Editing Varicocele (section)

====== Microsurgical Inguinal and Subinguinal ======
* '''Advantages'''
*# '''Facilitates artery and lymphatic sparing'''
*# '''Low rate of varicocele recurrence'''
*# '''Low risk of hydrocele'''
* '''Disadvantages:'''
*# '''May be time-consuming'''
*# '''Requires microscopic surgical skills'''
* '''Indications for inguinal vs. subinguinal varicocelectomy (see CW11 Table 25-6)'''
** '''Subinguinal approach'''
*** '''Currently the most popular approach'''
*** '''Preferred in men with a history of any prior inguinal surgery'''
*** Significantly more difficult than a high inguinal operation and should be used only by surgeons who perform the operation frequently
*** '''Associated in rare cases with testicular atrophy (necrosis), which has not been reported for suprainguinal procedures'''
** '''Inguinal approach'''
*** '''Used when simultaneous ipsilateral hernia repair is performed'''
* '''An inguinal or subinguinal approach allows access to cremesteric/external spermatic vein and even gubernacular veins'''
* '''At the completion of the microsurgical varicocelectomy, only the testicular arteries, cremasteric arteries, lymphatics, and vas deferens with its vessels remain (i.e. deferential artery and vein are intact)'''
** '''As long as at least one set of deferential veins remains intact, venous return will be adequate'''