Comparative study between dye assisted microsurgical Subinguinal Varicocelectomy versus Subinguinal Conventional Technique for treatment of primary varicocele

Abstract

Background Division of lymphatic vessels during varicocelectomy could lead to secondary hydrocele formation and decrease of testicular function due to testicular edema. It was suggested that the use of methylene blue dye combined with optical magnification could reduce the incidence of postvaricocelectomy complications. Aim of the work To evaluate efficacy and safety of the dye assisted subingunial varicocelectomy with optical magnification in the treatment of primary varicocele. Patients and methods Sixty five patients having 80 primary varicoceles were randomly divided into two groups according to treatment procedure. The indications of surgery included patients with primary varicocele with infertility or varicocele with life style limiting pain. Thirty three patients (having 40 varicoceles) underwent subinguinal varicocelectomy with the aid of optical magnification after injection of dye (group I), and 32 patients (having 40 varicoceles) treated by subinguinal varicocelectomy with neither injection of dye nor magnification (group II). After surgery, the patients were assessed at 2 weeks, 3 months and 6 months for hydrocele formation, size of the testes using ultrasound, varicocele recurrence, pain or other complications. Results There were no reported complications with arterial injury in group I, while four procedures (10%) in group II were complicated by minor injury of the internal spermatic artery with P value = 0.045*. One procedure was complicated by hydrocele in group I (2.5%) in contrast to 7 procedures in group II (17.5%) with P value = 0.006*. Also, one procedure in group I and 7 procedures in group II were complicated by varicocele recurrence. This difference was statistically significant, P value = 0.006*. Conclusion Dye assisted lymphatic sparing subinguinal microsurgical varicocelectomy is simple, feasible, and could minimize varicocelectomy related complications.