Testicular arterial supply: effect of different varicocelectomy approaches

Aim The aim was to compare the effect of three different approaches of varicocelectomy (laparoscopic, open, and microscopic) on testicular artery depending on preoperative and postoperative testicular duplex. Patients and methods This study included 60 patients with primary varicocele collected from Minia Health Insurance and Minia University Hospitals during the period from April 2016 to January 2018. The patients were divided into three groups. Group A included 20 patients who have undergone open varicocelectomy; group B included 20 patients who have undergone open subinguinal varicocelectomy with microscopic assistance; and group C included 20 patients who have undergone laparoscopic varicocelectomy. Results There is a significant difference between the three groups as regards operative time. Preoperative and 6-month postoperative semen analyses were improved after surgery but no couple achieved spontaneous pregnancy within the follow-up in all three groups. At 2 weeks postoperative arterial duplex, the testicular artery and the testicular arterial perfusion was not affected or disturbed. There was no statistically significant difference between preoperative and postoperative values of testicular volume. No recurrence after 6 months follow-up was found in both A and B groups, but in group C 20% of cases was recurrent clinically. Conclusion No single method has proven superiority over another as the best approach to secure testicular blood supply. We found that there is no statistical difference between the three approaches concerning preservation of the testicular artery from accidental injury or ligation.