Modified subinguinal varicocelectomy for painful varicocele and varicocele-associated infertility

Patients with varicocele comprise 15% of males in general population. Varicocele is considered the most cost-effectively treatable cause of male infertility. We introduce a modification in technique of subinguinal varicocelectomy and review the outcome of 58 patients from July 2000 to July 2002.

Four out of the 58 cases had both pain and infertility. For the 31 infertility patients, 8 (25.8%) were azoospermic, and testis biopsy was also performed. Post-operatively, we followed these patients on every-3-month basis with semen analysis, physical recovery and situation of fecundity. Patients with painful varicocele (n = 31) were also followed with physical check-up and optional semen analysis.

Fifty-four men had left varicocele only, while 4 had bilateral lesions. In the painful varicocele group, 28 of 31 patients (90%) felt complete resolution of pain and 3 patients (10%) felt partial resolution of pain. In the infertility group, 8 patients had asthenospermia only, 15 had oligo-asthenospermia and 8 were azoospermic. During the follow-up, 6 out of the 23 non-azoospermic couples (32%) got spontaneous pregnancy in 7 months in average. For the 8 azoospermic patients, the simultaneous testicular biopsy revealed Sertoli-cell-only syndrome in 4, maturation arrest in 3 and hyalinization of tubules in 1. However, they stayed azoospermic after the procedure. In oligo-asthenospermic patients (n = 15), mean sperm concentration improved from 6.1 to 24.2 x 10(6)/cc (p < 0.02). Improvement in morphology and motility were only significant in the patients with grade 3 varicocele.

The newly modified technique of subinguinal varicocelectomy is an effective procedure to either eliminate the pain of varicocele or improve the semen parameters in infertility patients. The procedure is also very promising in avoiding complication and residual lesions.