Comparative study between loupe-assisted and conventional subinguinal varicocelectomy

Introduction In this prospective randomized study, the outcome and the complication rates of loupe-assisted subinguinal varicocelectomy (LASV) are compared with conventional subinguinal varicocelectomy. Patients and methods Between December 2014 and June 2017, 66 patients aged from 20 to 38 years old were enrolled in this study in Al-Azhar University Hospital, New Damietta, and Al-Zahraa University Hospital, Cairo. The patients were randomly subdivided into two groups: group A included 33 patients who underwent LASV using surgical loupes with three times magnification, group B included 33 patients who underwent conventional open subinguinal varicocelectomy. Postoperative complications along with preoperative and postoperative (3 months) seminal parameters were compared between the two groups. Moreover, the number of identified internal spermatic arteries was also compared between the two groups. Results The hydrocele formation was significantly lesser in group A treated by LASV [none of the patients (0%)] than group B treated by conventional subinguinal varicocelectomy (three patients; 9.09%). The recurrence rate was better in group A (one patient; 3.03%) than group B (two patients; 6.06%), but the result was nonsignificant regarding recurrence rate. Testicular hypertrophy does not occur in both groups. The average number of preserved arteries was more in group A than group B (0.95±0.51 in group A vs. 0.88±0.47 in group B). Semen parameters including semen concentration, sperm motility, and percentage of abnormal forms were improved in both groups, but the improvement was nonsignificantly better in group A than group B, so the improvement was nonsignificantly between the two groups, but it was significant between the preoperative and postoperative results within each group. Conclusion LASV is better than conventional open subinguinal varicocelectomy as loupe allows clear visualization of the testicular artery, lymphatics, and small venous channels, resulting in decrease in the incidence of complications, including hydrocele formation, testicular artery injury, and varicocele recurrence.