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Review of current varicocelectomy techniques and their outcomes
Author(s) -
Diegidio Paul,
Jhaveri Jay K.,
Ghannam Suzanne,
Pinkhasov Ruben,
Shabsigh Ridwan,
Fisch Harry
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09959.x
Subject(s) - varicocele , hydrocele , medicine , gold standard (test) , microsurgery , surgery , radiological weapon , general surgery , medical physics , infertility , pregnancy , radiology , genetics , biology
What’s known on the subject? and What does the study add? The relationship between varicocele and infertility is well established, and several surgical and radiological techniques for varicocelectomy are currently used in practice. The postoperative benefits of the surgery is also well established. The AUA has set forth guidelines on the evaluation and indications for treatment of varicocele; however, to date, there is no consensus as to which surgical technique should be considered the gold standard. This paper evaluates the current methods in practice and evaluates them based on specific and stringent criteria. All surgical and radiological methods that are frequently used were included. We suggest that by using either of the two microsurgical techniques, inguinal or subinguinal, that there would be better outcomes across all parameters postoperatively with better long term outcomes. We also investigated several new techniques and made recommendations for further research. OBJECTIVES• To review all the various techniques and their results and efficiencies to provide practicing urologists with some guidance for choice of technique • To discuss improvements of varicocelectomy techniques in the last 15 years and their impact on results of surgery.PATIENTS AND METHODS• A PubMed English literature review of literature from 1995 to present.RESULTS• Pregnancy rates were highest with microsurgical subinguinal technique • Varicocele recurrence rates were lowest with microsurgical subinguinal technique • Hydrocele formation rates were lowest with microsurgical inguinal technique • Surgical complications were highest in the laparoscopic technique • Varicocelectomy by itself or in conjunction with IVF is cost effectiveCONCLUSIONS• Microsurgical subinguinal or microsurgical inguinal techniques offer best outcomes • Varicocelectomy is a cost effective treatment modality for infertility • Further research is needed to explore new developments in varicocelectomy