Comparison of the pulling technique versus the standard technique in microsurgical subinguinal varicocelectomy: a randomized controlled trial

Abstract Background We compare the outcome of microsurgical subinguinal varicocelectomy (MSV) using the pulling technique (P-MSV) compared to the standard technique (S-MSV). Methods A total of 60 patients were diagnosed with varicocele compounded with infertility and/or scrotal pain not responding to medical treatment. Twenty-nine patients were randomized to the P-MSV, while 31 were randomized to S-MSV. The number of ligated veins was counted intraoperative and compared. Follow-up was done at 1 and 3 months including clinical examination, scrotal duplex ultrasound scan, and semen analysis. Results A total of 85 sides were operated upon, 43 (50.5%) were done by the P-MSV technique while 42 (49.5%) were done by the S-MSV technique. The median gained cord length after using the P-MSV was [3 cm; IQR 2–5 cm]. For the P-MSV technique, the mean number of detected internal spermatic veins after cord pulling was (4 ± 1.3 SD) compared to (6 ± 1.4 SD) before pulling (P value