Loupe-assisted high inguinal varicocelectomy for sub-fertile men with varicoceles.

BACKGROUND Microsurgical sub-inguinal varicocelectomy has been associated with extremely high success rates and minimal postoperative complications. The aim of this study was to report the techniques and outcomes of varicocelectomy using a modified microsurgical method, specifically a loupe-assisted high inguinal varicocelectomy instead of the usual microscope and sub-inguinal approach. METHODS From 1997 through 2000, 116 patients underwent modified high inguinal varicocelectomy. All patients had at least a 1-year history of infertility with abnormal semen parameters and varicocele proven by physical examination and/or color Doppler ultrasound. Varicocelectomy was performed as an outpatient procedure. To facilitate the procedure, a x3.0 loupe was used during the spermatic cord dissection at the level of the internal inguinal ring. During dissection, the dilated veins were ligated and divided including vasal veins and external spermatic veins. All of the patients were followed postoperatively with semen analysis and physical examination every 3 months. RESULTS A total of 96 patients were followed for more than 1 year, with at least two semen analyses being conducted. Moreover, 136 varicocelectomies were performed among the 96 patients. No intra-operative complications occurred. A temporary reactive hydrocele was noted in one patient, but subsequently completely resolved. In addition, recurrent or persistent varicocele was identified by physical examination and/or color Doppler in four patients (2.9%). Motile sperm concentration increased from 31.8 +/- 18.6% to 47.5 +/- 16.9% (p = 0.0004) in the sample group, and the sperm concentration (10(6)/cc) increased from 26.2 +/- 18.7 to 42.8 +/- 28.5 (p = 0.0002). CONCLUSION Loupe-assisted high inguinal varicocelectomy is a safe, simple. and effective method for the treatment of sub-fertile men, especially in medical facilities without microscopic equipment. However, further study with control groups is needed to strengthen the evidence.