Comparison of efficacy between inguinal and subinguinal microscopic varicocelectomy

doi:10.3877/cma.j.issn.1674-3253.2021.01.012

Abstract

Abstract:

Objective

To compare the efficacy and safety between microscopic inguinal and subinguinal varicocelectomy for varicocele.

Methods

The data of 145 cases underwent microscopic varicocelectomy in our hospital from January 2016 to June 2019 were analyzed retrospectively. Microscopic inguinal varicocelectomy (MIV) and microscopic subinguinal varicocelectomy (MSV) were performed in 53 and 92 patients. Operation duration, number of ligated veins, postoperation scrotum pain relief rate, and changes of sperm parameters were compared between the two groups. Complications, such as hydrocele, testicular atrophy, and recurrence of varicocele, were compared between the two groups.

Results

Operation duration was significantly shorter in the MIV group than in the MSV group [(34.2±5.0)min vs (37.8±8.4)min, t=-3.245, P=0.001]. And the number of ligated veins was significantly fewer in the MIV group [(6.1±1.3) veins vs (8.3±1.5) veins, t=-9.171, P<0.001]. No statistically significant difference was found between the two groups in terms of changes of sperm parameters, postoperation scrotum pain relief rate, and complications.

Conclusion

Microscopic inguinal and subinguinal varicocelectomy are both safe and effective in treatment of varicocele. Subinguinal approach need fewer veins ligated and shorter operation duration.

Key words: Microscopy, Varicocelectomy, Approach, Subinguinal approach

Jianhua Huang, Yuxiang Zhong, Pengpeng Zhao, Yuan Mai, Wei Wei, Fuxiang Lin, Jingmiao Jin, Zhanping Xu. Comparison of efficacy between inguinal and subinguinal microscopic varicocelectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(01): 47-50.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2021.01.012

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2021/V15/I01/47

Figures/Tables 3

References 15

[6]	Cayan S, Shavakhabov S, Kadioglu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique[J]. J Androl, 2009, 30(1):33-40.
[7]	黄泽海, 梁燊, 王子明, 等. 3种手术方式治疗成人精索静脉曲张疗效比较[J]. 实用医学杂志, 2018, 34(23): 3929-3932.
[8]	《精索静脉曲张诊断与治疗中国专家共识》编写组. 精索静脉曲张诊断与治疗中国专家共识 [J]. 中华男科学杂志, 2015, 21(11): 1035-1042.
[9]	俞能旺, 沈戈桢, 宋华, 等. 治疗精索静脉曲张不同术式疗效的荟萃分析[J]. 中华泌尿外科杂志, 2013, 34(1): 45-49.
[10]	聂欢, 高强利, 陈磊, 等. 三种精索静脉曲张手术疗效的对比观察[J]. 中国性科学, 2017, 26(3): 24-27.
[11]	Pettersson S, Söderholm B, Persson JE, et al. Testicular blood flow in man measured with venous occlusion plethysmography and xenon133 [J]. Scand J Urol Nephrol, 1973, 7(2): 115-119.
[12]	Saban OD, Fatih O, Ahmet EC, et al. A comparison between the efficacy and safety of microscopic inguinal and subinguinal varicocelectomy [J]. Turk J Urol, 2019, 45(4): 254-260.
[13]	苏剑锋, 张炎, 杨晓健, 等. 显微镜下两种入路治疗精索静脉曲张引起的阴囊疼痛疗效对比 [J]. 中华腔镜泌尿外科杂志（电子版）, 2017, 11(1): 55-58.
[14]	Lv KL, Zhuang JT, Zhao L, et al. Varicocele anatomy during subinguinal microsurgical varicocelectomy in Chinese men [J]. Andrologia, 2015, 47(10): 1190-1195.
[15]	Hopps CV, Lemer ML, Schlegel PN, et al. Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach [J]. J Urol, 2003, 170 (6 Pt 1): 2366-2370.
[1]	Palomo A. Radical cure of varicocele by a new technique; preliminary report [J]. J Urol, 1949, 61(3): 604-607.
[2]	Glassberg KI, Poon SA, Gjertson CK, et al. Laparoscopic lymphatic sparing varicocelectomy in adolescents [J]. J Urol, 2008, 180(1): 326-331.
[3]	Nabi G, Asterlings S, Greene DR, et al. Percutaneous embolization of varicoceles: outcomes and correlation of semen improvement with pregnancy [J]. Urology, 2004, 63(2): 359-363.
[4]	Watanabe M, Nagai A, Kusumi N, et al. Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches[J]. Int J Urol, 2005, 12(10): 892-898.
[5]	Cayan S, Kadioglu TC, Tefekli A, et al. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele [J]. Urology, 2000, 55(5): 750-754.

