Assessing the outcomes of subinguinal microsurgical varicocelectomy: pulling technique compared to the conventional method.

INTRODUCTION

The positive effect of varicocelectomy on sperm parameters (sperm morphology, concentration, motility) and fertility and pregnancy rates has been proven. Although various techniques have been defined for varicocele treatment, varicocelectomy with the pulling technique was first defined in 2017. The aim of this retrospective study is to compare the effectiveness and reliability of subinguinal microsurgical varicocelectomy with the "pulling" technique and conventional subinguinal varicocelectomy.

METHODS

A total of 841 patients who underwent subinguinal microsurgical varicocelectomy using the "pulling" or conventional technique between January 2015 and January 2024 were examined retrospectively. Patients with missing and/or inaccessible data, who were using empirical treatments, were excluded from the study. Demographic data, laboratory and imaging results, and peroperative and postoperative 3rd and 6th month semen analysis results of the remaining 231 patients were evaluated.

RESULTS

The mean age of 231 patients who underwent varicocelectomy was 31.1 ± 5.5 years. 202 of the patients (87.4%) were primary infertile. Conventional technique was applied to 124 (53.7%) of the 231 patients, while pulling technique was applied to 107 (46.3%) patients. No significant difference was found between the demographic and clinical data of the patients. The median number of ligated pampiniform plexus veins in the patient group who underwent pulling technique was statistically significantly less than that in the patient group that underwent the conventional method (4 vs 5, p = 0.03). In all patients who underwent varicocelectomy, semen volume, spermatozoa concentration, and progressive motile spermatozoa proportion increased significantly in the postoperative period (p = 0.002, p = 0.006, p = 0.001, respectively). No significant change was found in the proportion of spermatozoa with normal morphology (p = 0.617). The changes in semen analysis data from the preoperative period to the third and sixth postoperative months after varicocelectomy with conventional and pulling techniques were compared. No significant difference was found between the two techniques.

CONCLUSION

Subinguinal microsurgical varicocelectomy with the "pulling" technique may be a safe and effective treatment option with fewer vein ligations compared to the standard surgical method.