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.
Matsuda
T
T
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
Horii
Y
Y
Yoshida
O
O
D000328:Adult; D001158:Arteries; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008026:Ligation / Q000379:methods; D008297:Male; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D013076:Sperm Count; D013081:Sperm Motility; D013737:Testis / Q000098:blood supply* / Q000601:surgery; D016896:Treatment Outcome; D014646:Varicocele / Q000150:complications / Q000601:surgery*