Abstract
Objective
To compare the surgical outcomes and complications between laparoscopic Doppler ultrasound assisted laparoscopic varicocelectomy (LDU-LV) and conventional LV for infertile patients with varicoceles. To examine the microanatomy of the spermatic cord within suprainguinal portion.
Methods
One hundred and forty-seven infertile patients with varicoceles were randomly divided into LDU-LV group and LV group. Operative and postoperative parameters, semen parameters and the pregnancy rate were compared.
Results
The operative time was significantly longer and the incidence of postoperative hydrocele was lower in LDU-LV group than LV group. The other surgical outcomes, such as postoperative hospital stay, postoperative varicocele recurrence, sperm morphology and pregnancy rate showed no difference. Sperm count and sperm motility were significantly increased in both groups at 3, 6 and 12 months after surgery, and they were higher in LDU-LV than LV group in 12 months after surgery. A mean number of 3.73 internal spermatic veins (ISVs), 2.25 lymphatics and 1.11 internal spermatic arteries (ISAs) were identified per cord at supra-inguinal level in patients from LDU-LV group. 68.6% of the ISAs were accompanied closely by a single ISV, 18.6% were surrounded by a dense network of adherent veins, only 12.8% were isolated and anterior to the veins.
Conclusions
LDU-LV could safely and effectively ligate all spermatic veins, preserve spermatic arteries and lymphatics, thereby improve sperm count and motility without leading to high recurrence and hydrocele. The number of ISVs at the supra-inguinal level is highly variable. Most ISAs are accompanied closely by a single ISV.
Keywords: Varicocele, Doppler ultrasound, laparoscopic varicocelectomy