Microsurgical high inguinal varicocelectomy with delivery of the testis.

This study describes the results of 50 consecutive cases of varicocelectomy by the inguinal approach. The testicle is delivered through a small inguinal incision, and all external spermatic and gubernacular veins are ligated. The testis is returned to the scrotum and the spermatic cord is dissected under optical magnification. The testicular artery, the lymphatics and the vas deferens are identified and preserved. All internal spermatic veins are ligated. 94 varicocelectomies were performed in 50 men. Follow-up period extended from 12 months to 24 months. No hydroceles, no clinical recurrences and no wound infection were found. One scrotal hematoma occurred and resolved progressively. Preoperative and postoperative semen analysis were obtained. The changes in sperm count mean value (million/cc) (20 to 28.6) (p < 0.005), per cent normal forms (42.9 to 52.1%) (p < 0.005) and per cent motility (31.5 to 39.2%) (p < 0.005) were significant. The pregnancy rate was 10 of 21 couples available for follow-up (47.6%). This technique results in a significant decrease in the incidence of hydrocele formation, testicular artery injury and varicocele clinical recurrence.