Comparing three different surgical techniques used in adult bilateral varicocele

Abstract

Varicocele is a common disease in adult men that can be treated with one of several surgical methods. Each technique has advantages and disadvantages, and conflicting results have been obtained by different studies. To evaluate the most effective surgical techniques used in adult bilateral varicocele, including minimally invasive procedures, we compared the outcomes of three common surgical approaches in this prospective randomized study. The study included 153 patients with bilateral varicoceles who underwent varicocelectomy. These patients were randomly divided into three equal groups according to surgical approach used - open inguinal, retroperitoneal or laparoscopic. The assessment included operative time, length of hospital stay, clinical outcome and, in cases of infertility, semen analysis. The mean follow-up was 12 months (range, 8 to 15 months). The operative time and hospital stay in the laparoscopic group were significantly shorter than in the other groups (P < 0.01). Of the 51 cases in each group, there were seven cases (13.73%) of recurrence in the open inguinal group, six cases (11.76%) in the retroperitoneal group, and one case (1.96%) in the laparoscopic group. This lower rate of recurrence was statistically significant in the laparoscopic group (P < 0.05). Among the three groups, comparisons between preoperative and postoperative semen parameters showed visible improvements in sperm concentration and motility (P < 0.01), but there were no significant differences between the three groups for postoperative changes in semen parameters (P > 0.05). Compared with open inguinal and retroperitoneal varicocelectomy, laparoscopic varicolerectomy offers the best outcome.