title: Microsurgical treatment of persistent or recurrent varicocele.
abstract: OBJECTIVE
  To examine the effectiveness of subinguinal microsurgical varicocelectomy in the treatment of persistent or recurrent varicocele.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Urban, tertiary care, academic teaching hospital.
  
  
  METHODS
  Fifty-four men who presented for treatment of persistent or recurrent varicocele.
  
  
  METHODS
  A single surgeon using an artery and lymphatic sparing subinguinal microsurgical technique with delivery of the testis repaired all varicocele.
  
  
  METHODS
  Preoperative to postoperative changes in semen parameters (volume of ejaculate, sperm concentration, percent motility, percent morphologically normal sperm, total motile sperm concentration), serum hormone levels, and testicular volume. Pregnancy rates and surgical complications were documented.
  
  
  RESULTS
  Postoperative mean serum T and mean testicular volume increased significantly from prevaricocelectomy levels. Median sperm concentration, percent motility, and total motile sperm per ejaculate improved significantly following recurrent varicocelectomy. Among patients with follow-up over 24 weeks (65%, 35 out of 54), the overall pregnancy rate was 40% (14 out of 35), including 23% (8 out of 35) of pregnancies achieved through natural intercourse, 9% (3 out of 35) with IVF/intracytoplasmic sperm injection, and 9% (3 out of 35) with IUI. Complications such as hydrocele, hematoma, wound infection, and testicular atrophy were not observed during the follow-up period.
  
  
  CONCLUSIONS
  Treatment of persistent or recurrent varicocele using an artery and lymphatic sparing subinguinal microsurgical technique with delivery of the testis improves semen parameters, serum T levels, and testicular volume from preoperative levels without a significant risk of postoperative complications.
authors.affiliation: Department of Surgery, Division of Urology, Mt. Sinai Hospital, University of Toronto, 155 Rosewell Avenue, Toronto, Ontario, Canada. ethan.grober@utoronto.ca
authors.forename: Ethan D
authors.initials: ED
authors.lastname: Grober
authors.forename: Peter T K
authors.initials: PT
authors.lastname: Chan
authors.forename: Armand
authors.initials: A
authors.lastname: Zini
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D011247:Pregnancy; D012008:Recurrence; D012189:Retrospective Studies; D012661:Semen / Q000502:physiology*; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery*
chemical_list: D013739:Testosterone