TREATMENT OF VARICOCELE FOR MALE-INFERTILITY - A COMPARATIVE-STUDY EVALUATING CURRENTLY USED APPROACHES

Objective: To evaluate the results of four currently used approaches f or the treatment of clinically diagnosed varicoceles, and compare thei r influence on semen parameters. Methods: We prospectively evaluated 8 8 patients, 23-39 years old (mean age 31), with a clinically diagnosed varicocele. Patients were allocated randomly to be treated either by a retroperitoneal (group A), inguinal (group B), subinguinal (group C) , or percutaneous venous embolization approaches (group D). All patien ts were evaluated 6 and 12 months postoperatively. Results: Clinical r ecurrence of varicocele occurred in 4 patients of group A (18.2%), 1 p atient of group B (4.5%), and 2 patients of group D (9.1%). Hydrocele formation was seen in 1 patient of group B (4.5%), and 2 patients of g roup C (9.1%). In all groups statistically significant improvement as to the sperm concentration was found in both the 6- and 12-month follo wup. This significance was more prominent in group C followed by group s B and D, and finally by group A. As to sperm motility, in group C th ere was a statistical significance in both follow-up evaluations, and in group B statistical difference was reached only in the 12-month eva luation. Sperm morphology did not differ in any of the groups postoper atively compared to the preoperative values. Conclusions: The subingui nal approach disclosed a more prominent improvement in both semen conc entration and motility in the 6- and 12-month follow-up evaluation whe n compared to the other techniques. Furthermore, due to its simplicity and avoidance of opening the external oblique fascia, we believe it r epresents the more plausible approach when treating clinical varicocel e.