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 .
Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome.
OBJECTIVES To compare and assess objective ly the postoperative outcome parameters of both microsurgical subinguinal artery sparing and retroperitoneal high ligation techniques for varicocele in infertile men . METHODS We performed a prospect i ve study that included 413 consecutive patients who presented with varicocele . Of the 413 patients , 304 underwent subinguinal varicocelectomy ( group 1 ) and 109 patients underwent high ligation varicocelectomy ( group 2 ) .  Subinguinal varicocelectomies were performed under local anesthesia , with intravenous propofol sedation administered as needed . The operating microscope ( x10 to x16 ) was used to spare the arteries and lymphatics . High ligation was performed through a retroperitoneal approach . RESULTS All patients went home on the evening after surgery with minimal discomfort . No intraoperative complications occurred . The internal spermatic artery was identified in all microvaricocelectomy cases . No testicular atrophy occurred in either group . Five ( 1.6 % ) and seven ( 6.4 % ) hydroceles were identified at the 3-month postoperative visit in groups 1 and 2 , respectively . CONCLUSIONS Microvaricocelectomy is safe and effective and associated with a rapid recovery and minimal morbidity . However , it requires microsurgical training
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 .