Impact of microscopic intermediate sub inguinal varicocelectomy on varicocele and infertility

Abstract

Varicocele is primarily tortuous dilation of the internal spermatic veins [ISV] and pampiniform plexus in the scrotum. It is the most common correctable cause of infertility. It has a higher prevalence in primary and secondary infertile in men. In this article, we reviewed the advantages and disadvantages of microscopic intermediate sub inguinal [MISV] varicocelectomies over conventional surgical methods. Although various mechanisms are postulated for pathogenesis, increased venous reflux is accepted as the predominant cause. Varicocelectomy is done to ligate the veins and reduce venous reflux without affecting the arteries, vas deferens and lymphatics. Open, laparoscopic and microscopic varicocelectomies are the different surgical approaches of varicocele. Embolization is another treatment option. MISV is a relatively novel technique and considered superior to the conventional treatment approaches because of increased spontaneous pregnancy rates, reduced recurrence, increased seminal parameters and fewer postoperative complications, as evidenced by many studies. Microscopic visualization and usage of micro-doppler in surgery improves safety. Absolute indications for varicocelectomy are documented infertility, clinically palpable varicocele abnormal seminal parameters and potentially treatable female infertility or normal fertility. Persistent pain, discrepancies in the testicular volume of more than 20% and hypogonadism are considered as relative indications for varicocelectomies. MISV should be regarded as the gold standard treatment method for varicocele.