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Loupe-Assisted High Inguinal Varicocelectomy for Sub-fertile Men with Varicoceles

Keywords: varicoceles , infertility , varicocelectomy

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Abstract:

Background: Microsurgical sub-inguinal varicocelectomy has been associated withextremely high success rates and minimal postoperative complications. Theaim of this study was to report the techniques and outcomes of varicocelectomyusing a modified microsurgical method, specifically a loupe-assisted highinguinal varicocelectomy instead of the usual microscope and sub-inguinalapproach.Methods: From 1997 through 2000, 116 patients underwent modified high inguinalvaricocelectomy. All patients had at least a 1-year history of infertility withabnormal semen parameters and varicocele proven by physical examinationand/or color Doppler ultrasound. Varicocelectomy was performed as an outpatientprocedure. To facilitate the procedure, a x3.0 loupe was used duringthe spermatic cord dissection at the level of the internal inguinal ring. Duringdissection, the dilated veins were ligated and divided including vasal veinsand external spermatic veins. All of the patients were followed postoperativelywith semen analysis and physical examination every 3 months.Results: A total of 96 patients were followed for more than 1 year, with at least twosemen analyses being conducted. Moreover, 136 varicocelectomies were performedamong the 96 patients. No intra-operative complications occurred. Atemporary reactive hydrocele was noted in one patient, but subsequentlycompletely resolved. In addition, recurrent or persistent varicocele was identifiedby physical examination and/or color Doppler in four patients (2.9%).Motile sperm concentration increased from 31.8

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