Outcome of Extended Varicocelectomy in Case of High Grade Varicocele

Abstract

aricocele is defined as abnormal dilation and tourtousity of the internal spermatic veins within the pampiniform plexus. It is common among adolescents and may contribute significantly to the risk of subfertility in adulthood. The prevalence of clinically diagnosed varicocele in adolescents is 8% to 10%, meanwhile the prevalence rate in adults is 15%. The presence of a varicocele is known to be associated with an adverse effect on spermatogenesis in a subset of men. The pathophysiology of this testicular dysfunction has been attributed to one or a combination of several mechanisms, including reflux of adrenal metabolites, hyperthermia, hypoxia, local testicular hormonal imbalance, and intra-testicular hyper-perfusion injury. The surgical decision for correction of varicocele revolves around (1) whether to spare the testicular artery and/or lymphatic using the the available approaches, and (2) the effect on the rate of recurrence and hydrocele formation. The ideal method of varicocele treatment is still a matter of controversy. Several methods have been used, including open surgical ligation of the spermatic vein like retro-peritoneal (Palomo), inguinal (Ivanissevich), and sub-inguinal, retrograde or antigrade sclerotherapy, microsurgical and laparoscopic varicocelectomy. Each technique has its own advantages and disadvantages, and conflicting results have been obtained from different studies.