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 .
Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial.
OBJECTIVES To compare the outcomes of the different surgical techniques used in varicocelectomy . METHODS The study included 120 patients with 147 clinical ly palpable varicoceles who underwent varicocelectomy .  The patients were r and omly allocated to one of three equal groups according to the varicocelectomy technique , which included the open inguinal approach , a laparoscopic approach , and subinguinal microscopic varicocelectomy . The assessment included operative and postoperative parameters , together with semen analysis and pregnancy rate . The mean follow-up was 18 months ( range 11 to 26 ) . RESULTS The operative time in the microscopic group was significantly longer than that for the other two groups . At follow-up , none of the patients of the microscopic group had developed postoperative hydrocele ; however , it was observed in 7 ( 13 % ) of 52 varicoceles in the open group and 10 ( 20 % ) of 50 in the laparoscopic group . This difference was statistically significant in favor of the microscopic group only . Only 1 patient in the microscopic group experienced recurrence of one varicocele compared with 7 and 9 patients in the open and laparoscopic groups , respectively . This difference was statistically significant in favor of the microscopic group only . Improvement in sperm motility and /or concentration was comparable and observed in 65 % , 67 % , and 76 % of the open , laparoscopic , and microscopic groups , respectively . Also , the pregnancy rate at 1 year was not significantly different and was 28 % , 30 % , and 40 % in three groups , respectively . CONCLUSIONS The findings of our study have demonstrated that , compared with open inguinal and laparoscopic varicocelectomy , subinguinal microsurgical varicocelectomy offers the best outcome
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 .