TREATMENT OF VARICOCELE - A COMPARATIVE-STUDY OF CONVENTIONAL OPEN SURGERY, PERCUTANEOUS RETROGRADE SCLEROTHERAPY, AND LAPAROSCOPY

Objectives. To present our experience with the results of three differ ent methods of treatment of idiopathic varicoceles. Methods. A total o f 301 patients with 417 varicoceles were retrospectively assigned into three groups according to the method of treatment. Group 1 included 9 4 patients with 131 varicoceles treated by open surgery. Group 2 consi sted of 120 patients with 163 varicoceles treated by percutaneous retr ograde sclerotherapy, and in group 3, 87 patients with 123 varicoceles were treated by laparoscopic varicocelectomy. Of all patients, 222 (7 3.8%) were closely followed up with clinical and Doppler ultrasound ex aminations 6 and 12 months after the treatment. Seminal analysis was c arried out before treatment and repeated in 172 patients with subferti lity or infertility 4 to 6 months after treatment. Results. Patients i n the three treatment groups were balanced regarding the different var iables. The mean operative time was significantly shorter among patien ts with open surgery. The cost of sclerotherapy is one fourth to one f ifth that of surgery and the cost of laparoscopy is double. Sclerother apy was successful in 96 (82.8%) of 1 1 6 left varicoceles and in only 24 (51%) of 47 right varicoceles. The recurrence rate at follow-up wa s not significantly different among the three groups. The recurrence r ate increased progressively with the increase of varicocele size from grade I to grade III in all groups. The overall incidence of postopera tive complications was significantly higher among patients with open s urgery. Postoperative spermiogram showed a significant increase in the density and motility and a significant reduction in the percentage of abnormal forms in all groups. The pregnancy rate was approximately si milar in all groups. Conclusions. First, sclerotherapy is best used fo r isolated left-sided varicoceles. Second. laparoscopy is the treatmen t of choice for bilateral varicoceles. Finally, open surgery still has a role in isolated right-sided varicoceles and in left-sided cases wi th failed sclerotherapy. UROLOGY 52: 294-300, 1998. (C) 1998, Elsevier Science Inc. All rights reserved.