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Preservation of Testicular Arteries During Subinguinal Microsurgical Varicocelectomy: Clinical Considerations

From the Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada.

Correspondence to: Dr Armand Zini, St Mary's Hospital, 3830 Lacombe Ave, Montreal, Canada H3T 1M5 (e-mails: armand.zini{at}ssss.gouv.qc.ca; ziniarmand{at}yahoo.com).

Microsurgical varicocelectomy with intentional preservation of the testicular artery(ies) is regarded as the gold standard approach to varicocele repair. We sought to determine whether the number of testicular arteries preserved at the time of micro-surgical varicocelectomy predicts improvement in postoperative semen parameters. We analyzed the records of 334 infertile men who underwent varicocelectomy performed by a single surgeon using a subinguinal microsurgical technique between July 1996 and January 2003. We examined the association between the number of testicular arteries preserved at the time of varicocelectomy and serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), varicocele grade, testicular volume, and postoperative improvement in semen parameters. Unilateral, left-sided varicocelectomy was performed in 194 men, while bilateral varicocelectomy was performed in 140 men. Mean (±SE) sperm concentration (20.1 ± 1.5 x 10⁶/mL to 26.7 ± 1.9 x 10⁶/mL, P = .001), percent motility (24.7 ± 1.0% to 30.9 ± 1.2%, P = .001), and percent normal morphology (35.8 ± 1.4% to 37.7 ± 1.5%, P = .046) improved significantly following varicocelectomy. The mean number of preserved testicular arteries was 1.5 on the left (range, 1–4) and 1.5 on the right (range, 1–4). The number of testicular arteries preserved at the time of varicocelectomy did not correlate significantly with preoperative assessment of serum FSH, LH, varicocele grade, and testicular volume or with postoperative improvement in semen parameters. Our data indicate that preoperative parameters are not predictive of the number of testicular arteries identified at the time of microsurgery. These data also suggest that the number of arteries identified and preserved with meticulous spermatic cord dissection does not correlate with improvement in semen parameters.

     Key words: Varicocele, male infertility, semen