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Impact of testicular delivery and vasal vein ligation on clinical outcomes in men undergoing microsurgical varicocelectomy

  • Urology - Original Paper
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Abstract

Purpose

To assess the impact of microsurgical varicocelectomy technique on clinical outcomes.

Methods

Men diagnosed with varicocele between 2017 and 2020 were reviewed. We included men who underwent microsurgical varicocelectomy by two high-volume surgeons who differed in surgical technique: Method (1) testicular delivery with gubernacular vein ligation, and ligation of vasal veins > 2.5 mm; Method (2) no delivery and ligation of dilated vasal veins in cases of recurrence. Post-operative changes for semen parameters, DNA fragmentation, and serum testosterone were evaluated for each technique and compared.

Results

313 patients were included; 162 with Method 1 and 151 with Method 2. The cohorts were of similar age (median 35 years, interquartile range (IQR) 28–43; 34, IQR 28–39, respectively), and BMI (25 kg/m2, IQR 23–27; 25, IQR 23–28, respectively). For Method 1, 84 (51.9%) had bilateral surgery, and 78 (48.1%) had unilateral surgery. For Method 2, 63 (41.7%) had bilateral surgery, and 88 (58.3%) unilateral surgery. In patients with sperm concentration > 5 M/mL, both techniques resulted in an improvement (p < 0.01), but there was no difference between the methods (p = 0.18). Both methods were associated with an improvement in total motile count (p < 0.05) and the amount of DNA fragmentation (p < 0.05), although no differences were apparent between the techniques (p = 0.09, p = 0.81, respectively). Finally, testosterone levels improved with Method 1, but the post-operative difference was not different than Method 2 (p = 0.06).

Conclusion

Delivery of the testis and ligation of dilated vasal veins compared to not performing those steps do not impact semen parameters, but are associated with improvement in testosterone levels.

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Data availability

The data that support the findings of this study are available from the corresponding author, [JAK].

Code availability

Not applicable.

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Acknowledgements

The authors thank the staff of the Center for Reproductive Medicine and Surgery at Weill Cornell Medicine, Department of Urology.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Weill Cornell Medical College, Weill Cornell Medicine, New York, USA

    Gal Wald

  2. Center for Male Reproductive Medicine and Surgery, Institution for Reproductive Medicine and Department of Urology, Weill Cornell Medicine, New York, USA

    Nahid Punjani & Marc Goldstein

  3. Center for Male Reproductive Medicine and Surgery, Department of Urology, Weill Cornell Medicine, 525 E 68th St, Starr 900, New York, NY, 10065, USA

    Nahid Punjani, Christopher Gaffney & James A. Kashanian

Authors
  1. Gal Wald
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  2. Nahid Punjani
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  3. Christopher Gaffney
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  4. Marc Goldstein
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  5. James A. Kashanian
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Contributions

W: data collection and management, data analysis, and manuscript writing/editing. P: project development, data analysis, and manuscript writing/editing. G: project development and manuscript editing. G: project development and manuscript editing. K: project development and manuscript editing.

Corresponding author

Correspondence to James A. Kashanian.

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Conflict of interest

Dr. James A Kashanian serves as an advisor to Roman Health. Dr. Nahid Punjani is supported by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust and Urology Care Foundation Research Scholars Award.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study has been approved by the Weill Cornell Institutional Review Board.

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication.

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Wald, G., Punjani, N., Gaffney, C. et al. Impact of testicular delivery and vasal vein ligation on clinical outcomes in men undergoing microsurgical varicocelectomy. Int Urol Nephrol 53, 2453–2458 (2021). https://doi.org/10.1007/s11255-021-03009-z

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  • DOI: https://doi.org/10.1007/s11255-021-03009-z

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