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Simultaneous vasectomy and varicocelectomy: indications and technique.

Richard K Lee1, Philip S Li, Marc Goldstein

  • 1Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Cornell Institute for Reproductive Medicine, Weill Medical College of Cornell University, New York, New York 10021, USA.

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Men undergoing vasectomy may have varicoceles. Simultaneous microsurgical vasectomy and varicocelectomy safely addresses this, preserving testicular function and venous return.

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Area of Science:

  • Urology
  • Andrology
  • Surgical Techniques

Background:

  • Incidental varicoceles are discovered in men seeking vasectomy.
  • Varicocelectomy compromises testicular venous return, potentially impacting fertility.
  • Simultaneous vasectomy and varicocelectomy is a viable surgical option.

Purpose of the Study:

  • To discuss indications and techniques for safe, simultaneous vasectomy and varicocelectomy.
  • To evaluate the safety and efficacy of combined microsurgical procedures.
  • To assess outcomes in men with incidental varicoceles undergoing combined surgery.

Main Methods:

  • 18 men with incidental varicoceles and low testosterone underwent microsurgical subinguinal varicocelectomy and vasectomy.
  • All spermatic, cremasteric, and gubernacular veins were ligated.
  • The vas deferens was isolated, transected, and clipped after preserving deferential vessels.

Main Results:

  • 18 men (mean age 39.6) with grade II-III varicoceles underwent 27 procedures.
  • Mean testosterone increased from 348 to 416 ng/dL post-operatively.
  • No complications, testicular atrophy, vasectomy failures, or varicocelectomy recurrences were observed.

Conclusions:

  • Simultaneous microsurgical vasectomy-varicocelectomy benefits men with incidental varicoceles.
  • Microsurgical approach is crucial for ligating vessels and preserving testicular artery and deferential vessels.
  • This combined procedure minimizes risks of testicular atrophy and compromised venous drainage.