Comparison between Microsurgical Subinguinal Varicocelectomy with and without Testicular Delivery for Infertile Men: Is Testicular Delivery an Unnecessary Procedure.

PURPOSE: Controversy still exists as to whether testicular delivery during microsurgical subinguinal varicocelecto­my (MSV) provides benefit to the patient or not. This study specifically compared the therapeutic effect of MSV with and without testicular delivery for the treatment of varicocele in a cohort of infertile men.

MATERIALS AND METHODS: We conducted a prospective, randomized, controlled study to evaluate the therapeutic efficacy of MSV with and without testicular delivery for the treatment of varicocele in infertile men. A total of 100 patients were specifically recruited using strict inclusion criteria to undergo MSV with testicular delivery (group 1, n = 50) or MSV without testicular delivery (group 2, n = 50). All patients were followed-up at 3, 6 and 12 months following surgery. Semen parameters, pregnancy and recurrence rates, and complications were monitored.

RESULTS: Mean surgical time for group 1 was significantly longer than group 2 (90.50 ± 15.60 min vs. 84.30 ± 15.58 min; P = .001). Sperm count and motility were significantly improved at the 12-month follow-up appoint­ment in both groups compared with pre-operative values, but were not significantly different at 3, 6, and 12 months when compared between the two treatment groups. The incidence of scrotal edema, and spermatic/testicular en­gorgement were higher in group 1 (both P = .001), although natural pregnancy rate was not significantly different between the two groups at the 12 month follow-up appointment (46% vs. 42%) (P = .817).

CONCLUSION: MSV with testicular delivery did not reduce the risk of recurrence and led to improved semen quality compared with MSV without testicular delivery. However, there was a higher risk of complication with this tech­nique, which must be borne in mind when considering the clinical implications of our dataset.