Comparison between Microsurgical Subinguinal Varicocelectomy with and without Testicular Delivery for Infertile Men: Is Testicular Delivery an Unnecessary Procedure.
OBJECTIVE
Controversy still exists as to whether testicular delivery during microsurgical subinguinal varicocelecto­my (MSV) provides benefit to the patient or not. This study specifically compared the therapeutic effect of MSV with and without testicular delivery for the treatment of varicocele in a cohort of infertile men.


METHODS
We conducted a prospective, randomized, controlled study to evaluate the therapeutic efficacy of MSV with and without testicular delivery for the treatment of varicocele in infertile men. A total of 100 patients were specifically recruited using strict inclusion criteria to undergo MSV with testicular delivery (group 1, n = 50) or MSV without testicular delivery (group 2, n = 50). All patients were followed-up at 3, 6 and 12 months following surgery. Semen parameters, pregnancy and recurrence rates, and complications were monitored.


RESULTS
Mean surgical time for group 1 was significantly longer than group 2 (90.50 ± 15.60 min vs. 84.30 ± 15.58 min; P = .001). Sperm count and motility were significantly improved at the 12-month follow-up appoint­ment in both groups compared with pre-operative values, but were not significantly different at 3, 6, and 12 months when compared between the two treatment groups. The incidence of scrotal edema, and spermatic/testicular en­gorgement were higher in group 1 (both P = .001), although natural pregnancy rate was not significantly different between the two groups at the 12 month follow-up appointment (46% vs. 42%) (P = .817).


CONCLUSIONS
MSV with testicular delivery did not reduce the risk of recurrence and led to improved semen quality compared with MSV without testicular delivery. However, there was a higher risk of complication with this tech­nique, which must be borne in mind when considering the clinical implications of our dataset.
Department of Urology, China and Japan union hospital of Jilin University, 126 Xiantai Street, Changchun City, Jilin province, China.
Yi
Y
Hou
Department of Urology, China and Japan union hospital of Jilin University, 126 Xiantai Street, Changchun City, Jilin province, China.
Ying
Y
Zhang
Department of Urology, China and Japan union hospital of Jilin University, 126 Xiantai Street, Changchun City, Jilin province, China. 986062616@qq.com.
Yun
Y
Zhang
Department of Urology, China and Japan union hospital of Jilin University, 126 Xiantai Street, Changchun City, Jilin province, China.
Wei
W
Huo
Department of Urology, China and Japan union hospital of Jilin University, 126 Xiantai Street, Changchun City, Jilin province, China.
Hai
H
Li
D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D007264:Inguinal Canal; D008297:Male; D008866:Microsurgery / Q000379:methods*; D061646:Operative Time; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends; D011446:Prospective Studies; D012008:Recurrence; D012187:Retroperitoneal Space; D012661:Semen / Q000378:metabolism*; D055101:Semen Analysis; D013085:Spermatic Cord / Q000098:blood supply*; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D014646:Varicocele / Q000150:complications / Q000601:surgery*