Varicocele is primarily tortuous dilation of the internal spermatic vein [ISV] and pampiniform plexus in the scrotum. It’s the most common correctable cause of infertility. It has a higher prevalence in primary and secondary infertility 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 gives more safe and easy handling of the operative field. 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.

Hypertension is a major preventable cause of cardiovascular and kidney related morbidity and mortality. It affects one third of the Sri Lankan population and is the single leading cause of death annually. Home blood pressure monitoring (HBPM) gained interest compared to office BP measurement (OBPM) after several studies demonstrated its superior prognostic value in predicting cardiovascular risk. White coat uncontrolled hypertension (WUCH) and masked uncontrolled hypertension (MUCH) may be overlooked in office BP measurement. Both of these phenomena are correctly identified in HBPM. Behavioural modification, patient involvement and initiation of antihypertensive medications at the right point are important in the management of hypertension. HBPM allows healthcare providers to make behavioural and pharmacological modification at the crucial point, because of the accuracy in BP measurement. Further it reduces health expenditure in the long run by reducing outpatient clinic visits and preventing adverse cardiovascular and kidney related outcomes. Given the challenges posed by the pandemic, HBPM is a better option in managing hypertension with the help of technology and telehealth. However further studies are needed on HBPM in Sri Lanka to analyse the efficacy in our own context.