title: Improvement in the fertility rate after placement of microsurgical shunts in men with recurrent varicocele.
abstract: OBJECTIVE
  To evaluate the effectiveness of microsurgical shunts for secondary varicocele repair after ligation-like procedures, focusing on long-term functional outcomes.
  
  
  METHODS
  Long-term survey (mean follow-up, 8.5 years) of infertile men after secondary microsurgical reconstructive varicocelectomy.
  
  
  METHODS
  University-based medical center.
  
  
  METHODS
  Thirty-four infertile men (group A, <30 years of age; and group B, >30 years) with recurrent palpable varicocele after varicocelectomy, according to Ivanissevich (n = 28), or after angiographic vein occlusion (n = 6). Ten patients presented bilateral recurrence.
  
  
  METHODS
  Microsurgical shunts between spermatic vein and inferior epigastric vein.
  
  
  METHODS
  Sperm count, pregnancy rate, and ultrasound evaluation of varicosity.
  
  
  RESULTS
  Complete disappearance of varicosity was achieved in 97.06% of patients, while in 2.94%, a consistent reduction in size was observed. In patients with severe infertility, a significant postoperative increase in seminal parameters was observed. Pregnancy rates were 43.75% in group A and 22.22% in group B.
  
  
  CONCLUSIONS
  Microsurgical drainage in patients with recurrent varicocele after ligation-like procedures was shown to be an effective minimally invasive treatment, with immediate hemodynamic recovery of testicular venous outflow and excellent long-term results in patients with left or bilateral recurrences.
authors.affiliation: II Department of Surgery P. Stefanini, University of Rome La Sapienza, Rome, Italy. giancarloflati@hotmail.com
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Flati
authors.forename: Barbara
authors.initials: B
authors.lastname: Porowska
authors.forename: Donato
authors.initials: D
authors.lastname: Flati
authors.forename: Salvatore
authors.initials: S
authors.lastname: Veltri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sportelli
authors.forename: Manlio
authors.initials: M
authors.lastname: Carboni
mesh_terms: D000328:Adult; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D011184:Postoperative Period; D011247:Pregnancy; D018873:Pregnancy Rate; D012008:Recurrence; D013076:Sperm Count; D013081:Sperm Motility; D013085:Spermatic Cord / Q000098:blood supply*; D014463:Ultrasonography; D014646:Varicocele / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D014680:Veins / Q000601:surgery