Outcome of Loupe-Assisted Sub-inguinal Varicocelectomy in Infertile Men

BACKGROUND: Sub-inguinal varicocelectomy is widely used among surgeons. OBJECTIVES: The aim of this study was to evaluate the outcome of varicocelectomy using a modified microsurgical method, specifically a loupe-assisted method, and its effects on sperm parameters in infertile men. PATIENTS AND METHODS: This study was performed in 40 patients who presented with varicocele. All patients had at least a 1-year history of infertility with abnormal semen parameters and varicocele proven by physical examination and confirmed with color Doppler ultrasound. Routine preoperative investigations were performed. Semen analysis and hormonal profiling were also performed and repeated postoperatively for follow-up. Half of the patients (20 patients) were treated by a sub-inguinal approach assisted by loupe magnification (Group A) and the other half was treated by the same approach but without magnification (Group B). To facilitate the procedure, an ×3.0 loupe was used during the spermatic cord dissection at the level of the external inguinal ring. During dissection, the dilated veins, including the vassal veins and external spermatic veins, were ligated and divided. RESULTS: In total, 40 patients were followed for more than 6 months. The age of the patients varied from 25 to 38 years (mean 32.5). No intra-operative complications occurred in both groups. Regarding post-operative complications, Group A contained only one patient (5%) who developed scrotal hematoma and two (10%) who developed wound infection, whereas in Group B, the complication rate was higher: two patients (10%) developed scrotal hematoma, two patients (10 %) developed wound infection, three patients (15%) developed hydrocele, two patients (10%) developed recurrence, and two patients (10%) developed scrotal edema. Regarding the seminal parameters, much improvement was observed in the sperm count and sperm motility, and a decrease in abnormal forms was observed after surgery with significant differences in Group A. In Group B, similar effects were observed, but without significant differences. CONCLUSIONS: Loupe-assisted sub- inguinal varicocelectomy is a safe, simple, and effective method for the treatment of sub-fertile men, especially in medical facilities without microscopic equipment, and permits significant improvement in sperm parameters.