Outcomes of Microscopic Subinguinal Varicocelectomy With and Without the Assistance of Doppler Ultrasound: A Randomized Clinical Trial.

OBJECTIVE: To compare the surgical outcomes and complications between microscopic subinguinal varicocelectomy (MV) and intraoperative vascular Doppler ultrasound-assisted microscopic subinguinal varicocelectomy (IVDU-MV) for infertile patients with varicoceles.

MATERIALS AND METHODS: One hundred seventy-two infertile patients with varicoceles were randomly divided into IVDU-MV group (n = 85) and MV group (n = 87). We assessed patients' operative and postoperative parameters, semen parameters, and the pregnancy rate. The mean follow-up period was 21 months (range, 13-34 months).

RESULTS: The operative time was significantly shorter in the IVDU-MV group than MV group (41.9 ± 13.6 vs 52.7 ± 14.1 minutes, P <.05). The number of intraoperative arteries spared was significantly greater in the IVDU-MV group than the MV group (1.9 ± 0.8 vs 1.3 ± 0.7, P <.05). In addition, the average number of spermatic veins ligated was significantly greater in the IVDU-MV group (7.8 ± 2.1 vs 7.0 ± 1.9, P <.05). Lymphatic spared showed no significant difference (P >.05). The postoperative hospital stay showed no significant difference. Sperm concentration, sperm motility, and the percentage of grade a+b sperm were significantly increased in both groups at 3, 6, and 12 months after surgery (P <.05), and the sperm motility was higher in IVDU-MV than MV group (43.98 ± 7.64 vs 36.98 ± 5.10, P <.05) in 12 months after surgery. Sperm morphology was comparable between the 2 groups. The pregnancy rate showed no significant difference (36.8% of the MV vs 34.1% of the IVDU-MV, P >.05).

CONCLUSION: Our study demonstrated that both MV and IVDU-MV are effective methods for the improvement of semen parameters in infertile men with varicocele, with a natural conception rate of 35% over a mean follow-up of 21 months. Compared with MV, IVDU-MV is superior in shortening operative time, increasing the number of spermatic arteries spared, spermatic veins ligated, and sperm motility after surgery. IVDU should be routinely used as an effective tool to improve outcomes and safety of varicocelectomy.