I-4: A Simple and Safe Technique for Varicocele Surgery

s:2127:"Varicocele is the most common pathologic finding in men in infertility study programs and is the most treatable cause of male infertility. Its correction is performed by different surgical techniques, none of which is yet acknowledged as the "gold standard." Some of them, especially the microsurgical ones, are very time consuming and thus expensive; furthermore, all varicocele surgery is not completely free from some complications and recurrencies. With this short video we present our antegrade subinguinal sclerotization technique. Our variation of the antegrade subinguinal sclerotization technique is derived from our experience in using the Tauber’s technique. A subinguinal incision is performed with the exposure and subsequent suspension of the spermatic cord between two elastic bands; the internal and external spermatic fasciae are opened to identify the venous vessels afferent to the internal spermatic veins in the fat of the spermatic cord; the latter is temporarily clamped by using the two above mentioned elastic bands (one upstream and one downstream) at 7-10 cm distance, a 25-G short Butterfly needle is inserted into the largest vessel and 1.5-3 mL of 3% aethoxysclerol mixed with 0.5 mL air is injected into it; after sclerotization the vein at the injection site is ligated to prevent loss of the sclerosing agent outside the vessel. With our technique varicocele persistence (= finding again a continuous venous reflux at the 3-month ultrasonographic follow-up) is very low (1.9%). The most common complication (< 2%) is an isolate and small transient penile lymphangitis, the cause of which is unclear. Major complications, such as orchitis, orchio-epididymitis, orchiofuniculitis, and testicular atrophy, were never observed in our series of more than 1500 filed cases. Colpi’s antegrade sclerotization is easy to be performed and safe. Given its favorable results in terms of complications and recurrencies, this technique can be used not only for the first-line treatment of varicocele, but for treating recurrencies following other surgical techniques.";