Preserving One Artery Shortens the Surgical Time and Does Not Affect the Efficacy of Microsurgical Subinguinal Varicocelectomy: Preliminary Findings from a Retrospective Study

Background: To analyze the safety and efficacy of microsurgical subinguinal varicocelectomy(MSV) performed with and without preservation of all testicular arteries and lymphatic system.

Methods: All of the 98 patients with varicocele who underwent MSV were included in the analysis. Fifty-eight male patients surgically underwent MSV with preservation of all testicular arteries and lymphatic system(Group 1). The other 40 male patients surgically underwent MSV with preservation of a single testicular artery, while the remaining vascular bundle sparing the vas deferens with its vessels was then isolated"en bloc," ligated and cut(Group 2). Operative time, semen parameters and complications were then compared.

Results: Mean operative time for Group 1 was significantly longer than that of Group 2(90.26 ± 21.69 min vs. 79.30 ± 19.58 min, P = 0.01). Visual analogue pain scale (VAS) decreased significantly in both groups. Group 1 experienced a decrease from a median of 5 (interquartile range, IQR: 4 ~ 6) to 1 (IQR: 0 ~ 2), P < 0.001; similarly, Group 2 saw a reduction from a median of 4 (IQR: 3 ~ 5.75) to 1 (IQR: 1 ~ 2), P < 0.001. Additionally, notable improvements were recorded in sperm count and motility in both groups at the 12-month follow-up compared to their pre-operative measurements. For Group 1, sperm count increased from a median of 35.5 × 10/mL(IQR: 29 ~ 60) to 60 × 10/mL(IQR: 50 ~ 74.25), and motility from 46.5% (IQR: 32 ~ 56%) to 69%(IQR: 54.5 ~ 79%), both with P < 0.001. Group 2 showed similar enhancements, with sperm count rising from a median of 31 × 10/mL (IQR: 20 ~ 56.25) to 57.5 × 10/mL(IQR: 51.25 ~ 73.75) and motility from 44% (IQR: 23 ~ 54.75%) to 75% (IQR: 51.25 ~ 80%), P < 0.001. The duration of postoperative hospital stay was comparable between the two groups, with both reporting a median stay of 3 days (IQR: 2-3 days, P = 0.83). No testicular atrophy and varicocele recurrence was observed in all patients. The incidence rates of hydrocele, wound infection, and orchitis and epididymitis showed no significant disparity between the two groups. Specifically, both groups each had a single incidence of hydrocele. Group 1 had one incidence of wound infection, while Group 2 had none. Orchitis and epididymitis occurred once in Group 1, but not in Group 2.

Conclusion: Our study provides preliminary evidence supporting the implementation of the"en bloc" procedure in MSV as a potentially safe and effective option, especially for managing cases with severe adhesion.