RESULTS OF BILATERAL LAPAROSCOPIC VARICOCELECTOMY

Abstract

Left varicocele (LV) is a common clinical condition that is pre sent in approximately 15% of the general male population. Bi l a t e ral varicocele (BV) is an association of clinical LV and subclinical or ultrasound diagnosed right varicocele. Recent dia gnostic technology suggests that BV is much more common than p reviously suspected va rying from 15 to 57%. The laparo s c o pic technique offers the possibility of planning bilateral va r i x ligation but only a few re p o rts are currently available. The aim of this study was to evaluate the outcome of contempora ry bila t e ral correction of BV on spermatogenesis. From 1992 january to 1998 december a total of 207 patients with clinical left va r i cocele and a pathological sperm count we re studied. Scro t a l s o n o g raphy was perf o rmed and in 96 patients (group A) sub clincal right varicocele was diagnosed while 111 patients (gro u p B) only had LV. 84 patients we re married and had tried insuc cesfully for a pregnancy for at least one year before eva l u a t i o n .

All patients underwent laparoscopic varicocelectomy, performed under general anestesia with a three trocar technique with application of clips to the spermatic vein and resection. Patients with right reflux received bilateral varix ligation. Operating time averaged 28 minutes for unilateral cases and 42 minutes for bilateral legatures.

No significant differences were found in age distribution or preoperative seminal paramenters between the two groups. Postoperative hospital stay was 1.2 and 1.3 days respectively. 168 patients underwent sperm count four to six months after surgery. Both groups showed improvements in number (group A 41 milions, group b 27 milions), 2nd hour motility (group A 32%, group B 19%) and morphology (group A 52%, group B 51%). 95 patients achieved normalization of seminal parameters, 40 (63%) in group A and 37 (30%) in group B, and there was a statitically significant difference between the two groups. The pregnancy rate was calculated on married population after one year; it was 41% in total. The role of the subclinical right varicocele associated to clinical left varicocele is uncertain and there are few papers concerning this argument. In this serie normalization of seminal parameters and the pregnancy rate were significantly higher in patients with bilateral correction of reflux.

In conclusion our data confirm that subclinical right reflux also has a detrimental effect on spermatogenesis and we suggest that it must be corrected contemporary when associated with clinical left varicocele.