Antegrade subinguinal sclerotization with temporary clamping of the spermatic cord: a new surgical technique for varicocele.
OBJECTIVE
The purpose of our study was to evaluate the duration, effectiveness, and complications associated with a new operating technique for varicocele, using a subinguinal surgical approach and antegrade sclerotization of the spermatic veins.


METHODS
A total of 756 varicocele patients who came under our care for infertility underwent surgical treatment with our technique. The diagnosis was based on clinical examination and confirmed by color-Doppler ultrasound of the spermatic cord. Only patients with continuous basal reflux inside the left spermatic vein detected in orthostatism underwent operation. The Colpi technique was used, which consists of a subinguinal incision with suspension of the spermatic cord; cord clamping for 8-10 minutes using two elastic bands; and injection of 1.5-3 mL of sclerosing agent during induced ischemia without any intraoperative radiological control.


RESULTS
The average operating time was 25 minutes (range: 18-45 minutes). At the 3-month postoperative follow-up, there were 15 cases of persistent reflux (1.9%), 6 cases of hydrocele requiring surgical correction (0.7%), and 50 cases of fibrotic sequelae of penile lymphangiitis (6.6%).


CONCLUSIONS
The new technique was more effective than the previous ones, with the exception of the microsurgical technique, which, however, takes 2-3 times longer to perform. The only significant complication was superficial single-vessel lymphangiitis of the penis, which resolved within 3 months with no apparent consequences. In conclusion, this new operating technique for varicocele is simpler to perform and may be effective compared with other techniques.
Mancini
Mario
M
Andro-Urology Unit, San Paolo Hospital, University of Milan, Milan, Italy. mancinis178@msn.com
Carmignani
Luca
L
Agarwal
Ashok
A
Ciociola
Francesco
F
Pasqualotto
Fabio
F
Castiglioni
M Fabrizio
MF
Piediferro
Guido
G
Colpi
Giovanni M
GM
D000293:Adolescent; D000328:Adult; D003250:Constriction; D006801:Humans; D007264:Inguinal Canal; D008297:Male; D008875:Middle Aged; D015911:Sclerotherapy / Q000379:methods*; D013085:Spermatic Cord; D013997:Time Factors; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014646:Varicocele / Q000601:surgery*; D055815:Young Adult