Subinguinal microsurgery versus conventional inguinal approach for varicocele repair

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Objective: Varicocele has been treated with inguinal approach resulting in an improvement in semen parameters as well as in pregnancy rates. Recently, the microsurgical artery and lymphatic sparing technique was described. The purpose of this study was to evaluate the subinguinal microsurgical versus conventional inguinal approach in the treatment of varicocele patients. Design: Prospective study. Materials/Methods: Based on the last number located in the chart of the patient, they were submitted to one of the two approaches for the varicocele treatment: even (inguinal approach) and odd (microsurgery). Seventy-one patients with varicocele were treated through conventional inguinal (Group I; n = 38) and microsurgical (Group II; n = 33) approach from July 1999 to April 2001. No differences were seen in the mean age, levels of LH and testosterone, nor grade of varicocele between the groups (p >0.05). However, FSH levels were higher in Group II (26.3 ± 9.8) compared to group I (6.78 ± 4.85). Although no differences were seen in the mean volume of right testis in Groups I (18.81 ± 8.05) and II (20.51 ± 8.4), the left testis was higher in Group I (19 ± 12.13) compared to Group II (17.9 ± 8.9), (P = 0.04). The mean sperm concentration (32.74 ± 63.7 vs. 35.11 ± 49.47) and motility (34.6 ± 27.1 vs. 40.3 ± 19.6) before treatment was not different (p >0.05). A semen analysis after treatment was evaluated in all patients. Pregnancy data was available in 30 patients in Group I and 26 in Group II. Results: Although no improvement in both testicular size was seen in Group I and right testis in Group II, the mean volume of the left testis in Group II increased (19.3 ± 8.34; P = 0.02). No differences were seen between the groups regarding the mean post-operative sperm concentration (40.09 ± 51.7 vs. 37.76 ± 43.96) and motility (36.7 ± 23.4 vs. 46.09 ± 19.9) (p >0.05). Also, the pregnancy rate was not different between Group I (46.67%) and II (42.3%) ( p >0.05). Conclusions: No differences were seen in the mean post-operative sperm concentration and motility as well as in pregnancy rates between the two groups. We postulate that maybe these is due to higher FSH and lower left testis size in patients who underwent microsurgical approach compared to the other group of patients. Supported by: None.