Objective: Varicocele is associated with male infertility and/or scrotal pain. Microsurgical varicocelectomy provides advantages of reliable identification of spermatic vessels and has been advocated as the gold standard procedure for varicocele repair. The purpose of this study was to assess the outcome after microsurgical subinguinal varicocelectomy in patients with varicocele associated infertility or scrotal pain. Materials and Methods: A total of 224 men underwent 327 operations of microsurgical subinguinal varicocelectomy at a single university hospital because of infertility or painful scrotum. The diagnosis of varicocele was based on the findings of physical examination. The vast majority of the surgeries were performed on an outpatient basis. All patients underwent pre- and postoperative semen analysis or pain scale evaluation. Results: For the 114 infertile patients who underwent varicocelectomy, significant improvements were noted between pre- and postoperative mean sperm count and total motile sperm count. Patients who received bilateral surgery had greater improvement than patients who received unilateral surgery. Repair of larger varicocele was associated with postoperative sperm count changes. Induction of spermatogenesis was observed in at least two of 11 patients with nonobstructive azoospermia. The overall semen improvement rate (improvement index, >0.5) was 70.2% and the 1-year spontaneous pregnancy rate was 33.3%. Of the 102 patients with painful scrotum, 66 patients (64.7%) reported complete resolution of pain, 30 patients (29.4%) had partial resolution, and no change was claimed in six patients (5.9%). For all patients, the pre-and postoperative mean verbal pain scale were 5.8 ±0.4 and 1.2 ± 0.4, respectively (p <0.001). Postoperatively, four patients were found to have varicocele recurrence, four patients had epididymal discomfort, and three patients had transient hydrocele. Conclusion: Microsurgical subinguinal varicocelectomy provides a minimally invasive and effective therapy to varicocele repair with significant improvements in semen quality and scrotal discomfort, and a low incidence of morbidity.
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