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Abstract
Introduction: Varicoceles represent the most common attributable cause of primary and secondary infertility in the male. A number of studies have established the effect of performing varicocelectomy in order to improve semen parameters. Several techniques of varicocelectomy has been described in literature, however, the microsurgical technique has been considered as the gold standard in doing this procedure.
Objectives: The study primarily aims to establish the effect of microsurgical varicocelectomy on postoperative semenalysis when compared to baseline semenalysis. It also aimed to establish the impregnation rate and the span at which impregnation occurs following varicocelectomy. Lastly, the study also describes the technique and modifications of microsurgical subinguinal varicoelectomy performed by a single surgeon using an operating microscope and microdoppler throughout the procedure.
Materials and Methods: Microsurgical subinguinal varicocelectomy was performed on 37 patients in SLMC from June 2015 to May 2017 by a single microsurgeon (DGL). Patient age, varicocele grade, operative time, intraoperative findings, postoperative complication, and 3-month follow-up semenalysis results were recorded and compared. Successful impregnation of the partner and the number of months from the operation to the successful impregnation were also recorded.
Results: Three months postoperative semenalysis parameters were compared to the baseline semenalysis. The total sperm motility was noted to have increased from 27.95± 15.02 to 50.95±12.60, postoperatively with p-value of 0.010. There was no significant difference observed in the total count, concentration, and percent immature forms. Eleven or 30% of patients were able to successfully impregnate their partners in an average span of 9 months from the time of surgery.
Conclusion: In their experience, Microsurgical subinguinal varicocelectomy has improved the semen analysis after 3 months with a 30% chance of impregnation at an average span of 9 months, postoperatively. Furthermore, the use of microdoppler ultrasound in microsurgical varicocelectomy facilitated better identification of the testicular arteries.