Optimizing the outcome of microsurgical subinguinal varicocelectomy using isosulfan blue: a prospective randomized trial.
OBJECTIVE
Varicoceles are the main cause of correctible male factor infertility. Loss of testicular volume and abnormal seminal parameters are indications for varicocelectomy. We assessed a prospective randomized trial comparing standard microsurgical varicocele repair with the microsurgical approach using isosulfan blue. We determined if the use of isosulfan blue reduces the incidence of postoperative hydroceles following microsurgical varicocele repair.


METHODS
Two groups of 25 consecutive patients each were randomized. Indications for surgery included fertility problems as well as scrotal pain and difference in testicular size. All patients underwent microsurgical repair using the subinguinal approach. Patients in group 1 underwent standard microsurgery. Those in group 2 had additional isosulfan blue administration. All were investigated 3 and 6 months postoperatively regarding varicocele recurrence, hydrocele, atrophy, pain or other complications.


RESULTS
There were no intraoperative complications. At 3 months postoperatively the incidence of hydrocele in group 1 was 20% decreasing to 16% at 6 months, whereas in group 2 no hydrocele was detectable. There were 2 patients in each group who reported ongoing pain, and 1 in each presented with recurrent varicocele. No atrophy was seen. In 1 patient blue pigmentation of the left hemiscrotum was seen at 3 months but vanished at 6 months.


CONCLUSIONS
Microsurgical repair of varicoceles using isosulfan blue helps in identifying and preserving the lymphatic drainage. It prevents postoperative hydrocele, the most common postoperative complication, without any supplementary risk to the patient. Additionally, testicular edema causing impaired spermatogenesis can be avoided.
Department of Pediatric Urology, Medical University, Innsbruck, Austria.
Christian
C
Schwentner
Josef
J
Oswald
Andreas
A
Lunacek
Martina
M
Deibl
Georg
G
Bartsch
Christian
C
Radmayr
D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011446:Prospective Studies; D012394:Rosaniline Dyes; D006848:Testicular Hydrocele / Q000517:prevention & control; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods; D014646:Varicocele / Q000473:pathology* / Q000601:surgery*
D012394:Rosaniline Dyes; C025484:iso-sulfan blue