Surgical Outcomes of Subinguinal and Retroperitoneal Approaches in Varicocelectomy: A Prospective Comparative Study

Background: Varicocele, or the dilatation and tortuosity of the pampiniform plexus of veins, remains the most common surgically correctable cause of male infertility. Surgical intervention through varicocelectomy has been associated with significant improvement in semen parameters and fertility outcomes. This study compared subinguinal and retroperitoneal approaches regarding the duration of surgery, complications after the operation, and improvement in semen parameters. Patients and Methods: A randomized prospective study of 60 male patients aged 15-40 years with symptomatic varicocele had been performed. Patients were then randomized into two groups: Group A undergoing subinguinal varicocelectomy and Group B undergoing retroperitoneal varicocelectomy. Assessment of preoperative and postoperative operative time, complication rates, and semen analysis was performed. All data and results of both approaches had been analyzed. Results: Operative time was significantly shorter in the retroperitoneal approach as compared to the subinguinal approach 44.2 ± 11.5 minutes versus 50.9 ± 12.5 minutes, P = 0.037. In both groups, a statistically significant improvement in semen parameters regarding sperm count, motility, and morphology was noted. These changes did not differ statistically between the two groups. Postoperative complications like hydrocele formation and recurrence were minimal and comparable between the two groups. Conclusions: Subinguinal and retroperitoneal approaches are effective in improving semen parameters in patients undergoing varicocelectomy. The significant advantage of the retroperitoneal approach is shorter operative time, but similar outcomes can be achieved by the subinguinal approach.