DOI: http://dx.doi.org/10.18203/2349-2902.isj20191867

Avoidance of hydrocele after non microsurgical varicocelectomy by pre-emptive eversion of tunica vaginalis in infertile men with varicocele

Hosam Farouk Abdelhameed, Mohammed Abu El‑Hamd, Mena Zarif Helmy

Abstract


Background: In infertile men with varicocele, controlled studies clearly indicate that varicocelectomy improves pregnancy rates.  Non microsurgical varicocelectomy is associated with many complications; hydrocele is the most common one. Many techniques have been done to reduce the incidence of post-varicocelectomy hydrocele which is somewhat difficult to be done. This study aimed to evaluate the efficacy of pre-emptive eversion of tunica vaginalis in avoidance of post-operative hydrocele after non microsurgical varicocelectomy and its effect on fertility.

Methods: A total number of 115 infertile men with varicocele underwent varicocelectomy during August 2015 to December 2016 in Sohag university hospital. Fifty five patients underwent bilateral microsurgical varicocelectomy (group A), were compared with 60 patients who underwent bilateral non microsurgical varicocelectomy with pre-emptive eversion of tunica vaginalis (group B) as regard, development of post-operative hydrocele, operative time, complication rates, hospital stay and effect on spontaneous pregnancy.

Results: Group A has longer duration of surgery (26±11.7minutes versus 20±10.2minutes) while there was no significant difference in hospital stay (6±2.5 hours versus 6±1.5 hours) in both groups. No post-operative wound infection in both groups. There was one case (1.6%) develop scrotal haematoma in (group B) only. No post-operative recurrence in both groups.  No post-operative hydrocele developed in both groups. Improvement in sperm count, motility and morphology occurred in both groups. No significant difference in percentage of paternity during 6-24 months.

Conclusions: Pre-emptive eversion of tunica during non- microsurgical varicocelectomy might be offered as an adjunctive technique to avoid development of post-operative hydrocele that is easy, not time consuming and has comparable results of microsurgical varicocelectomy.


Keywords


Hydrocele, Male infertility, Varicocele, Varicocelectomy

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References


Saleh B, Kirk CLo. Varicocelectomy: microsurgical inguinal varicocelectomy is the treatment of choice. Can Urol Assoc J. 2007;1(3):277-8.

Nader S, Saeed B. Immediate development of post-varicocelectomy hydrocele: a case report and review of the literatureJ Med Case Rep. 2014;8:70.

Marcello C, Marco C, Enrico DG. Management of hydrocele in adolescent patients Nature Reviews Urol. 2010;7:379-85.

Ali HA, Haider MA. Concomitant Varicocelectomy and Jaboulay s Operation Medical Journal of Babylon. 2014;6:2.

Castagnetti M, Cimador M, DiPace MR, Catalano P, DeGrazia E. 'Preemptive hydrocelectomy' in subinguinal varicocelectomy. Urol Int. 2008;81(1):14-6.

B. PAJOVIC. Advantages of microsurgical varicocelectomy over conventional techniques. European Review for Medic Pharmacol Sci. 2015;19:532-8.

Sun HB, Liu Y, Yan MB, Li ZD, Gui XG. Comparing three different surgical techniques used in adult bilateral varicocele. Asian J Endosc Surg. 2012;5:12-6.

Cho SY, Kim TB, Ku JH, Paick JS, Kim SW. Beneficial effects of microsurgical varicocelectomy on semen parameters in patients who underwent surgery for causes other than infertility. Urol. 2011;77:1107-10.

Diegidio P, Jhaveri JK, Ghannam S, Pinkhasov R, Shabsigh R, Fisch H. Review of current varicocelectomy techniques and their outcomes. BJU International. 2011;108(7):1157-72.

Alaa HA. Laparoscopic versus open varicocelectomy comparative study for early post-operative complications among patients in Basrah, Iraq. Int Surg J. 2018;5(4):1176

Shamsa A, Nademi M, Aqaee M, Fard AN, Molaei M. Complications and the effect of varicocelectomy on semen analysis, fertility, early ejaculation and spontaneous abortion. Saudi J Kidney Dis Transpl. 2010;21:1100-5.

Mattews GJ, Matthews ED, Goldstein M. Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenosperm. Fertil Steril. 2014;70(1):71-5.

Cayan S, Acar D, Ulger S, Akbay E. Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. J. Urol. 2005;174:2003-6.

Yaman O, Soygur T, Zumrutbas AE, Resorlu, B. Results of microsurgical subinguinal varicocelectomy in children and adolescents. Urol. 2006;68:410-2.

Singh DR, Gupta SK, Gupta S. Lord's procedure: a curative outpatient operation for primary hydrocele. J. Indian Med. Assoc. 1996;94:141-2.

Rodriguez WC, Rodriguez DD, Fortuno RF. The operative treatment of hydrocele: a comparison of 4 basic techniques. J Urol. 1981;125;804-5.

Van der Brink BA, Palmer LS, Gitlin J, Levitt SB, Franco I. Lymphatic-sparing laparoscopic varicocelectomy versus microscopic varicocelectomy: is there a difference? Urol. 2007;70:1207-10.

Glassberg KI, Poon SA, Gjertson C K, DeCastro GJ, Misseri R. Laparoscopic lymphatic sparing varicocelectomy in adolescents. J Urol. 2008;180:326-30.

Castagnetti M, Cimador M, DiPace MR, Catalano, P. & De Grazia E. 'Preemptive hydrocelectomy' in subinguinal varicocelectomy. Urol Int. 2008;1:14-6.

Tsikopoulos GK, Roussis XS, Georgaki, J, Papouis G, Tryfonas GJ. Does incision of the tunica vaginalis during the Palomo procedure prevent post-operative hydrocele? Br. J. Urol. 1998;81:612-3.

Castagnetti M. Evolving management of adolescent varicocele. J Pediatr Urol. 2008;4:107-12.

ACJ. Kroese NM. de Lange JA. Collins JLH. Evers Varicocele surgery, new evidence .Human Reproduction Update. 2013;19(4):31.

Hamada A, Estevez SC, Agarwal A. Varicocele and Male Infertility: Current Concepts, Controversies and Consensus. Springer International Publishing, 2016.

Kim HJ. Clinical significance of subclinical varicocelectomy in male infertility: systematic review and meta-analysis. Androl. 2016;48:654-61.

Jungwirth A. EAU Guidelines on Male Infertility. European Association of Urology, 2016.

Esteves SC, Miyaoka R, Roque M, Agarwal A. Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl. 2016;18:246-53.

Chu DI. The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: a retrospective cohort study. J Pediatr. Urol. 2017;13:77.e1-5.