Varicocelectomy

The mechanism by which varicocele exerts a deleterious effect on testicular function and semen quality remains unknown. Nevertheless, varicocele is generally regarded as a significant factor in male infertility and is present in up to 40% of men presenting for an infertility evaluation. Early studies questioned the efficacy of varicocelectomy in improving male fertility potential; however, most of the data drawn from published series support a beneficial effect of varicocelectomy on semen quality and rates of pregnancy in the female partner of the patient. Up to 66% of men show significant improvement in semen quality after varicocelectomy, with rates of pregnancy in the female partner of the patient averaging 32%. Varicocelectomy is accomplished with a variety of approaches, including modified Palomo or high ligation, transinguinal or subinguinal with or without magnification, laparoscopic varix ligation, and transvenous percutaneous occlusion. The improvement in semen quality and the rate of pregnancy in the female partner of the patient appears comparable for all methods. The varicocele recurrence rate appears lowest with both microsurgical and nonmicrosurgical inguinal and subinguinal approaches. Hydrocele formation, the main complication of varicocelectomy, is uncommon with microsurgical techniques but averages 7% for nonmicrosurgical methods. Ligation of the testicular artery probably occurs more frequently than is generally realized but rarely leads to testicular atrophy. A subinguinal varicocelectomy performed with magnification may have the lowest recurrence and complication rates associated with lowest analgesic use and days missed from work.