Comparative Analysis Of Three Kinds Of Surgical Approaches To Varicocelectomy

Objective To evaluate the therapy effects of three different surgical approaches tovaricoceletomy by comparing operation time,postoperative hospital stay,eraly andlong-term complications, recurrence,semen quality and testicular volume,which dividedinto retroperitoneal high ligation group, laparoscopy group and microsurgery group.Method From September2010to September2012,collected in urology, the ThirdAffiliated Hospital of Anhui Medical University, Binhu Hospital, the Third AffiliatedHospital of Anhui Medical University, urology Shushan Branch98surgical hospitalizedpatients,which were single diseases and had no history of surgery by retroperitonealarea and pelvic area. The main reason for the treatment in patients with sterile marriage(married1years of normal sexual life is not birth) or with perineal discomfort and pain,a few people have no symptoms by physical examination found the varicocele, themean age were22.3years (18~35years).57cases found in which infertility treatment,30cases found in which had perineal discomfort and pain, and16cases found byphysical examination.Varicocele of grade Ⅱ have38cases,and Varicocele of grade Ⅲhave60cases.The cases of the left varicocele patients were90,and8cases werebilateral.All patients have the routine examination by B-ultrasound (measure spermaticvein and Testicular volume) and semen analysis.98patients were divided into threegroups, A group: retroperitoneal high ligation of the spermatic vein of48cases; Bgroup:10cases of laparoscopy group; C group:42cases of microsurgery group.98casesby using different surgical methods of varicocele patients were followed up, to compareoperation time,postoperative hospital stay,eraly and long-term complications,recurrence,semen quality and testicular volume,and to evaluate the therapy effects of three different surgical methods.Results The operation time of the microsurgery group was longer than the other twogroup,but hospital stay of the microsurgery group was shorter.Compare the recentsymptoms(pain in scrotum) and complications(hydrocele or scrotal edemas) after theoperations of one week,four weeks,three months and six months in three groups, therate of symptom improvement in the microsurgery group was significantly better thanthe other two groups(P<0.05).Over time, there was no statistical difference betweenthree groups. The recurrence rate of microsurgery group(0.0%) was obviously lowerthan the retroperitoneal high ligation group(14.28%) and the laparoscopygroup(11.11%),(P<0.05). To compare the semen quality (sperm count, sperm density,sperm motility and sperm deformity rate) between three groups, and to judge whetherthe semen quality improved, the results show that after operation the semen qualities ofall the three groups were improved,and the semen quality of the microsurgery groupwas significantly improved than the other two groups (p <0.05).After half a year,thetesticular volumes were increased,but there was no statistical difference between threegroups(P>0.05).Conclusion Microsurgery is obviously better than retroperitoneal high ligation andlaparoscopic approaches in preventing postoperative recurrence and improving semenquality.With the advantages of minor vulnus and quick recovery, microsurgery is easy toaccept by most patients.Nowadays microsurgical varicocelectomy has become the“golden standard” for the treatment of varicocele.