Treatment of varicocele: a comparative study of conventional open surgery, percutaneous retrograde sclerotherapy, and laparoscopy

Abstract

Objectives: To present our experience with the results of three different methods of treatment of idiopathic varicoceles.

Methods: A total of 301 patients with 417 varicoceles were retrospectively assigned into three groups according to the method of treatment. Group 1 included 94 patients with 131 varicoceles treated by open surgery. Group 2 consisted of 120 patients with 163 varicoceles treated by percutaneous retrograde sclerotherapy, and in group 3, 87 patients with 123 varicoceles were treated by laparoscopic varicocelectomy. Of all patients, 222 (73.8%) were closely followed up with clinical and Doppler ultrasound examinations 6 and 12 months after the treatment. Seminal analysis was carried out before treatment and repeated in 172 patients with subfertility or infertility 4 to 6 months after treatment.

Results: Patients in the three treatment groups were balanced regarding the different variables. The mean operative time was significantly shorter among patients with open surgery. The cost of sclerotherapy is one fourth to one fifth that of surgery and the cost of laparoscopy is double. Sclerotherapy was successful in 96 (82.8%) of 116 left varicoceles and in only 24 (51%) of 47 right varicoceles. The recurrence rate at follow-up was not significantly different among the three groups. The recurrence rate increased progressively with the increase of varicocele size from grade I to grade III in all groups. The overall incidence of postoperative complications was significantly higher among patients with open surgery. Postoperative spermiogram showed a significant increase in the density and motility and a significant reduction in the percentage of abnormal forms in all groups. The pregnancy rate was approximately similar in all groups.

Conclusions: First, sclerotherapy is best used for isolated left-sided varicoceles. Second, laparoscopy is the treatment of choice for bilateral varicoceles. Finally, open surgery still has a role in isolated right-sided varicoceles and in left-sided cases with failed sclerotherapy.