impregnate their partners in an average span of 9 months from the time of surgery.@*CONCLUSION@#In their experience, Microsurgical subinguinal varicocelectomy has improved the semenanalysis after 3 months with a 30% chance of impregnation at an average span of 9 months,postoperatively. Furthermore, the use of microdoppler ultrasound in microsurgical varicocelectomyfacilitated better identification of the testicular arteries.