A Clinical Study and Management of Varicocele

Background Data Varicocele, an abnormal dilatation and tortuosity of the pampiniformplexes of veins is found in about 15% of the general population with a marked left ed predominance. However this incidence rises to 35% in men with primary fertility and 70 to 80% in men with secondary infertility. Although varicocelectomy is the most commonly performed procedure for correction of male subfertility with seminal imp nent in 60 to 80% of the subjects and pregnancy rates ranging from 20 to 60% there is still no consensus on the best method of performing the varicocelectomy. Materials and Methods A prospective study of 50 adult patients suffering from unilateral/bilateral variccele presenting with infertility or pain. All the patients included in the study unit went varicocelcectomy in the period ranging between May 2006 and Sept 2008 and their ages ranged from 18 yrs to 50 Results The operating time was found to be nearly same for open (46.04min) and laparoscopic (45.4min) varicocelectomy in bilateral cases. Laparoscopic approach also provided the advantage of being performed through the same ports for both sides. However for unilateral varicocelectomy, operating time was much shorter for open procedures (23.02min to 40.66min). The postoperative pain score calculated over the first 3 postoperative days was found to be higher in the open group (6) compared to laparoscopic group (3.94). Among the open group, postoperative pain was found to be greatest with the inguinal group (6.54) compared to palomo group (5.85). Symptomatic relief in patients operated for painful varicocele was found to be better achieved by open (64.29%) than the laparoscopic approach (57.15%). Among the inguinal approach was found to give better results with relief of pain on 67.66% of the patients whereas the palomo's approach yielded success in 50% of patients. Improvement in seminal parameters was found to be achieved better with open (69.66%) than laparoscopic (62.5%) approaches and inguinal (71.43%) better than palomo's approach (57.15%). Conclusion Varicocelectomy has been performed as a procedure for correction of male sub fertility for a long time. Several uncontrolled studies have shown improvement in the seminal parameters after varicocelectomy and also enhanced pregnancy rates. The findings of our study were consistent with the above mentioned established facts. It was found that varicocelectomy performed by any method led to an improvement in seminal parameters and pregnancy rates in properly selected cases. There was significant difference in the operating time between open and laparascopic approaches for unilateral varicocelectomy. However, for bilateral varicocelcectomy operating time for the open or laparascopic procedure remains nearly the same. The laparascopic approach also provides the advantages of being able to be performed through the same ports for both sides thus avoiding additional incisions. Improvement in seminal parameters was noted in 62.5% of patients after laparoscopic varicocelectomy and pregnancy achieved in 32.5% of the patients which were comparable to the results obtained with open varicocelectomy. Thus, varicocelectomy in experienced hands could be considered as a good option for patients being considered for bilateral varicocelectomy over open varicocelectomy. Among the open approaches, the inguinal approach (66.66%) fared better than the Paloma's approach (50%).