组别	例数	年龄（岁，±s）	未婚（例）	主诉（例）			精索静脉曲张分度（例）			睾丸萎缩（例）
组别	例数	年龄（岁，±s）	未婚（例）	阴囊疼痛	不育	体检	Ⅰ	Ⅱ	Ⅲ	睾丸萎缩（例）
腹股沟	53	25.9±9.7	34	35	7	11	5	26	22	1
腹股沟下	92	25.7±8.6	57	63	9	20	5	41	46	1
统计值		t=0.139	χ²=0.069	χ²=0.402			Z=-1.124			-
P值		0.890	0.792	0.818			0.261			1.000^*

组别	例数	年龄（岁，±s）	未婚（例）	主诉（例）			精索静脉曲张分度（例）			睾丸萎缩（例）
组别	例数	年龄（岁，±s）	未婚（例）	阴囊疼痛	不育	体检	Ⅰ	Ⅱ	Ⅲ	睾丸萎缩（例）
腹股沟	53	25.9±9.7	34	35	7	11	5	26	22	1
腹股沟下	92	25.7±8.6	57	63	9	20	5	41	46	1
统计值		t=0.139	χ²=0.069	χ²=0.402			Z=-1.124			-
P值		0.890	0.792	0.818			0.261			1.000^*

组别	例数	手术时间（min）	结扎静脉（根）	保留动脉（根）			术后住院时间（d）	随访时间（月）	阴囊疼痛缓解	复发	睾丸鞘膜积液
组别	例数	手术时间（min）	结扎静脉（根）	0	1	2	术后住院时间（d）	随访时间（月）	阴囊疼痛缓解	复发	睾丸鞘膜积液
腹股沟	53	34.2±5.0	6.1±1.3	1	50	2	1.8±0.6	7.9±2.1	80%（28/35）	1	0
腹股沟下	92	37.8±8.4	8.3±1.5	2	82	8	1.8±0.4	8.0±1.8	87%（55/63）	2	1
统计值		t=-3.245	t=-9.171	χ²=1.295			t=0.284	t=-0.162	χ²=0.925
P值		0.001	0.000	0.635			0.777	0.872	0.336	1.000*	1.000*

组别	例数	手术时间（min）	结扎静脉（根）	保留动脉（根）			术后住院时间（d）	随访时间（月）	阴囊疼痛缓解	复发	睾丸鞘膜积液
组别	例数	手术时间（min）	结扎静脉（根）	0	1	2	术后住院时间（d）	随访时间（月）	阴囊疼痛缓解	复发	睾丸鞘膜积液
腹股沟	53	34.2±5.0	6.1±1.3	1	50	2	1.8±0.6	7.9±2.1	80%（28/35）	1	0
腹股沟下	92	37.8±8.4	8.3±1.5	2	82	8	1.8±0.4	8.0±1.8	87%（55/63）	2	1
统计值		t=-3.245	t=-9.171	χ²=1.295			t=0.284	t=-0.162	χ²=0.925
P值		0.001	0.000	0.635			0.777	0.872	0.336	1.000*	1.000*

组别		精子浓度（10⁶/ml）			精子总活力（%）
组别	例数	术前	术后	术后恢复正常（例）	术前	术后	术后恢复正常（例）
腹股沟	17	9.05±3.38	23.19±9.28	15	30.8±12.1	43.3±16.4	7
腹股沟下	26	9.36±2.95	18.52±4.30	21	28.3±6.7	41.8±7.2	14
统计值		t=-0.318	t=1.941	χ²=0.051	t=0.781	t=0.366	χ²=0.660
P值		0.752	0.066	0.821	0.443	0.718	0.416

Please choose a citation manager

Content to export