Comparison of the pulling technique versus the standard technique in microsurgical subinguinal varicocelectomy: a randomized controlled trial

We compare the outcome of microsurgical subinguinal varicocelectomy (MSV) using the pulling technique (P-MSV) compared to the standard technique (S-MSV). A total of 60 patients were diagnosed with varicocele compounded with infertility and/or scrotal pain not responding to medical treatment. Twenty-nine patients were randomized to the P-MSV, while 31 were randomized to S-MSV. The number of ligated veins was counted intraoperative and compared. Follow-up was done at 1 and 3 months including clinical examination, scrotal duplex ultrasound scan, and semen analysis. A total of 85 sides were operated upon, 43 (50.5%) were done by the P-MSV technique while 42 (49.5%) were done by the S-MSV technique. The median gained cord length after using the P-MSV was [3 cm; IQR 2–5 cm]. For the P-MSV technique, the mean number of detected internal spermatic veins after cord pulling was (4 ± 1.3 SD) compared to (6 ± 1.4 SD) before pulling (P value < 0.01) and for the S-MSV was 3 (2.75–5). There was no statistical or clinically significant difference in the perioperative outcomes between both groups. The overall conception rate was 47.1%. Ninety-two percent of patients complaining of preoperative scrotal pain had resolution of the pain on follow-up with no statistical difference between both techniques (P values 0.53, 0.3 respectively). There was no statistical difference in the recurrence rate between both groups (P = 0.11). The number of ligated veins decreased significantly using the P-MSV technique leading to an improvement in the surgical feasibility of MSV. There is a significant benefit for the new pulling technique in decreasing the number of internal spermatic veins which leads to improving the surgical feasibility of microsurgical varicocelectomy.