Varicoceles are common. They may be detected in 15% of the male population, 35% of men with primary infertility and up to 80% of men with secondary infertility. Studies have shown that varicocele causes progressive duration-dependent injury to testicular function over time. The most likely pathophysiologic mechanism is an elevation of testicular temperature due to impaired scrotal thermoregulation. Varicocele repair will halt and often reverse this duration-dependent process.
The most common complications from non-microsurgical varicocelectomy are hydrocele formation, varicocele recurrence, and testicular artery injury.
Use of the operating microscope allows for reliable identification of spermatic cord lymphatics, internal spermatic veins and venous collaterals, and the testicular artery or arteries so that the incidence of these complications can be virtually eliminated. Delivery of the testis through a small subinguinal incision provides direct visual access to all possible avenues of testicular drainage. Although some controversy continues to surround varicocelectomy as a treatment of male factor infertility, a great deal of data does exist to support this form of therapy.
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