Varicocelectomy: Modified loupe-assisted versus microscopic technique – A prospective comparative study

ABSTRACT OBJECTIVE: To compare our novel loupe-assisted varicocelectomy (LV) technique to the ‘gold standard’ demanding microscopic varicocelectomy (MV) technique for the management of varicoceles. PATIENT AND METHODS: Our LV technique, featuring testicular delivery and proximal spermatic cord occlusion using a tourniquet, has not been used before nor to our knowledge has it been reported in the literature. In the LV group, inguinal incision was done prior to testicular delivery and spermatic cord occlusion. Pampiniform and gubernacular veins were identified then tackled. Proximal spermatic cord occlusion helped in identifying those veins, and not confusing them with other cord structures that should be preserved. In all, 95 infertile men were included in this prospective, comparative study; and divided into LV and MV groups. They were followed-up for 1 year, pregnancy achievement, improvements in semen parameters, and complication rates were assessed. RESULTS: Both groups had statistically significant pregnancy rates and negligible complication rates. However, LV cost 33% less than MV and was quicker to perform. We did not find that the MV technique was better than our simple, more cost-effective, less time-consuming LV technique. CONCLUSION: Our novel LV technique has similar success and complication rates as the ‘gold standard’ MV technique for the management of varicoceles, and is more cost-effective and less time consuming.