Evaluating the Efficay of Microscopic Varicocelectomy in the Treatment of Primary and Recurrent Varicocele

Abstract

Introduction: Varicocele is the most common and correctable cause of male infertility. Microscopic subinguinal varicocelectomy is the golden standard in the treatment of this disease, and recurrence is the most common complication. The aim of this study was to investigate the outcomes of microscopic varicocelectomy in primary and recurrent varicocele. Materials and Methods: The data of 20 patients undergoing left subinguinal microscopic varicocelectomy due to left varicocele for the first time and 20 patients undergoing the same operation for the second time due to recurrence between April 2015 and May 2017, were retrospectively evaluated. Semen analyses, testicular volumes and complication rates were compared between the groups both prior to and 12 months after the operation. Findings: The mean age was 30.2±1.4 in the primary varicocele group and 31.3±1.1 in the recurrent varicocele group (p>0.05). No significant difference was observed between the preand the post-operative values of testicular volume in patients undergoing primary microscopic varicocelectomy (3.2±1.4 ml and 3.1±1.7 ml, respectively; p>0.05); however, a significant improvement was observed in sperm count, motility and morphology parameters (10.3±2.9 millions/ml, 28.2±7.8%, 2.2±1.4% and 11.3±3.3 millions/ ml, 30.2±6.8%, 2.5±1.8%, p<0.05). In the recurrent varicocele group, no significant difference was observed between the preand post-operative semen volume (3.23±1.7 ml and 2.4±1.6 ml, p>0.05), whereas a significant improvement was observed in sperm concentration, morphology and motility parameters (9.6±3.3 millions/ml, 20.3±4.5%, 2.3±1.7% and 11.6±2.6 millions/ml, 23.2±7.5%, 2.5±1.9%, p<0.05). The testicular volume was observed to have increased in the post-operative period in both primary and recurrent varicocele groups (12.5±2.6 ml and 13.2±3.4 ml vs (11.8±2.4 ml and 12.3±2.7 ml), which was not statistically significant (p>0.05). Conclusion: Microscopic subinguinal varicocelectomy, which is related to the highest success rates and lowest recurrence and complication rates in the treatment of varicocele, may be safely used in the treatment of recurrent varicocele as well. Introduction Varcicocele is one of the most common and correctable pathologies observed in males presenting to urology clinics due to infertility [1]. The incidence in the normal population is 10-15%; however, it may be as high as 40% among patients with primary infertility and 80% among those with secondary infertility [2]. Varicocele is characterized by impairment in sperm count, motility and morphology parameters, reduced testicular volume and Leydig cell dysfunction, and leads to infertility [3]. The disease should be treated in case of diagnosed varicocele in the patient with infertility via physical examination or radiological imaging, if more than one parameter in seminal analysis is impaired and when no pathology that may lead to infertility is detected in his sexual partner [3,4]. One of the most common complications observed following varicocele surgery is recurrence. Ineffective venous ligation and anatomical variants have been shown as the common causes of the recurrence observed [5]. Some investigators have related collateral reflux to recuurence as well [6,7]. The rates of recurrence may be as high as 29% in high ligation, whereas it may be as low as 1% in the microscopic subinguinal approach [8,9]. The aim of this study was to investigate the outcomes of microscopic varicocelectomy in patients undergoing left subinguinal microscopic varicocelectomy due to left varicocele diagnosed for the first time and patients undergoing the same operation for the second time due to recurrence. Materials and Methods The data of 20 patients undergoing left subinguinal microscopic varicocelectomy in our clinics due to left varicocele for the first time and 20 patients undertaken the same operation for the second time due to recurrence between April 2015 and May 2017, were retrospectively evaluated. All examinations were done 1 Volume 2018; Issue 01 Citation: Erdem E (2018) Evaluating the Efficay of Microscopic Varicocelectomy in the Treatment of Primary and Recurrent Varicocele. Adv Androl Gynecol: AAG-106. DOI: 10.29011/AAG-106. 000006 by one examiner (an experienced urologist) with the patients in the upright position. The clinical guidelines for grading were defined as follows: Grade 3: typical appearance on inspection, Grade 2: typical ‘bag of wonns’ sensation on palpation, Grade 1: typical Valsalva/cough induced impulse, and Grade 0: imaging based (with uncertain clinical significance). Associated symptoms/signs were pain, infertility and atrophy. Semen was obtained by masturbation at the laboratory after a minimum of 3 days abstinence, each case one specimen. Specimens were examined within a quarter hour of collection and assessed for volume, sperm concentration, motility, and morphology. Sperm counts were performed with a Neubauer chamber, motility was evaluated under light microscopy, and morphology was assessed after preparation with Fuschin stain. All patients underwent left surgical repair of varicocele. Sub-inguinal approach assisted by loupe magnification was performed by the surgical team. They all received the pre-surgical guidelines and signed an informed consent form. Patients were discharged from the hospital on the same day as the surgical procedure. Age, semen analysis parameters, testicular volumes and complication rates were compared between the groups both prior to and 12 months after the operation. Statistical analysis was performed using the SPSS for Windows, Version 22 program package (SPSS, Chicago, IL, USA). The Wilcoxon test was used to analyze the data of the NMCV group, and the Paired Sample T testi was used to evaluate the data of the PMCV group. The Independent Samples T test was used for the comparison between the groups; a p value of <0,05 was accepted as statistically significant.