Microsurgical Varicocelectomy: Experience of Our Sub-Subinguinal Approach and Review of the Literature

Abstract

Objective. To discuss the experience with a novel surgical approach in the treatment of varicocele for fertility or pain in 772 patients. Methods. Retrospective analysis of 772 patients undergoing microsurgical sub-subinguinal (SSI) varicocelectomy in our hospital and the discussion of historical surgical approaches. Results. A total of 690 patients with left varicocele underwent surgical treatment for infertility (n = 519) and pain (n = 171). The sperm concentrations (mean ± standard deviation (SD)) of 519 patients measured preoperatively, 6 months postoperatively, and 12 months postoperatively were 19.24 ± 3.69 (106/ml), 27.42 ± 10.32 (106/ml), and 34.20 ± 16.29 (106/ml) ( ${\hspace{0.17em}}^{\ast \ast }P<0.01$ ), respectively. The sperm motilities (mean ± SD) of 519 patients measured preoperatively, 6 months postoperatively, and 12 months postoperatively were 13.78 ± 3.25, 20.98 ± 8.21, and 27.59 ± 13.71 (grade (a + b) %) ( ${\hspace{0.17em}}^{\ast \ast }P<0.01$ ), respectively. Pain was released surgically in 131 (76.6%) of the 171 patients. A total of 82 patients with bilateral varicocele underwent surgical treatment for infertility (n = 58) and pain (n = 24). The sperm concentrations (mean ± SD) of 58 patients measured preoperatively, 6 months postoperatively, and 12 months postoperatively were 19.21 ± 3.24 (106/ml), 27.36 ± 10.26 (106/ml), and 33.87 ± 15.20 (106/ml) ( ${\hspace{0.17em}}^{\ast \ast }P<0.01$ ), respectively. The sperm motilities (mean ± SD) of 58 patients measured preoperatively, 6 months postoperatively, and 12 months postoperatively were 13.54 ± 2.75, 20.75 ± 8.21, and 28.53 ± 14.83 (grade (a + b) %) ( ${\hspace{0.17em}}^{\ast \ast }P<0.01$ ), respectively. Pain was released surgically in 19 (79.2%) of the 24 patients. The probability of occurrence in one artery, two arteries, three arteries, and more than three arteries was 29.5%, 28.8%, 19.9%, and 1.9%, respectively. Conclusion. This surgical approach achieves a small and esthetic skin wound with fewer complications. The SSI approach is a safe and widely adopted surgical approach option for the treatment of varicocele.