The goal of varicocele treatment is to stop the backward flow of blood from the body to the scrotum, and therefore to "cool off" the testicles. To achieve this, veins leading from the testis to the body are tied off or interrupted as completely as possible. A single vein is left open (vasal vein) that is not subject to the same issues as the varicose veins and allows the blood to leave the testicle after surgery. There are several ways to treat varicoceles. Surgical or incisional methods are performed in the upper scrotum (subinguinal), groin area (inguinal) or lower abdomen (retroperitoneal). The procedure can also be performed with "telescope" surgery (laparoscopy) and also by an intereventional radiologist through a procedure called venography and embolization (Table 2).
Outcome Parameter Incisional Laparoscopic Radiologic
Semen Improvement 66% 50-70% 60%
Pregnancy Rate 35% 12-32% 10-50%
Recurrence 0-5% 10-25% 10%
Technical Failure Negligible Small 10-20%
Cost X 2X X
Pain pills (average) 3-6 3-6 0-3
Days to Work 3 3 1
TABLE 2. VARICOCELE TREATMENTS: COMPARISON OF OUTCOMES
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In general, all approaches give similar results; their differences stem mainly from other issues. For example, the incisional approach has the lowest recurrence rate, because it is performed in the groin or scrotum, where all of the venous "action" is taking place. With the radiologic approach, there is a significant "technical" failure rate as it is sometimes difficult to manipulate catheters through the necessary veins to reach and interrupt the veins of interest. This is especially true for varicoceles on both sides. With laparoscopy, again the varicocele recurrence rate after the procedure is high, because all of the venous "action" occurs in the scrotum and laparoscopy is performed in the abdomen.
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