Pathogenesis of persistent infertility in men after varicocelectomy

Laparoscopic surgery for adolescent varicocele: preliminary report on 80 patients

Laparoscopic clipping and division of the internal spermatic vessels was performed without complications in 80 adolescents to treat varicocele. In four cases the procedure had to be converted to open surgery. Two of the cases were converted because of technical errors during CO2 insufflation and in two cases because dissection of the vessels was impossible owing to abnormal adhesion of sigmoid colon. At 6 months' follow-up there was only one relapse. Only one hydrocele was noted postoperatively, and testicular size did not decrease in any patient. The authors believe that laparoscopic varicocelectomy is a simple, safe, and effective surgical procedure, which could be proposed as an alternative to open surgical or percutaneous embolization approaches. However, much more experience is needed to obtain a definitive conclusion.

Comparison of artery-ligating and artery-preserving varicocelectomy: effect on post-operative spermatogenesis

To evaluate the effects of ligature of the internal spermatic artery at varicocelectomy on fertility, we conducted a prospective randomized study for comparison of two surgical methods (artery-ligated and artery-preserved). A total of 66 infertile patients with palpable varicocele was randomly assigned to an artery-ligated or artery-preserved group at varicocelectomy and the change in seminal characteristics and testis volume was prospectively investigated. Sperm density and motility improved significantly in the artery-ligated group. There was significant improvement in sperm density in the artery-preserved group, but motility did not reach the level of statistical significance in this group. The significant change in testis volume was not observed in both groups. Seven (23.3%) of 30 patients in the artery-ligated group and 5 (13.9%) of 36 men in the artery-preserved group managed to impregnate their partners. The difference was not statistically significant. In spite of the advocative advantage of artery preservation, our present study did not show any significant difference between artery-ligating and artery-preserving varicocelectomy when improvements in semen quality and pregnancy rate were assessed. Thus, artery-ligated varicocelectomy is warranted with regard to post-operative fertility in the patients with clinical varicocele.

Should the testicular artery be preserved at varicocelectomy?

A surgical method of varicocelectomy, in which the internal spermatic veins together with the testicular artery are ligated as a whole in the retroperitoneal space, has been proposed as a simple and reliable procedure. We evaluated the effects of ligating the testicular artery at varicocelectomy on fertility. A total of 34 subfertile patients with a left varicocele was randomized into an artery-preserved or artery-ligated group at open varicocelectomy and the change in semen quality was prospectively studied. The artery-preserved group showed improvements in sperm density and total sperm count, while the artery-ligated group showed improvements in sperm density, total sperm count and sperm motility. The results indicated identical improvement in semen quality in both groups of patients. Testicular volume, measured by a punched-out orchidometer, did not change in any of the patients in the ligated group, except for 1 with a grade 3 varicocele, although this decrease could not be detected by sonography. The effects of artery-preserving and artery-ligating varicocelectomy on postoperative pregnancy rates were investigated by examining 116 patients retrospectively. The pregnancy rates of 37.8% and 23.8% in the artery-preserved and artery-ligated groups, respectively, were not significantly different. Despite the theoretical advantage of artery preservation, our study did not show any significant difference between artery-preserving varicocelectomy and the artery-ligating operation when improvements in semen quality and postoperative pregnancy rate were evaluated.

Varicocelectomy: incidence of external spermatic vein involvement in the clinical varicocele

The vascular anatomy of the clinical varicocele, and the incidence of involvement of the external spermatic vein were studied. Dilation of the external spermatic vein (4 mm) was found in 49.5 percent of 93 varicoceles in 67 patients. The location of this vein, its potential involvement in a varicocele, and its management were reviewed.