[Surgical treatment of varicocele. Our experience in the last 10 years]

Varicocele means a varicose dilatation with stretching of the veins in the pampiniform plexus. In the last years the problem of varicocele has emerged again in all its importance for the increasing of couple sterility which, in Italy, is certified to 13%. It is known that this problem is connected to anomalies of the spermiogram, even in the subclinical forms located with the ultrasound method, and that the surgical operation allows to correct in a high percentage of cases.

For treatment of varicocele we use a technique with inguinal approach of 5-6 cm and isolation of all the dilated veins intra- and extrafunicular. After their ligation and section we transpose the funiculus proximally with a little traction on the testicle and we fix it to the great oblique muscle fascia, using margin of cremasteric muscle prepared in advance and distal stumps of resected veins. This manoeuvre forms a short ansa of the funiculus that, in the orthostatic position, helgs to stop the hematic column which weighs on the testicle. This operation has been performed in 54 patients. In 18 (60%), oligoastenospermia was present and 10 (33%) had consulted their physician for sterility problems (4 of them with a sub-clinical varicocele). The patients have been recalled for clinical and echo-doppler control as well qualitative evaluation of the sperm. The follow-up goes from 8 months to 7 years.

We have noticed the presence of six relapses (13.3%) so divided: 4 relapses with a first grade reflux; 1 relapse with a second grade reflux and 1 relapse with a third grade reflux. Only in two patients with first grade reflux was the spermiogram normal, while in all the others oligoastenospermia persisted. Seric evaluation of testosterone and androstenedione have excluded hormonal causes of sterility. Among the 10 sterile patients 6 (60%), had a normalization of the spermiogram and 4 of them (2 of which with preceding subclinical varicocele), had a partner pregnancy in periods within 7 and 18 months after the operation.

On the basis their experience, the authors confirm the validity of the selective varicocelectomy by inguinal approach, with probable further advantage using funicular transposition. To agree with other authors there isn't any very important advantage, in the cost/benefit ratio, between microsurgical diversion and laparoscopic surgery, and traditional varicocelectomy in local anesthesia. The incidence of relapses noticed (13.3%), lower than that rated at the high ligature (29%), is the expression of the anatomic complexity of the spermatic venous drainage, in such a way to think right a phlebographic anterograde intraoperative evaluation. We also confirm the importance of ultrasonographic and ecographic methods in the pre and postoperative evaluation, we underline that, in the subclinical cases, it is possible to verify spermiogram alteration corrected, in a high percentage, by varicocelectomy.