Improvement in the fertility rate after placement of microsurgical shunts in men with recurrent varicocele

Objective: To evaluate the effectiveness of microsurgical shunts for secondary varicocele repair after ligation-like procedures, focusing on long-term functional outcomes. Design: Long-term survey (mean follow-up, 8.5 years) of infertile men after secondary microsurgical reconstructive varicocelectomy. Setting: University-based medical center. Patient(s): Thirty-four infertile men (group A, <30 years of age; and group B, >30 years) with recurrent palpable varicocele after varicocelectomy, according to Ivanissevich (n = 28), or after angiographic vein occlusion (n = 6). Ten patients presented bilateral recurrence. Intervention(s): Microsurgical shunts between spermatic vein and inferior epigastric vein. Main Outcome Measure(s): Sperm count, pregnancy rate, and ultrasound evaluation of varicosity. Result(s): Complete disappearance of varicosity was achieved in 97.06% of patients, while in 2.94%, a consistent reduction in size was observed. In patients with severe infertility, a significant postoperative increase in seminal parameters was observed. Pregnancy rates were 43.75% in group A and 22.22% in Group B. Conclusion(s): Microsurgical drainage in patients with recurrent varicocele after ligation-like procedures was shown to be an effective minimally invasive treatment, with immediate hemodynamic recovery of testicular venous outflow and excellent long-term results in patients with left or bilateral recurrences. (C) 2004 by American Society for Reproductive Medicine.