The dilatation, tortuosity and elongation of the spermatic plexus are called varicocele. Varicocele is most commonly seen in young and middle-aged men, with a prevalence of 15% in the adult male population, 40% in male infertility, and 20% in combined pain and discomfort. It is currently known to be an important cause of male infertility.
The treatment of varicocele is mainly surgical and the main surgical procedures are open transinguinal surgery, laparoscopic spermatic ligation and microscopic spermatic ligation. Microscopic spermatic vein ligation can ligate the veins more thoroughly, preserving the arteries and lymphatic vessels, improving semen quality significantly after surgery, with quick recovery and fewer complications. It has obvious advantages compared with traditional surgery and has become the gold standard for varicocele surgery.
Comparison of three types of varicocele surgery
Surgical method
Microscopic spermatic vein ligation
Transinguinal open spermatic vein ligation
Laparoscopic spermatic vein ligation
Incision size
2cm below the external ring
5 to 6 cm in the groin
3 incisions in the abdomen, each about 0.5 to 1 cm
Postoperative scars
Small scar
Obvious scar
Small scar
Spermatic varicocele grading criteria.
Degree I: The varicose vein is not obvious on palpation, but can be palpated when the patient holds his breath and increases abdominal pressure;
Ⅱ degree: the varicose vein can be palpated under non-palpable condition but the appearance is normal;
Grade III: varicose veins are like a mass of earthworms, which are extremely obvious on palpation and visualization.
Indications for varicocele surgery.
Patients with combined oligospermia between Ⅱ and Ⅲ degrees or more.
Patients with combined oligospermia or weak spermatozoa between Ⅰ and Ⅱ degrees without significant improvement after 3-6 months of conservative treatment.
Ⅰ～Ⅲ degree combined with scrotal swelling and pain discomfort affecting the quality of life.