Taken together , the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy .
Abstract Despite being first described two thous and years ago , the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility , hypogonadism , and chronic orchidalgia .
The underlying mechanisms remain poorly understood and likely include hypoxia , oxidative stress , hyperthermia , anatomical aberrations , and genetics as primary components .
Despite a high prevalence amongst asymptomatic fertile men , varicoceles paradoxically also represent the most common correctable cause for male infertility .
In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations .
We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain .
Inguinal versus subinguinal varicocele vein ligation using magnifying loupe under local anesthesia: which technique is preferable in clinical practice?
OBJECTIVES To compare the intraoperative results of inguinal versus subinguinal varicocelectomy using magnifying loupe , in terms of vein ligation and arterial preservation , recurrence rate , and patient tolerability . METHODS Ninety-nine patients were r and omized to undergo a varicocele repair with an inguinal or a subinguinal approach under local anesthesia .  Data concerning the number of veins ligated and arterial preservation were recorded during each procedure . The amount of intraoperative and postoperative pain was assessed by means of visual analogue scale ( VAS ) scores . The recurrence rate was documented by color Doppler ultrasound examination . RESULTS The average number of ligated veins was 5.6 with a subinguinal dissection and 4.4 with the inguinal approach .  Inadvertent injury of the spermatic artery occurred in 6 of 47 subinguinal and 3 of 50 inguinal dissections ; the artery could not be identified during 2 subinguinal and 1 inguinal dissection . Recurrent varicocele was detected in 8 % and 14.9 % of patients after an inguinal and a subinguinal approach , respectively . The intraoperative VAS score was significantly higher in the inguinal than in the subinguinal patients ( P = 0.008 ) . CONCLUSIONS In our h and s , the inguinal approach to the spermatic cord showed a trend toward an easier preservation of the artery and a reduced incidence of persistent pathologic vein reflux . The subinguinal approach had a lower degree of intraoperative pain . On the whole , an inguinal repair might be preferable when magnifying loupe are used for varicocelectomy
Taken together , the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy .
Abstract Despite being first described two thous and years ago , the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility , hypogonadism , and chronic orchidalgia .
The underlying mechanisms remain poorly understood and likely include hypoxia , oxidative stress , hyperthermia , anatomical aberrations , and genetics as primary components .
Despite a high prevalence amongst asymptomatic fertile men , varicoceles paradoxically also represent the most common correctable cause for male infertility .
In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations .
We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain .