Intraoperative hydrodissection and Doppler ultrasound during magnified varicocelectomy: A comparative study
https://doi.org/10.4081/aiua.2023.11008
Accepted: December 24, 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Methods: We performed a non-randomized comparative trial that recruited infertile men with varicocele who were scheduled to undergo MSV. Eligible patients were allocated by the investigators in a 1:1 ratio to receive intraoperative Doppler (group I) or intraoperative Doppler plus hydrodissection (group II).
Results: Sixty men were included in each group. The two study groups showed a comparable number of ligated veins on the right (4.22 ±1.57 versus 4.42 ± 1.65; p = 0.49) and left side (6.77 ± 2.14 versus 6.98 ± 2.29; p = 0.59). On the contrary, group II showed a significantly higher number of preserved arteries on the right (2.42 ± 0.56 versus 1.47 ±0.5 in group I) and left side (2.6 ± 0.53 versus 1.63 ± 0.55 in group I), with p-value < 0.001. The sperm motility was significantly higher in group II than in group I (21.25 ± 13.73 versus 13.85 ± 12.25, respectively; p = 0.002). In both groups, the sperm motility increased significantly at the end of follow-up compared to the preoperative period. The postoperative sperm mortality remained significantly higher in group II than in group I (p = 0.008).
Conclusions: Intraoperative Doppler plus hydrodissection (D+IH-MSV) has advantages in preserving more arteries and enhancing the motility of sperms. Based on these findings, we strongly recommend D+IH-MSV when treating infertile men with varicocele.
Cocuzza M, Cocuzza MA, Bragais FM, Agarwal A. The role of varicocele repair in the new era of assisted reproductive technology. Clinics (Sao Paulo). 2008; 63:395-404. DOI: https://doi.org/10.1590/S1807-59322008000300018
Dubin L, Amelar RD. Varicocelectomy: 986 cases in a twelve-year study. Urology. 1977; 10:446-9. DOI: https://doi.org/10.1016/0090-4295(77)90132-7
Shridharani A, Lockwood G, Sandlow J. Varicocelectomy in the treatment of testicular pain: a review. Curr Opin Urol. 2012; 22:499-506. DOI: https://doi.org/10.1097/MOU.0b013e328358f69f
Lundy SD, Sabanegh ES Jr. Varicocele management for infertility and pain: A systematic review. Arab J Urol. 2017; 16:157-170. DOI: https://doi.org/10.1016/j.aju.2017.11.003
Schlegel PN, Goldstein M. Anatomical approach to varicocelecto-my. Semin Urol. 1992; 10:242-7.
Chan PT, Wright EJ, Goldstein M. Incidence and postoperative outcomes of accidental ligation of the testicular artery during micro-surgical varicocelectomy. J Urol. 2005; 173:482-4. DOI: https://doi.org/10.1097/01.ju.0000148942.61914.2e
Guo L, Sun W, Shao G, et al. Outcomes of Microscopic Subinguinal Varicocelectomy With and Without the Assistance of Doppler Ultrasound: A Randomized Clinical Trial. Urology. 2015; 86:922-8. DOI: https://doi.org/10.1016/j.urology.2015.08.002
Tatem AJ, Brannigan RE. The role of microsurgical varicocelecto-my in treating male infertility. Transl Androl Urol. 2017; 6:722-9. DOI: https://doi.org/10.21037/tau.2017.07.16
Cocuzza M, Pagani R, Coelho R, et al. The systematic use of intra-operative vascular Doppler ultrasound during microsurgical subin-guinal varicocelectomy improves precise identification and preserva-tion of testicular blood supply. Fertil Steril. 2010; 93:2396-9. DOI: https://doi.org/10.1016/j.fertnstert.2009.01.088
World Medical Association. World Medical Association Declaration of Helsinki. Ethical principles for medical research involv-ing human subjects. Bull World Health Organ. 2001; 79:373-4. DOI: https://doi.org/10.4414/fms.2001.04031
Sarteschi M, Paoli R, Bianchini M, Menchini Fabris GF. Lo stu-dio del varicocele con eco-color-Doppler. G Ital Ultrasonol 1993; 4:43-9.
World Health Organization. WHO laboratory manual for the examination and processing of human semen (Sixth edition) 2021 Available from: http://whqlibdoc.who.int/publications/2010/ 9789241547789_eng.pdf
Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007; 88:639-48. DOI: https://doi.org/10.1016/j.fertnstert.2006.12.008
Agarwal A, Deepinder F, Cocuzza M, et al. Efficacy of varicoc-electomy in improving semen parameters: new meta-analytical approach. Urology. 2007; 70:532-8. DOI: https://doi.org/10.1016/j.urology.2007.04.011
Reyes JG, Farias JG, Henríquez-Olavarrieta S, et al. The hypoxic testicle: physiology and pathophysiology. Oxid Med Cell Longev. 2012; 2012:929285. DOI: https://doi.org/10.1155/2012/929285
Marmar JL, DeBenedictis TJ, Praiss D. The management of varicoceles by microdissection of the spermatic cord at the external inguinal ring. Fertil Steril. 1985; 43:583-8. DOI: https://doi.org/10.1016/S0015-0282(16)48501-8
Goldstein M, Gilbert BR, Dicker AP, et al. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol. 1992; 148:1808-11. DOI: https://doi.org/10.1016/S0022-5347(17)37035-0
Shindel AW, Yan Y, Naughton CK. Does the number and size of veins ligated at left-sided microsurgical subinguinal varicocelectomy affect semen analysis outcomes? Urology. 2007; 69:1176-80. DOI: https://doi.org/10.1016/j.urology.2007.01.086
Soetandar A, Noegroho BS, Siregar S, et al. Microsurgical varic-ocelectomy effects on sperm DNA fragmentation and sperm param-eters in infertile male patients: A systematic review and meta-analy-sis of more recent evidence. Arch Ital Urol Androl. 2022; 94:360-5. DOI: https://doi.org/10.4081/aiua.2022.3.360
Salama N, Blgozah S. Immediate development of post-varicoc-electomy hydrocele: a case report and review of the literature. J Med Case Rep. 2014; 8:70. DOI: https://doi.org/10.1186/1752-1947-8-70
Paduch DA, Niedzielski J. Repair versus observation in adoles-cent varicocele: a prospective study. J Urol. 1997; 158:1128-32. DOI: https://doi.org/10.1016/S0022-5347(01)64403-3
Atteya A, Amer M, AbdelHady A, Al-Azzizi H, et al. Lymphatic vessel hydrodissection during varicocelectomy. Urology. 2007; 70:165-7. DOI: https://doi.org/10.1016/j.urology.2007.04.012
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
