High Inguinal Loupe-Assisted Varicocelectomy for Subfertile Men With Varicococeles: Technical Feasibility, Clinical Outcomes and Complications

Liu

et al. 2018

Sci Rep

Varicocele is a common abnormality, but the conventional microsurgical subinguinal varicocelectomy (CMSV) has some disadvantages. We invented Modified Inguinal Microscope-Assisted Varicocelectomy (MIMV) under local anesthesia. This study aims to evaluate MIMV by comparing it to CMSV in operating duration, time to return to normal activity, postoperative complications, achievement of natural pregnancy and improvement of semen quality for patients with infertility, pain score for those with scrotal pain, and so on. We enrolled 3089 patients who underwent MIMV and 476 who underwent CMSV in our hospital. Both the operating duration and the time to return to normal activity of MIMV was shorter than that of CMSV (P < 0.001). The recurrence rate (P < 0.001) and injury rate of vas deferens (P = 0.011) after MIMV were lower than that after CMSV. Moreover, patients with MIMV showed higher degree of satisfaction with the surgery experience and outcome than those with CMSV (P < 0.001). However, no statistical difference was found between the two groups in scores of pain due to surgery, postoperative varicose veins diameters, reflux duration, and the postoperative complications of wound infection, hydrocele, atrophy of testis, epididymitis, and scrotal hematoma. In summary, MIMV is a promising varicocelectomy and could be applied more in clinical practice.

Section: Discussionmentioning

confidence: 94%

“…Hsieh et al . performed high inguinal loupe-assisted varicocelectomy in 254 cases, revealing a palpable recurrence rate of 3.1% 33 . In patients who underwent MIMV, the recurrence rate, as determined using results of physical examination and/or color Doppler ultrasound, was 0.7%.…”

Section: Discussionmentioning

confidence: 99%

Modified Inguinal Microscope-Assisted Varicocelectomy under Local Anesthesia: A Non-randomised Controlled Study of 3565 Cases

Liu

et al. 2018

Sci Rep

“…Again, Abdelrahman et al [16] reported that they achieved more significant improvement in the concentration and motility with the loupe varicocelectomy compared to the non-microscopic varicocelectomy group. In another study, in which the results of loupe-assisted varicocelectomy were shared, the increase in motility was reported to be 46% and the mean sperm concentration was 17 X 10 6 /mL (24 -41 X 10 6 /mL) [17]. In another study in which the results of microscopic varicocelectomy were reported, the rate of pregnancy was 55%, improvement in sperm concentration was 22%, motile A + B was 59%, and normal morphology ratio was 51% [18].…”

Section: Discussionmentioning

confidence: 98%

The effect of surgical method on sperm parameters and pregnancy outcomes in primary infertile male patients who underwent varicocelectomy

Öğreden¹,

Demirelli²,

Karadayi³

et al. 2019

SARJMS

Background/aim: The purpose of the present study was to review the effect of varicocelectomy on semen parameters and spontaneous pregnancy in infertile men. Materials and methods: Data regarding 227 patients who underwent varicocelectomy were analyzed. Patients that was used a loop magnifier were labeled as group I(n=90), patients whom was used a microscope were labeled as group II(n=90) and patients who underwent open ligation were labeled as group III(n=47). Semen parameters and spontaneous pregnancy were compared between the groups. Results: The average age was 28.5 years. Preoperative azoospermia, oligospermia and normospermia were 13.3%, 52.2% and 34.4% in group I, 22.2%, 36.7% and 41.1% in group II, 6.4%, 48.9% and 44.7% in group III, respectively. Postoperative azoospermia, oligospermia and normospermia were 1.1%, 46.7% and 52.2% in group II, respectively(p<0.05). Postoperatively, oligospermia and normospermia were 50% and 50% in group I, 42.6% and 57.4% in group III, respectivly(p<0.05). Postoperative azoospermia were not observed in any of the patients in group I and grup III. Preoperative concentration was 12X10 6 /mL in group I, 12,9X10 6 /mL in group II, and 13X10 6 /mL in group III, postoperative concentration were 16,5X10 6 /mL, 27,5X10 6 /mL and 23X10 6 /mL in group I, group II and group III, respectively(p>0.05). Preoperative morphology were 26.7% in group I, 33% in group II and 25.5% in group III, postoperative morphology were 58.9%, 75.6% and 76.6% in group I, group II and group III, respectively(p<0.05). Preoperative sperm A was 19.9% in group I, 8.3% in group II, 21.3% in group III, postoperative sperm A was 32%, 21.1% and 33.7% in all groups, respectively(p<0.05). Preoperative sperm A+B was 42.1% in group I, 14.2% in group II, 45.1% in group III, postoperative sperm A+B was 52.3%, 45.2% and 55.9% in all groups, respectively(p<0.05). Spontaneous pregnancy was 37.8% in group I, 26.7% in group II and 38.3% in group III(p>0.05). Conclusions: Improvement in semen parameters were found significant in microsurgery groups. While the concentration was insignificant in the open ligation group, spontaneous pregnancy was similar in groups.

Arab Journal of Urology

“…One study that was conducted on a smaller number of cases ( n = 26) showed significant intraoperative anatomical differences between the two techniques, but they neither occluded the spermatic cord nor delivered the testis [9] . Classical LV has proven its efficacy in multiple studies, especially when it was compared to classic open techniques [10] , [11] , [12] .…”

Section: Discussionmentioning

confidence: 99%

Varicocelectomy: Modified loupe-assisted versus microscopic technique – A prospective comparative study

Alkandari

Al-Hunayan

2017

objectiveTo compare our novel loupe-assisted varicocelectomy (LV) technique to the ‘gold standard’ demanding microscopic varicocelectomy (MV) technique for the management of varicoceles.Patient and methodsOur LV technique, featuring testicular delivery and proximal spermatic cord occlusion using a tourniquet, has not been used before nor to our knowledge has it been reported in the literature. In the LV group, inguinal incision was done prior to testicular delivery and spermatic cord occlusion. Pampiniform and gubernacular veins were identified then tackled. Proximal spermatic cord occlusion helped in identifying those veins, and not confusing them with other cord structures that should be preserved. In all, 95 infertile men were included in this prospective, comparative study; and divided into LV and MV groups. They were followed-up for 1 year, pregnancy achievement, improvements in semen parameters, and complication rates were assessed.ResultsBoth groups had statistically significant pregnancy rates and negligible complication rates. However, LV cost 33% less than MV and was quicker to perform. We did not find that the MV technique was better than our simple, more cost-effective, less time-consuming LV technique.ConclusionOur novel LV technique has similar success and complication rates as the ‘gold standard’ MV technique for the management of varicoceles, and is more cost-effective and less time consuming.