Improvement in the fertility rate after placement of microsurgical shunts in men with recurrent varicocele.
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.
Flati
Giancarlo
G
II Department of Surgery P. Stefanini, University of Rome La Sapienza, Rome, Italy. giancarloflati@hotmail.com
Porowska
Barbara
B
Flati
Donato
D
Veltri
Salvatore
S
Sportelli
Giuseppe
G
Carboni
Manlio
M
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