Treatment of varicocele for male infertility: A comparative study evaluating currently used approaches

Objective: To evaluate the results of four currently used approaches for the treatment of clinically diagnosed varicoceles, and compare their influence on semen parameters. Methods: We prospectively evaluated 88 patients, 23-39 years old (mean age 31), with a clinically diagnosed varicocele. Patients were allocated randomly to be treated either by a retroperitoneal (group A), inguinal (group B), subinguinal (group C), or percutaneous venous embolization approaches (group D). All patients were evaluated 6 and 12 months postoperatively. Results: Clinical recurrence of varicocele occurred in 4 patients of group A (18.2%), 1 patient of group B (4.5%), and 2 patients of group D (9.1%). Hydrocele formation was seen in 1 patient of group B (4.5%), and 2 patients of group C (9.1%). In all groups statistically significant improvement as to the sperm concentration was found in both the 6- and 12-month followup. This significance was more prominent in group C followed by groups B and D, and finally by group A. As to sperm motility, in group C there was a statistical significance in both follow-up evaluations, and in group B statistical difference was reached only in the 12-month evaluation. Sperm morphology did not differ in any of the groups postoperatively compared to the preoperative values. Conclusions: The subinguinal approach disclosed a more prominent improvement in both semen concentration and motility in the 6- and 12-month follow-up evaluation when compared to the other techniques. Furthermore, due to its simplicity and avoidance of opening the external oblique fascia, we believe it represents the more plausible approach when treating clinical varicocele.