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 results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele.
OBJECTIVES To prospect ively compare sperm parameters , pregnancy and recurrence rates , and complications after  r and omized high ligation surgery versus microsurgical high inguinal varicocelectomy ( MHIV ) .  METHODS Varicocele was diagnosed by physical examination and color Doppler ultrasound in 468 patients who underwent one of two procedures : high ligation surgery ( n = 232 ) or MHIV ( n = 236 ) . The high ligation surgery was left unilateral in 142 and bilateral in 90 . The MHIV was left unilateral in 128 and bilateral in 108 . The patients were postoperatively evaluated by spermiograms and physical examination . The pregnancy rate was monitored for 2 years . RESULTS One year after surgery , 34.05 % in the high ligation group and 46.61 % in the MHIV group had a more than 50 % increase in their total motile sperm count ( P = 0.000 ) . The increase in sperm count was not statistically different between the two groups ( P = 0.1 ) , but the difference in the increase in sperm motility in the MHIV group was statistically significant ( P = 0.000 ) . Pregnancy rates at the end of 2 years reached 33.57 % in the high ligation group and 42.85 % in the MHIV group , not a statistically significant difference ( P = 0.0571 ) . The postoperative recurrence as detected by physical examination was markedly different between the two techniques . The recurrence rate was 15.51 % in the high ligation group and 2.11 % in the MHIV group ( P = 0.000 ) . Also , the incidence of postoperative hydrocele was significantly different between the two groups ( 9.09 % in the high ligation group and 0.69 % in the MHIV group ; P = 0.000 ) . CONCLUSIONS MHIV has lower recurrence and hydrocele rates , a higher increase in sperm motility , and results in higher pregnancy rates . Therefore , it should be the preferred technique 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 .