title: Simultaneous vasectomy and varicocelectomy: indications and technique.
abstract: BACKGROUND
  When men present for vasectomy, incidental varicoceles may be discovered. After varicocelectomy, the deferential veins become the only avenue for testicular venous return and could be compromised during nonmicroscopic vasectomy. We discuss the indications and technique required to safely perform simultaneous vasectomy and varicocelectomy.
  
  
  METHODS
  From 1992 to 2005, 18 (4.8%) of 379 men presenting for vasectomy had incidental palpable varicoceles and low or low normal serum testosterone levels. All underwent microsurgical subinguinal varicocelectomy. All spermatic, cremasteric, and gubernacular veins were ligated. The vas was then isolated under magnification, the deferential vessels were preserved, and the vas was transected, cauterized, and clipped.
  
  
  RESULTS
  All 18 men (mean age 39.6 years) had grade II to III varicoceles on physical examination. We performed 27 microsurgical varicocelectomies with simultaneous microsurgical vasectomy. On average, the first follow-up visit occurred 14 weeks postoperatively. The mean testosterone level increased from 348 ng/dL preoperatively to 416 ng/dL postoperatively. No complications, episodes of testicular atrophy, vasectomy failures, or varicocelectomy recurrences developed. The incidence of varicoceles in fertile men presenting for vasectomy (4.8%) was lower than in the general population (15%); fertile men appear to be less likely to possess varicoceles.
  
  
  CONCLUSIONS
  Men presenting for vasectomy with incidental palpable varicoceles could benefit from simultaneous vasectomy-varicocelectomy. This should be performed microsurgically to identify and ligate both spermatic veins and vasa deferentia and to preserve not only the testicular artery, but also the deferential vessels to minimize the risk of testicular atrophy and the risk of insufficient venous drainage.
authors.affiliation: Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Cornell Institute for Reproductive Medicine, Weill Medical College of Cornell University, New York, New York 10021, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
authors.forename: Philip S
authors.initials: PS
authors.lastname: Li
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D006801:Humans; D033162:Incidental Findings; D008297:Male; D014646:Varicocele / Q000601:surgery*; D014659:Vasectomy / Q000379:methods*