[Laparoscopic selective varicocelectomy versus microscopy-assisted low ligation of the spermatic vein in the treatment of varicocele].

Abstract

OBJECTIVE:

To compare the effects and adverse events of laparoscopic selective varicocelectomy (LV) and microscopy-assisted low ligation of the spermatic vein (MV) in the treatment of varicocele.

METHODS:

We retrospectively analyzed the clinical data on 310 cases of varicocele treated in our hospital from January 2011 to March 2016, 162 (64 with infertility) by LV with preservation of the testis artery and lymph vessel and the other 148 (69 with infertility) by MV. We followed up the patients for 12 months and made comparisons between the two groups in the operation time, hospital stay, hospital costs, recurrence rate, incidence of complications, and semen quality before and at 3 and 6 months after surgery, and spontaneous pregnancy rate at 12 months postoperatively.

RESULTS:

The bilateral operation time was markedly shorter in the LV than in the MV group (［60 ± 16］ vs ［92 ± 23］ min, P < 0.05), but no statistically significant differences were found between the two groups in the unilateral operation time (［38 ± 7］ vs ［45 ± 10］ min, P >0.05), hospital stay (［3.2 ± 0.7］ vs ［3.5 ± 0.9］ d, P > 0.05), hospital costs (［14 862.7 ± 813.2］ vs ［13 907.3 ± 729.2］ RMB ¥, P > 0.05), or spontaneous pregnancy rate at 12 months after surgery (35.9% vs 39.1%, P > 0.05). Compared with the baseline, significant improvement was observed in both the LV and MV groups in sperm concentration and the percentage of grade a + b sperm at 6 months postoperatively (P < 0.05), but not at 3 months (P > 0.05). The rate of recurrence was remarkably higher in the LV than in the MV group (7.4% vs 1.4%, P < 0.05) but there were no statistically significant differences between the two groups in the incidence rates of postoperative orchialgia (1.8% vs 0.7%, P > 0.05) and epididymitis (1.2% vs 0, P > 0.05).

CONCLUSIONS:

For the treatment of varicocele, laparoscopic selective varicocelectomy is comparable to microscopy-assisted low ligation of the spermatic vein in the clinical effect. The former, however, has a significantly higher rate of recurrence than the latter.

• Authors: Qi-Sheng Tang, Lei Wang, Rui-Xiao Li, He Wang, Jian-Jun Ma
• Journal: Zhonghua nan ke xue = National journal of andrology (Zhonghua Nan Ke Xue) Vol. 24 Issue 9 Pg. 782-787 (Sep 2018) ISSN: 1009-3591 [Print] China
• PMID: 32212455 (Publication Type: English Abstract, Journal Article)