BERKELEY, CA (UroToday.com) - This is a wonderful study comprising 120 infertility patients with 147 clinically palpable varicoceles randomized to open inguinal, laparoscopic, and subinuginal microscopic treatment.

The incidence of postoperative hydrocele (13%, 10%, and 0%) and recurrence (13%, 18%, and 2%) clearly favored the subinguinal microscopic approach (p < .05), while the improvement in semen parameters (65%, 67%, and 76%) and pregnancy at one year (28%, 30%, and 40%) both trended in favor of the subinguinal microscopic group. Of note, there was no convalescence advantage found for the laparoscopic group; indeed the hospital stay was nearly identical (1.8, 1.6, and 1.7 days) while the time to return to work was quicker for the microscopic approach (7.2, 6.3, and 5.5 days). The only drawback to the microscopic approach was higher cost than for the open approach ($1800, $2700, $2400) and a longer operative time (37, 32, and 64 minutes). Truly, not all things laparoscopic are better; randomized trials, such as this one, are the science that we need to guide the way that we practice.

M. Al-Kandari, H. Shabaan, H. M. Ibrahim, Y. H. Elshebiny, and A. A. Shokeir

Urology 69(3): 417-420, March, 2007
S0090-4295(07)00123-9 doi:10.1016/j.urology.2007.01.057

UroToday.com Laproscopic and Robotic Section

Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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