| Objective: To evaluate the therapy effects of three different operation techniques on varicocelectomy by comparing early and long-term complications, the quality of semen and the rate of natural conception . Methods: From January 1990 to November 2006, 685 inpatients with primary varicocele above grade II were recruited for this study. 124 patients were found having varicocele because of feeling heaviness or dragging or aching pain in the scrotum with or without radiated pain in left abdominal and pars lumbalis. Varicocele and sperm abnormality were found during physical examination in 561 patients of sterility more than one year after marriage. These patients were divided into three groups according to three kinds of operation techniques on varicocelectomy: group A was 218 patients (median age 26.3 + 10.3 years, range 16~44 years) treated with traditional trans inguinal canal operation; group B was 369 patients (median age 25.2+11.2 years , range 15-47 years) treated with highly selective high ligation of spermatic vein; and group C was 98 patients (median age 27.2 + 11.6 years, range 15~50 years) treated with laparoscopic high ligation of spermatic vein. The therapy effects of three different operation techniques on varicocelectomy were evaluated by comparing early and long-term complications, the quality of semen and the rate of natural conception. Results: Early complications, including the rate of scrotal edema and hydrocele, in highly selective high ligation of spermatic vein group (group B) (1.36%) was obviously lower than traditional transinguinal canal operation group (group A) (17.43%) and laparoscopic high ligation of spermatic vein group (group C ) (16.33%)(p<0.05). The long-term complication, the rate of testicular atrophy in highly selective high ligation of spermatic vein group (group B) (0.54%) is lower than laparoscopic high ligation of spermatic vein group (group C ) (9.18%)and traditional trans inguinal canal operation group (group A)( 17.89%)(p<0.05) after three months. The rate of testicular atrophy in laparoscopic high ligation of spermatic vein group (group C ) was lower than traditional trans inguinal canal operation group (group A), but no statistical difference was found (p>0.05) . The recurrence rate in highly selective high ligation of spermatic vein group (group B) (3.25%) was obviously lower than traditional trans inguinal canal operation group (group A) (7.34%) (p<0.05) .No statistical difference was found between highly selective high ligation of spermatic vein group (group B) and laparoscopic high ligation of spermatic vein group (group C ) (5.10%) (p>0.05) . No difference was found between traditional trans inguinal canal operation group (group A) and laparoscopic high ligation of spermatic vein group (group C ) (p> 0.05) . The quality of semen in every group was all increased by comparing spermatozoa density, motility rate and teratospermia before and after operation (p>0.05) , but no difference was found between three groups. The rate of natural conception in 1 to 2 years after varicocelectomy in patients with infertility in highly selective high ligation of spermatic vein group (group B) (69.51%) was higher than traditional trans inguinal canal operation group (group A) (58.42%) and laparoscopic high ligation of spermatic vein group (group C) (55.56% ) (p<0.05 ) if patients' ages were lower than 30. Traditional trans inguinal canal operation group (group A) and laparoscopic high ligation of spermatic vein group (group C) have the near rate of natural conception in patients lower than 30 years. No difference was found between three groups in the rate of natural conception if patients' ages were more than 30 (p<0.05) . The data about complications after operation and changes of quality of semen were obtain: The recurrence rate in highly selective high ligation of spermatic vein group (group B) was obviously lower than traditional trans inguinal canal operation group (group A) (p<0.05) . No statistical difference in recurrence rate was found between highly selective high ligation of spermatic vein group (group B) and laparoscopic high ligation of spermatic vein group (group C). No statistical difference in recurrence rate was found between traditional trans inguinal canal operation group (group A) and laparoscopic high ligation of spermatic vein group (group C) also. Increase tendency of recurrence rate is obvious among group A, group C and group B in order. Maybe statistical difference would be found by accumulated cases. The rate of testicular atrophy three months after operation in group A was higher than group B, group B was higher than group C and obvious difference was found between three groups (.p <0.05) . There was statistically significant difference in the natural conception rate in 1 to 2 years after varicocelectomy between group A and the other two groups if patients' ages were lower than 30, respectively (p<0.05) . No difference was found between traditional trans inguinal canal operation group (group A) and laparoscopic high ligation of spermatic vein group (group C) in natural conception rate if patients' ages were lower than 30 (p>0.05). No difference was found between three groups in natural conception rate if patients' ages were higher than 30 (p>0.05) . Conclusions: The method of highly selective high ligation of spermatic vein opetation has the lowest rate of scrotal edema, hydrocele, testicular atrophy, and the recurrence rate. The quality of semen after operation was better than that before operation regardless of different operation methods. The patients performed by highly selective high ligation of spermatic vein operation lower than 30 years has the highest natural conception rate .
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