Comparison Of Four Different Surgical Approaches For The Treatment Of Varicocele

Objective:Comparison of four different surgical approaches for the treatment of 246 cases of patients with varicocele in our hospital, and to evaluate the curative effect,merits and demerits of different surgical approaches.Method:From December 2013 to March 2015,246 cases of patients with varicocele which were single diseases and had no other medical diseases,were collected in andrology、urology in our hospital, the mean age were 24.7±5.3 years old(18～49years). All patients were diagnosed with varicocele through physical examination and spermatic cord CDFI. All patients have the routine examination of abdominal B-ultrasound(excluding secondary VC) and semen analysis, for patients with infertility(normal sexual life after marriage without birth control more than one year without children) excluding Azoospermia and the female infertility. All patients were divided into four groups by using different surgical approaches,A group:53 cases of inguinal approach group;B group:34 cases of retroperitoneal high ligation group;C group:71 cases of laparoscopy group;D group:88 cases of microsurgery group.We analyzed and compared the operation time,postoperative hospital stay, hospital costs.Patients were followed-up after the operations of two weeks,three months,six months and twelve months,to compare the incidence of complications, the rate of symptom improvement,recurrence rate,post-operation semen analysis and pregnancy rate.Rusults:Analyzing and comparing the operation time,postoperative hospital stay,hospital costs,the mean operation time of microsurgery group was significantly longer than that of the other three groups(P<0.05),but the postoperative hospital stay was shorter than the inguinal approach group and retroperitoneal high ligation group (P<0.05).The mean hospital costs of microsurgery group was significantly lower than that of the other three groups(P<0.05),the mean hospital costs of laparoscopy group was highest(P<0.05).Comparing the incidence of complications(scrotal edemas or hydrocele or atrophy of testis) and the rate of symptom improvement (pain in scrotum) after the operations of two weeks,three months and six months in four groups, the incidence of complications and the rate of symptom improvement in the microsurgery group were significantly better than the other three groups(P<0.05).Compared to preoperative semen parameters,postoperative semen parameters of all the four groups were improved in sperm concentration and motility(P<0.05), the incidence of patients with improved semen parameters and the degree of semen quality improvement were significantly better in the microsurgical group(P<0.05).But when we compared the semen quality postoperative 3 months with the semen quality postoperative 6 months within groups, no significantly statistical differences were found(P>0.05).After 1 year,the recurrence rate of microsurgery group(0.0%) was obviously lower than the inguinal approach group(9.8%) and the retroperitoneal high ligation group(12.5%) and laparoscopy group(7.4%),(P<0.05).The pregnancy rate at 1 year was not significantly different among the four groups(P>0.05).Conclusions:Microsurgical subinguinal varicocelectomy is obviously superior to open inguinal approach,retroperitoneal high ligation and laparoscopic approaches in postoperative hospital stay, hospital costs,the incidence of complications, the rate of symptom improvement,the recurrence rate,the postoperation semen quality.With the advantages of minimal invasion and better effect, microsurgical varicocelectomy is easier to accept by most patients,and can be widely recommended and popularized by clinic as a preferred approach.