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The following is a summary of “Preserving one artery shortens the surgical time and does not affect the efficacy of microsurgical subinguinal varicocelectomy: preliminary findings from a retrospective study,” published in the December 2024 issue of Urology by Cao et al.
Researchers conducted a retrospective study to analyze the safety and efficacy of microsurgical subinguinal varicocelectomy (MSV) with and without preservation of all testicular arteries and the lymphatic system.
They included 98 patients with varicocele who underwent MSV. Group 1 consisted of 58 patients who underwent MSV with preservation of all testicular arteries and the lymphatic system. Group 2 included 40 patients who underwent MSV with preservation of a single testicular artery, followed by “en bloc” isolation, ligation, and cutting of the remaining vascular bundle sparing the vas deferens. They compared operative time, semen parameters, and complications between the 2 groups.
The results showed that the mean operative time for group 1 was significantly longer than Group 2 (90.26 ± 21.69 min vs 79.30 ± 19.58 min, P = 0.01). Visual analog pain scale (VAS) decreased significantly in both groups: group 1 from 5 (Interquartile range (IQR): 4–6) to 1 (IQR: 0–2), P < 0.001, and group 2 from 4 (IQR: 3–5.75) to 1 (IQR: 1–2), P < 0.001. Sperm count and motility improved significantly in both groups at 12-month follow-up: group 1 sperm count increased from 35.5 × 106/mL (IQR: 29–60) to 60 × 106/mL (IQR: 50–74.25), motility from 46.5% (IQR: 32–56%) to 69% (IQR: 54.5–79%), both P < 0.001. Group 2 sperm count rose from 31 × 106/mL (IQR: 20–56.25) to 57.5 × 106/mL (IQR: 51.25–73.75), motility from 44% (IQR: 23–54.75%) to 75% (IQR: 51.25–80%), P < 0.001. Postoperative hospital stay was similar in both groups (3 days, IQR: 2–3 days, P = 0.83). No testicular atrophy or varicocele recurrence occurred. Hydrocele occurred once in both groups; group 1 had 1 wound infection and 1 case of orchitis and epididymitis, while group 2 had none.
Investigators found that the “en bloc” procedure in MSV was a safe and effective option, particularly for cases with severe adhesion. The findings supported its implementation as a viable alternative for improving surgical outcomes.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01670-x
