Urology & Andrology

Variocele is one of the causes for male factor infertility which can be treated through surgical correction. The commonly applied method is a surgical technique named Testicular Vein legation (TV ligation) which gives an improvement in semen quality with marginal pregnancy rate. Sadly, much of the patients are permanently rendered sterile and up to thirty per cent of them experience some complications like re-appearance of Varicocele or collection of fluid around the testicles called Hydrocele. Few surgeons offer laparoscopic TV ligation. But even in this case the pregnancy rate and complication rate are no better than TV ligation. The reasons for this poor revolts and high complication is the inability to identify and preserve the major blood supply to the testis and its lymphatic and incomplete removal of the pathogenic venous channels owing to the micro sizes of these structures. The new micro surgical technique (MSV) make use of an operating microscope and micro surgical instruments to correctly identify this micro structures and aid in preservation of the testicular blood supply and lymphatic channels and to completely remove the pathogenic venous channels, the results of which are truly encouraging. The semen quality improvement rate is over ninety per cent and pregnancy rates stand at around eighty per cent. More importantly, the complication rates is negligible with 0.2 -1%. The other advantage of MSV is that it is much less painful when compared to TV ligation and patient can be back to work on the third day of surgery. Even today over 98 % of patients undergo TV ligation, as a result of the low awareness of the advantages of this procedure.

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