The effects of varicocelectomy on testicular arterial blood flow: laparoscopic surgery versus microsurgery

Abstract

Purpose: To investigate the long term effects of laparoscopic varicocelectomy (LV) and microsurgical subinguinal varicocelectomy (MV) on ipsilateral testicular microcirculation using Color Doppler Flow Imaging (CDFI).

Materials and methods: A total of 29 patients with left varicocele who underwent LV and 30 patients who underwent MV were examined with CDFI for intratesticular flow parameters before and at 3- and 6-month after surgery. Preoperative and postoperative semen parameters were also evaluated.

Results: The mean values of peak systolic velocity, pulsatility index (PI) and resistive index (RI) of capsular artery (CA) and intratesticular artery (ITA) decreased significantly after LV and MV, whereas no significant change was observed in end-diastolic velocity. Comparing between two groups, the PI and RI values of left CA and ITA on 3rd month and of ITA on 6th month postoperatively in MV group were significantly lower than those in LV group. LV and MV resulted in a statistically increase in the sperm density, morphology and total motile sperm count. Moreover, the PI and RI values of ipsilateral CA and ITA seemed negatively correlated with sperm quality.

Conclusion: A significant improvement occurs in testicular blood supply and sperm parameters after either LV or MV, among MV advances an early and a more obvious hemodynamics promotion than LV. The values of RI and PI of ipsilateral CA and ITA are two important indexes for the prognosis after varicocelectomy.