Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis

Abstract

ObjectiveTo evaluate the detailed vascular anatomy of the spermatic cord during subinguinal microscopic varicocelectomy and to assess the outcome of the cases with regard to varicocele recurrence and hydrocele formation.Patients and methodsIn all, 100 varicocele cases including 74 left-sided and 26 bilateral, comprising 126 spermatic cord units with clinically palpable varicoceles underwent microscopic subinguinal varicocelectomy. Detailed description of vascular anatomy of the spermatic cords was reported. The number of spermatic, cremasteric, and inguinal veins was recorded. A record of testicular arteries and lymphatics was noted. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, as well as scrotal Doppler ultrasonography, to detect varicocele recurrence and hydrocele formation. The mean (range) postoperative evaluation period was 6 (3–12) months.ResultsThe mean number of spermatic veins was 14 on both sides. The mean number of spermatic arteries on both sides was 1.3. For lymphatics, the mean number was around three on both sides. The gubernacular veins were noted in 75% of the cases on the left side (mean number of 1.2) and in 85% on the right-side, (mean number of 1). The mean number of cremasteric veins on the left and right sides was 1.4 and 1.2, respectively. Finally, inguinal floor vessels were noted in 9% on the left-side and were not seen in the right-side cases. The incidence of varicocele recurrence was 2% and for hydrocele that was not clinically significant was 0.07%.ConclusionMicroscopic subinguinal varicocelectomy accurately evaluated the detailed vascular anatomy of the spermatic cord, achieving excellent surgical outcome with minimal varicocele recurrence and hydrocele formation. Microscopic subinguinal varicocelectomy should be the ‘gold standard’ for varicocelectomy.

Contribution of pre-varicocelectomy color Doppler ultrasonography finding to surgery and its correlation with semen parameters

“…In recent years, studies showed that robot-assisted microscopic varicocelectomy is as successful as the conventional methods (27). However, microscopic subinguinal varicocelectomy is the golden standard for the treatment of varicocele (28,29). This method includes the treatment of venous system by preserving testicular arterial and lymphatic vessels.…”

Robotic‐assisted laparoscopic artery‐sparing varicocelectomy using indocyanine green fluorescence angiography: Initial experience

“…Chan, Wright, and Goldstein (2005) reported an accidental artery ligation rate of 0.9%, and testicular atrophy was developed in 5% of these patients. Intraoperative Doppler utrasound was applied in some institutions to facilitate the detection of arteries (Al-Kandari et al, 2018;Almekaty et al, 2019;Guo et al, 2017). Under Doppler ultrasonography, these arteries were characterised by high-pitched pulsatile flow sound.…”

“…Many surgical approaches have been adopted in varicocele repair, such as macroscopic retroperitoneal, laparoscopic transperitoneal, microscopic subinguinal and percutaneous embolisation. The ideal solution should be characterised by occluding all the spermatic veins while preserving arteries and lymphatics (Al-Kandari et al, 2018). Although the best option is still under debate, microscopic varicocelectomy shows tremendous promise in treatment of varicocele with great efficacy and minimised complications and recurrence (Ding et al, 2012).…”

<p>Factors Associated with Varicocele Recurrence After Microscopic Sub-Inguinal Varicocelectomy</p>

“…In 2015, a meta-analysis of the comparative efficacy of various treatment techniques for varicocele revealed that subinguinal varicocelectomy was associated with a very low odds of recurrence (OR = 0.05; 95% CI: 0.01–0.19) in comparison to retroperitoneal open surgery. 22 In 2018, Alkandari et al 23 investigated the recurrence of varicocele in 100 patients (74 unilateral and 26 bilateral cases) who underwent microscopic subinguinal varicocelectomy, with a mean follow-up period of 6 months. The recurrence was reported in 3 out of the 126 (2.3%) spermatic cord units investigated, going in line with our observation.…”