title: Simultaneous microsurgical vasal reconstruction and varicocele ligation: safety profile and outcomes.
abstract: OBJECTIVE
  Simultaneous varicocele ligation and vasal reconstruction has previously been avoided because of concern regarding testicular devascularization. This study sought to investigate the safety of a simultaneous combined approach in the hands of an experienced microsurgeon.
  
  
  METHODS
  A retrospective review was conducted of the records of 47 men who underwent vasal reconstruction, 10 (21%) of whom had simultaneous ligation of a clinically palpable varicocele. Specific attention was focused on the development of postoperative testicular atrophy and hydrocele and the analysis of postoperative semen parameters.
  
  
  RESULTS
  No patient developed postoperative testicular atrophy or hydrocele. No statistically significant difference existed in postoperative seminal parameters between those patients who had vasal reconstruction alone and those who had a combined procedure.
  
  
  CONCLUSIONS
  In the hands of an experienced microsurgeon, simultaneous vasal reconstruction and varicocele ligation is a management strategy that has an excellent safety profile. This approach is not recommended for the occasional microsurgeon.
authors.affiliation: Department of Urology, University of Connecticut Health Center, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Mulhall
authors.forename: S
authors.initials: S
authors.lastname: Stokes
authors.forename: R
authors.initials: R
authors.lastname: Andrawis
authors.forename: J P
authors.initials: JP
authors.lastname: Buch
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011247:Pregnancy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D014646:Varicocele / Q000601:surgery*; D014649:Vas Deferens / Q000601:surgery*; D014669:Vasovasostomy