Comparison of the results and complications of retroperitoneal, microsurgical subinguinal, and high inguinal approaches in the treatment of varicoceles.
The simplicity of the surgical procedure, as well as the high rate of  success and low rate of complications, is of particular importance for  varicocelectomies. We compared operative parameters, complication rates, and  sperm parameters after retroperitoneal, microsurgical subinguinal and high  inguinal varicocelectomy approaches in infertile men with varicoceles. This  study included 307 infertile men with left varicoceles who underwent  varicocelectomy by the retroperitoneal (n = 43), microsurgical subinguinal (n  = 107), or high inguinal (n = 157) approach. The operative time was shorter  for the retroperitoneal approach (29 minutes) compared with the microsurgical  approaches and was significantly shorter for the high inguinal approach (52  minutes) compared with the subinguinal approach (66 minutes). Pain, as  assessed by a visual analogue scale, and the use of nonsteroidal  anti-inflammatory drugs were greatest following the retroperitoneal approach  and significantly preferable following the high inguinal compared with the  subinguinal approach. Recurrence/hydrocele was observed in 9.3%/9.3%,  0.9%/0.9%, and 1.3%/0.6% of patients after use of the retroperitoneal,  subinguinal, and high inguinal approaches, respectively. Significant  postoperative improvements in sperm concentration and motility were observed  after all approaches, but such improvements were observed sooner and showed  higher sperm concentration and motility after the use of the microsurgical  approaches. Both microsurgical subinguinal and high inguinal approaches  yielded comparable success rates, but the operative time and pain control were  superior with the high inguinal approach. Because of its favorable safety  profile, the microsurgical high inguinal approach should be of value to both  experienced microsurgeons and trainees.
Department of Urology, Yamaguchi University School of Medicine, Yamaguchi, Japan. shirak@yamaguchi-u.ac.jp
Koji
K
Shiraishi
Shintaro
S
Oka
Hideaki
H
Ito
Hideyasu
H
Matsuyama
D000328:Adult; D006801:Humans; D007248:Infertility, Male / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery*