Treatment of idiopathic varicocele: comparative study of Three techniques about 128 cases

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Published Dec 20, 2011
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Vol. 89 No. (2011): Issue Dec 2011

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Hassen Khouni
Nizar Bouchiba
Melik Melek Khelifa
Moez Ben Ali
Akrem Sebai
Meriem Dali
mehdi Charfi
Adnene Chouchene
Faycel El Kateb
Habib Bouhaouala
Med Hedi Balti

Abstract

Background: Several modalities of varicocele treatment are available, however, no therapeutic technique showed its superiority with regard to the other one.
Aim: To compare the results of three techniques of varicocelecomy.
Methods: Retrospective Analytical and comparative study of 128 patients treated by of three techniques of varicocelectomy: the opensurgery by retro peritoneal way for 42 patients (GI), the varicocelectomie coelioscopique for 41 patients (GII) and the antegrade scrotal sclerotherapy done for 45 patients (GIII), between march 2001 and January 2009.The mean age was 28 years. The main motive for consultation was represented by the painful varicocele in 67 % of the cases, followed by the hypofertility in 20.3 % of the cases and the association both in 12,5 % of the cases. The varicocele was in leftsider in 71.1 % of the cases, to the right side in 5.4 % of the cases and was bilateral in 23.43 % of the cases. Varicocele was infra-clinical at 6 patients, grade 1 in 16 sides, grade 2 in 105 sides and grade 3 in 31 sides. The numeration, the mobility as well as the morphology of sperm cells were comparable between the three groups
Results: The global rate success was 81.2 %, with the highest rate found in the group III which was treated by antégrade scrotal sclerotherapy (84.4 %). The improvement of the parameters of the spermogramme was noted in the three groups, however a statistically significant difference was found only in patients treated by antégrade scrotal sclerotherapy; it mainly concerned numeration and the mobility of spermatozoides. The highest rate of pregnancy was recorded in patients treated by antégrade scrotal sclerotherapy (13.3%). The main postoperative complications were hydrocele (16%) followed by testicular hypotrophy (3 patients).
Conclusion: Three techniques of varicocele treatment, offer either a similar succes rate, and improvement of parameters of the sperm cells. However, antegrade scrotal sclerotherpy seem to be the best treatment of first intention in proposed, regarding its efficiency, of the ease of its realization, its moderate cost and its feasibility in case of recurrence if varicocele was treated with open way’GIII).

Keywords:

Surgery, Laparoscopy, Sclérothérapie, Varicocele.

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