Outcomes of Microsurgical Subinguinal Varicocelectomy with Testicular Delivery, Gubernacular Vein Ligation, and External Spermatic Vein Excision

AIM: This study evaluated semen, Doppler ultrasonographic, and clinical outcomes after microsurgical subinguinal varicocelectomy incorporating testicular delivery, gubernacular vein ligation, and long-segment external spermatic vein excision.
MATRERIAL and METHOD: This retrospective single-center study included 117 patients treated between January 2018 and December 2024. Preoperative and postoperative semen parameters and Doppler findings were compared. Pain resolution, pregnancy, postoperative symptoms and complications, patient-reported recurrence, and need for repeat surgery were assessed.
RESULTS: Median sperm concentration increased from 11.0 to 28.0 million/mL, progressive motility from 23.5% to 40.0%, and normal morphology from 2.0% to 4.0% (all p<0.001). Total sperm count increased from 32.0 to 91.5 million/ejaculate and total progressive motile count from 6.7 to 39.7 million (both p<0.001). Venous diameter decreased on both operated sides, and reflux declined from 88.1% to 0% on the right and from 93.0% to 7.0% on the left (both p<0.001). Among 69 patients with baseline pain, 58 (84.1%) reported unqualified pain resolution. Among 61 respondents reporting pregnancy or no pregnancy, 42 (68.9%) reported pregnancy, including 34 spontaneous conceptions. Patient-reported recurrence occurred in 8 patients (6.8%); a need for repeat surgery was reported in 5 (4.3%).
CONCLUSION: This approach was associated with improved semen parameters, reduced venous reflux, and reported pain resolution in most symptomatic patients. Prospective comparative studies are needed to determine its additional benefit over conventional microsurgical repair.