title: Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches.
abstract: OBJECTIVE
  The standard management of varicocele repair is the subject of ongoing controversy. We retrospectively evaluated three surgical methods of varicocele treatment to determine the minimally invasive and most effective procedure.
  
  
  METHODS
  We performed 144 varicocelectomies on infertile patients with left clinical varicocele. Of the patients, 50 were treated with retroperitoneal high ligation under lumbar anesthesia, 33 with laparoscopic ligation under general anesthesia, and 61 with subinguinal microscopic ligation under local anesthesia. Operative time, hospital days, and clinical outcomes were compared between these techniques.
  
  
  RESULTS
  The operating time and hospitalization period required for subinguinal microscopic ligation was signi fi cantly shorter compared to those for the other procedures. All patients treated with subinguinal microscopic ligation could achieve normal activity as soon as they returned to their rooms. Postoperative complications were observed in fi ve (10.0%) cases treated with high ligation and three (9.1%) laparoscopic cases, but were not observed after the subinguinal procedure. There were six cases (12.0%) of recurrence in the high ligation group and six (6.1%) in the laparoscopic group, but none in the subinguinal group. Sperm density was signi fi cantly improved in all procedures postoperatively, but sperm motility was not improved. The two-year pregnancy rate calculated by the Kaplan-Meier method was 35.8% for high ligation, 40.4% for laparoscopic ligation and 50.9% for subinguinal microscopic ligation, although there were no statistical differences between the three groups.
  
  
  CONCLUSIONS
  We concluded that subinguinal microscopic varicocelectomy could be a minimally invasive procedure compared to the other two techniques and a worthy method for treating male infertility due to clinical varicocele.
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Watanabe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nagai
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kusumi
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tsuboi
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Nasu
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kumon
mesh_terms: D000328:Adult; D005260:Female; D005298:Fertility / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal; D010535:Laparoscopy; D007902:Length of Stay; D008026:Ligation / Q000379:methods; D008297:Male; D008866:Microsurgery; D011247:Pregnancy; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D014646:Varicocele / Q000000981:diagnostic imaging / Q000601:surgery*