Effectiveness and safety of microsurgical varicocelectomy for treating nutcracker phenomenon associated varicocele
Huang, W1; Cao, JJ1; Cao, M1; Zhang, Y1; Wu, HS1; Jin, XD1
1: Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
Purpose: The aim of our study was to access the clinical effectiveness and safety of microsurgical varicocelectomy in the treatment of male nutcracker phenomenon associated varicocele.
Materials and Methods: We retrospectively analyzed 66 patients with varicocele in our institution between August 2015 and February 2017. Patients were categorized into two groups. In group 1, 35 patients with nutcracker phenomenon associated varicocele were included. Furthermore, 25 patients underwent microsurgical varicocelectomy were classified as group 1A, and the rest 10 patients underwent microsurgical spermatic-inferior epigastric vein anastomosis were classified as group 1B. Group 2 included 31 patients with varicocele alone underwent microsurgical varicocelectomy.
Results: The preoperative serum hormone levels (E2, FSH, LH, PRL), results of scrotal ultrasound and semen analysis between group 1 and group 2 were observed no significant difference except in age, BMI, T level and peak velocity ratio. There was no significant difference in preoperative value between group 1A and group 1B. However, group 1A spent less surgical time compared with group 1B (p<0.001). Significant decreases in post-operative left internal spermatic vein diameter and the reflux time without the Valsalva maneuver were observed compared with preoperative among group 1A, 1B and 2, respectively. In addition, semen parameters significantly improved at 6 months postoperatively compared with preoperative among group 1A and 1B. But, the postoperative parameters like the results of scrotal ultrasound and semen analysis showed no statistically different among group 1A, 1B and 2.
Conclusions: This study indicated that microsurgical varicocelectomy is an efficient and safe surgical modality for treating patients with asymptomatic nutcracker phenomenon associated varicocele.
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