A study of the surgical outcome and impact on semen parameters after laparoscopic varicocelectomy and sub inguinal microscopic varicocelectomy

Abstract

Introduction: Varicocele is defined as a pathological dilation of the testicular pampiniform venous plexus that drains the testes and may be associated with male subfertility, hypogonadism, pain, discomfort, and failure of ipsilateral testicular growth and development. This condition is present in 11.7% of adult men and in 25.4% of men with abnormal semen analysis. Despite a recent meta-analysis showing semen improvement after surgical correction, the exact association between reduced male fertility and varicocele is unknown. Materials and Methods: This is prospective interventional study conducted from January 2020 to December 2020 in patients attending the OPD in the department of Urology, Santhiram Medical College and Hospital, Nandyal, Andhra Pradesh, India. Patients with abnormal semen parameters and clinical varicocele were selected. Doppler study of the scrotum (presence of varicocele graded using Sarteschi scale) was done for these patients. The patients fulfilling the selection criteria were counselled for varicocelectomy and consent for the study obtained. The patients were randomized into Group A (laparoscopic varicocelectomy) and Group B (sub-inguinal varicocelectomy) by random allocation method. Results: Review at immediate post-operative period, follow ups at 3 & 6 months were undertaken. History of conception, clinical examination, semen analysis according to WHO 2010 manual and doppler studies by Sarchetsi scale were performed. Three factors in seminal parameters namely sperm concentration, motility & morphology were assessed. Varicocele recurrence was also assessed. There had been a statistically significant improvement in semen parameters in all the patients who underwent varicocelectomy (p value p< 0.005). On comparing the laparoscopic and sub-inguinal surgical techniques, there was no significant variation in increase in sperm concentration, sperm motility and morphology. Conclusion: Varicocelectomy improves the semen parameters. No significant variation was observed when the different surgical approaches of varicocelectomy were compared.