Comparison of the pulling technique versus the standard technique in microsurgical subinguinal varicocelectomy: a randomized controlled trial

Background We compare the outcome of microsurgical subinguinal varicocelectomy (MSV) using the pulling technique (P-MSV) compared to the standard technique (S-MSV).

Methods A total of 60 patients were diagnosed with varicocele compounded with infertility and/or scrotal pain not responding to medical treatment.

Twenty-nine patients were randomized to the P-MSV, while 31 were randomized to S-MSV.

The number of ligated veins was counted intraoperative and compared.

Follow-up was done at 1 and 3 months including clinical examination, scrotal duplex ultrasound scan, and semen analysis.

Results A total of 85 sides were operated upon, 43 (50.5%) were done by the P-MSV technique while 42 (49.5%) were done by the S-MSV technique.

The median gained cord length after using the P-MSV was [3 cm; IQR 2–5 cm].

For the P-MSV technique, the mean number of detected internal spermatic veins after cord pulling was (4 ± 1.3 SD) compared to (6 ± 1.4 SD) before pulling ( P value < 0.01) and for the S-MSV was 3 (2.75–5).

There was no statistical or clinically significant difference in the perioperative outcomes between both groups.

The overall conception rate was 47.1%.

Ninety-two percent of patients complaining of preoperative scrotal pain had resolution of the pain on follow-up with no statistical difference between both techniques ( P values 0.53, 0.3 respectively).

There was no statistical difference in the recurrence rate between both groups ( P  = 0.11).

The number of ligated veins decreased significantly using the P-MSV technique leading to an improvement in the surgical feasibility of MSV.

Conclusion There is a significant benefit for the new pulling technique in decreasing the number of internal spermatic veins which leads to improving the surgical feasibility of microsurgical varicocelectomy.