INCIDENCE OF EXTERNAL SPERMATIC VEINS IN PATIENTS UNDERGOING INGUINALVARICOCELECTOMY

Objectives. To determine the incidence of external spermatic veins at inguinal varicocelectomy. Methods. A prospective study was performed b y making intraoperative observations on 78 varicocelectomies (47 patie nts) performed by a single surgeon. All patients were referred for eva luation of male infertility and had a palpable varicocele present when examined while performing a Valsalva maneuver in the upright position . Varicocelectomies were performed via the inguinal approach using x2. 5 loupe magnification. Presence of external spermatic veins was define d as visualization (with x2.5 loupe magnification) of veins on the flo or of the inguinal canal traveling posterolateral to the spermatic cor d that then subsequently exited the spermatic cord before passing thro ugh the internal inguinal ring. Age, anesthetic technique, and need fo r incision of the external inguinal ring were also recorded for each p atient. Results. One third of patients had undergone left-sided varico celectomies, while two thirds had undergone bilateral procedures. Exte rnal spermatic veins were identified in 15% of left-sided varicoceles and 19% of right-sided ones. Of 31 patients undergoing bilateral varic ocelectomies, 19% had at least 1 external spermatic vein. Of these pat ients, only 2 (7%) had a unilateral right external spermatic vein, non e had a unilateral left external spermatic vein, and 4 (13%) had bilat eral external spermatic veins. Overall, of all patients studied, 16% h ad at least 1 external spermatic vein. Follow-up at 1 year showed no e vidence of clinical recurrence in any patient. Conclusions. These resu lts emphasize the importance of distal gonadal venous anatomy in the s urgeon's choice of the proper approach to varicocele repair, since ext ernal spermatic veins are only accessible via an inguinal approach.