Microscopic Varicocelectomy under Local Anesthesia as the Treatment of Varicocele

Summary

Varicocele accounts for 35%-40% of infertility cases among men of reproductive age. The international standard treatment method is microscopic varicocelectomy, typically performed under general anesthesia. This study proposes and implements microscopic varicocelectomy under local anesthesia, which provides more humane care for patients and reduces the economic burden.

Abstract

Varicocele, characterized by the dilation of veins within the spermatic cord, is a prevalent disease in males, accounting for 35%-40% of infertility cases among men of reproductive age. This condition may disrupt normal neuroregulation, blood supply, and temperature regulation in the testicles, thereby impacting sperm count, quality (morphology, fragmentation rate), and functionality (motility). It may even induce symptoms such as pain and testicular atrophy. The international standard treatment method is microscopic varicocelectomy, typically performed under general anesthesia. This requires patients to fast before surgery and necessitates recovery and fasting care postoperatively. The arterial blood pressure drop caused by anesthesia may obscure the fluctuation of the spermatic artery, making the precise intraoperative isolation and protection of the spermatic artery more challenging. Therefore, this study proposes and implements microscopic varicocelectomy under local anesthesia. This method facilitates rapid and precise identification of the fluctuating spermatic artery, reducing the risk of spermatic artery damage. It also provides more humane care for patients, reduces economic burden, and offers a new perspective on the treatment of varicocele.

Introduction

With the advancement of modern society, male infertility has gradually emerged as a global health issue, with varicocele being one of the predominant causes. The prevalence of varicocele is estimated at 15% in the general healthy population, 35% in those with primary infertility, and can be as high as 80% in the secondary infertility group¹. Not only does varicocele lead to a decline in sperm count and quality², but it also profoundly impacts the psychological well-being and quality of life of affected men.

Contemporary treatment modalities, such as microscopic varicocelectomy, have been widel....

Protocol

This research is approved by the Affiliated Hospital of the Shanghai Institute for Biomedical and Pharmaceutical Technologies, and the ethics number is 2022001. Written informed consent was obtained from the human subjects to participate in the study. The inclusion criteria were: (1) Diagnosis of varicocele by clinical ultrasound; (2) Age between 20 and 40 years old; (3) Abnormalities detected in semen examination, indicating the need for surgery and consent to undergo the procedure. The exclusion criteria were: (1) Abno.......

Discussion

Varicocele presents a relatively high prevalence in infertile men of reproductive age, reaching 35%-44%⁶. The impact of this disease on male fertility cannot be overlooked, as it may lead to imbalances in testicular function, instability in blood supply, and thermoregulatory disturbances, subsequently affecting both the quality and quantity of sperm. More severe consequences include potential testicular atrophy and other related complications. Numerous studies have proved the effects of varicocele.......

Materials

Name	Company	Catalog Number	Comments
0.9% sodium chloride solution	Guangdong Otsuka Pharmaceutical Co. LTD	21M1204	Preparation for injection of medication during surgery
20 MHz Microvascular Doppler System	Vascular Technology, Inc.	102802	Doppler ultrasound was used to identify the spermatic artery
4-0 coated, Braided Silk	Jiasheng Medical Products Co., Ltd	1600-31	Ligation of spermatic vein
5-0 absorbable surgical suture	HORCON	MY313G4	Skin and fascial suture
6-0 absorbable surgical suture	HORCON	JE1264	Deep tissue suturing
Compound lidocaine cream	Tongfang Pharmaceutical Group	H20063466	25mg of propacaine and 25mg of lidocaine per gram for epidermal infiltration anesthesia
Dianerkang Iodophor Skin Disinfectant	Shanghai Likang Disinfectant HI-Tech Co,Lid	31005102	For skin disinfection and the effective iodine content is from 4.5g/L-5.5g/L
electrotome	Shanghai Hutong Electronics Co., Ltd	GD350-B	Used to cut open the fascia layer
Fosfomycin Trometamol Powder	Shanxi C&Y Pharmaceutical Group Co., Ltd.	H19994124	Oral antibiotics for infection prevention
haemostatic forceps	SHINVA	ZH240RN	Used in surgical procedures
Lidocaine Hydrochloride Injection	Shanghai Harvest Pharmaceutical Co., Ltd	H20023777	Mixed with Ropivocoine Hydrochloride injection for deep infiltration anesthesia
methylene blue	JUMPCAN	H32025285	Skin marker
micro scissors	SHINVA	ZF123RN	Used in surgical procedures
micro tweezers	SHINVA	ZD274RN	Used in surgical procedures
needle holder	SHINVA	ZM234R/RN/RB	Used in surgical procedures
NeutroPhase	NovaBay Pharmaceuticals,Inc	CA 94608 USA	Wound Cleanser
ophthalmic scissors	SHINVA	ZC120R/RN/RB	Used in surgical procedures
Ropivocoine Hydrochloride injection	Jiangsu Hengrui Pharmaceuticals Co., Ltd	H20060137	Mixed with Lidocaine Hydrochloride Injection for deep infiltration anesthesia
Surgical Microscope	Carl Zeiss Meditec AG	20162224730	for microscopic operations
Titanium Clips	WECK HORIZON	002200	used to clamp vena cava
Titanium Clips	WECK HORIZON	005200	used to clamp venule