Comparison of Success Rate and Complications of Open Inguinal and Subinguinal Varicocelectomy: A Randomized Controlled Trial

Abstract Background: Varicocele is the most common surgically correctable cause of infertility in men. The aim of this study was comparing the success rate and complications of open inguinal and subinguinal varicocelectomy.Methods: This randomized clinical trial was conducted from March 2017 to 2018. Sixty six patients that met inclusion criteria for varicocelectomy (persistent pain or impaired spermogram) were sequentially randomly allocated to inguinal and subinguinal varicocelectomy. Sperm analysis was performed in all patients before surgery. One week, one and three months after the operation patients were visited and evaluated for pain intensity (using visual analog scale) and complications( recurrence, hematoma, scrotal swelling, infection, hydrocele formation and numbness). Follow- up spermogram was done three months after varicocelectomy to evaluate the success of operation. Results: Mean time of operation was17.33±2.18 and 22.48± 4.45 minutes in the subinguinal and inguinal varicocelectomy method, respectively (p=0.001, CI95%=3.41-6.89). Semen analysis three months after surgery showed that there was no significant differences between semen volume (p=0.85), sperm count (p=0.09), sperm density (p=0.13), normal morphology (p=0.07) and motility (p=0.47) in both groups. There was no significant difference in pain density one week (p=0.51), one (p=0.29) and three months (p=0.67) after surgery between two groups. There wasn't any significant difference between two groups regarding recurrence of varicocele (p=0.67). Conclusions: In this study subinguinal varicocelectomy was superior to inguinal method due to less time of operation. However, there was no significant difference in postoperative complications and improvement of spermogram. Further studies with longer period of follow-up are recommended to compare fertility rate in inguinal and subinguinal varicocelectomy.Trial registration: IRCT, IRCT201710131323N12, Registered 20 October 2017, Retrospectively registered, https://www.irct.ir/trial/581