Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles

Purpose: The left varicocele is usually larger in men with bilateral varicoceles. We hypothesized that most of the benefit of varicocelectomy would derive from repair of the larger varicocele. To test this hypothesis we prospectively compared the effect of unilateral versus bilateral microsurgical varicocelectomy in men with large (grade III) or moderate (II) left varicocele associated with small but palpable (I) right varicocele. Materials and Methods: A total of 91 patients were prospectively followed and included in the study. Of the patients 65 underwent bilateral and 26 underwent unilateral left repair. All patients underwent preoperative and postoperative semen analysis. Results: Motile sperm concentration increased from 12.1 +/- 1.7 to 23.7 +/- 31.8 (95.8% change) in the bilateral group compared with an increase from 19.5 +/- 21.4 to 27.8 +/- 34.8 (42.6% change) in the unilateral group (p <0.05). Similarly, sperm concentration increased from 23.8 +/- 29.5 to 48.6 +/- 61.3 (157.6% change) in the bilateral group compared with an increase from 41.1 +/- 40.9 to 59.5 +/- 66.7 (44.8% change) in the unilateral group (p <0.05). Conclusions: Bilateral varicocelectomy resulted in significantly greater improvement in postoperative seminal parameters than unilateral repair in patients with grades II to III left varicocele associated with grade I right varicocele. Even a small, unrepaired palpable right varicocele continues to have a detrimental effect on bilateral testis function. Men with bilateral palpable varicoceles require bilateral repair.