title: Surgical treatment of varicocele by a subinguinal approach combined with antegrade intraoperative sclerotherapy of venous vessels.
abstract: OBJECTIVE
  To evaluate the efficacy, in terms of recurrences, complications and operative duration, of a new technique for treating varicocele.
  
  
  METHODS
  Between September 1999 and December 2002 we evaluated 307 men aged 17-51 years with varicocele. In all of the men the clinical diagnosis was confirmed by ultrasonography. The men were treated by a variant of the microsurgical technique described in 1994. A 2-3 cm distal subinguinal incision was made at the level of the superficial inguinal ring and the spermatic cord was exposed. The largest vein in the spermatic cord fat was cannulated. A 7-9 cm segment of the spermatic cord was clamped for 8-10 min; at the start of the ischaemia time, 1.5-3 mL of 3% atoxysclerol was injected into the cannulated vein. After sclerotherapy, the vein was ligated at the injection site, and the blood flow to the cord was restored.
  
  
  RESULTS
  The mean operative duration was 25 min. Follow-up at 3 and 6 months after surgery, with objective examination and scrotal ultrasonography, revealed one case of clinical recurrence/persistence. The most common complication was penile lymphangitis (nine men) that regressed spontaneously; three men had temporary orchialgia. There were no cases of secondary hydrocele or testicular atrophy.
  
  
  CONCLUSIONS
  The modified technique appears to be relatively easy and safe, and to of low cost. Given the promising results in terms of complications and persistence, the treatment appears to be a suitable first-line approach for the surgical treatment of varicocele.
authors.affiliation: University of Milan, Andrology Unit, San Paolo Hospital, Milan, Italy.
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Colpi
authors.forename: Luca
authors.initials: L
authors.lastname: Carmignani
authors.forename: Franco
authors.initials: F
authors.lastname: Nerva
authors.forename: Guido
authors.initials: G
authors.lastname: Piediferro
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Castiglioni
authors.forename: Cristina
authors.initials: C
authors.lastname: Grugnetti
authors.forename: Giacomo
authors.initials: G
authors.lastname: Galasso
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D015911:Sclerotherapy / Q000379:methods*; D055502:Secondary Prevention; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery / Q000628:therapy*