title: A Novel Approach of Microscopic Subinguinal Varicocelectomy With a "Pulling" Strategy.
abstract: To investigate the safety and efficacy of a novel approach of microscopic subinguinal varicocelectomy with a "pulling" strategy.
  
  
  
  Fifty-two male patients with varicocele were enrolled in this study. Twenty-six patients underwent conventional microscopic subinguinal varicocelectomy, whereas the remaining 26 patients accepted our novel approach of treatment. In this method, with a subinguinal incision, we dissociated the spermatic cord from the external ring. And thus we pulled the spermatic cord down and away from the external ring and exposed the spermatic cord that initially was proximal to the external ring in the surgical field. The remainder of the procedure was similar to that of the conventional method. Follow-up was made at 1 and 3 months. Postoperative complications were recorded and sperm parameters were evaluated by semen analysis.
  
  
  
  Fewer vein branches were ligated in the novel method group compared with the conventional method group (6.9 ± 2.1 vs 9.8 ± 2.2, P < .001; t = -5.316). There was no significant difference in the number of testicular arteries or lymphatic ducts between the 2 groups. The mean microsurgical operative time in the novel method group was significantly shorter than that in the conventional method group (34.7 ± 6.5 minutes vs 45.7 ± 8.8 minutes, P < .001; t = -5.621). The incidence of postoperative complications was similar for the 2 groups. There was no significant difference regarding semen quality improvement between the 2 groups.
  
  
  
  This study demonstrates that our novel approach of microscopic subinguinal varicocelectomy with a "pulling" strategy significantly reduces the number of internal veins to ligate and shortens operating time, with no increase in complications. It is a safe and effective method of varicocele treatment.
authors.affiliation: Department of Urology, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China; Department of Urology, First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China.
authors.forename: Kerong
authors.initials: K
authors.lastname: Wu
authors.affiliation: Soochow University, Suzhou, Jiangsu, China.
authors.forename: Guang
authors.initials: G
authors.lastname: Yan
authors.affiliation: Department of Urology, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China.
authors.forename: Weiqi
authors.initials: W
authors.lastname: Yin
authors.affiliation: Department of Reproductive Medicine, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China.
authors.forename: Xueqin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Urology, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China.
authors.forename: Guoyao
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Urology, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China. Electronic address: nburology@163.com.
authors.forename: Yue
authors.initials: Y
authors.lastname: Cheng
mesh_terms: D000328:Adult; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D006801:Humans; D007248:Infertility, Male / Q000517:prevention & control / Q000601:surgery; D007264:Inguinal Canal / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012661:Semen / Q000378:metabolism; D055101:Semen Analysis; D013085:Spermatic Cord / Q000098:blood supply*; D013737:Testis / Q000098:blood supply; D018608:Ultrasonography, Doppler; D014646:Varicocele / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*; D014680:Veins / Q000601:surgery; D055815:Young Adult
chemical_list: D005640:Follicle Stimulating Hormone