MODERN ASPECTS OF MICROSURGICAL VARICOCELECTOMY AND ASSISTIVE TECHNOLOGY

Background. Varicocele is one of the most common causes of male reproductive dysfunction and is associated with conditions such as infertility, hypogonadism and chronic pain syndrome. Despite advances in surgical and adjuvant treatment techniques, the incidence of complications such as recurrence, hydrocele and damage to vascular structures remains significant. The relevance of the present work is determined by the need for in-depth analysis and systematization of modern data on surgical methods and additional technologies in varicocelectomy to optimize the results of treatment and reduce the incidence of complications. Purpose. To analyze modern surgical and adjuvant techniques of varicocele treatment, their effect on testosterone levels, sperm parameters and pain syndrome, as well as to determine the place of new technologies such as micro-Doppler, fluorescence angiography and the use of platelet-rich plasma (PRP) in complex varicocele therapy. The review presents the results of recent studies and meta-analyses to formulate current recommendations for clinical practice. Materials and methods. To prepare the review article, publications from the last five years in PubMed, Scopus, Web of Science and Google Scholar databases were analyzed. The selection criteria included original articles, systematic reviews, and meta-analyses on varicocele surgery and additional adjunctive techniques such as microsurgery, intraoperative Doppler, fluorescence angiography, and the use of platelet-rich plasma (PRP). The results of studies reflecting the impact of these techniques on testosterone levels, spermatogenesis, pain, complications and postoperative recurrences were studied. Results. The analysis of modern publications has shown that microsurgical subinguinal varicocelectomy is the most effective and safe technique of surgical treatment of varicocele. Intraoperative use of Dopplerography and hydrodissection increases the accuracy of identification of vascular structures, reducing the risk of testicular artery damage (arterial preservation increases up to 100%) and decreasing the probability of hydrocele development and varicocele recurrences. The use of fluorescence angiography with indocyanine green (ICG) demonstrates significant potential to reduce ischemic complications and lymphatic vessel damage. Conclusions. Experimental studies have shown marked antioxidant and regenerative effects of PRP and platelet-rich fibrin matrix (i-PRF), but further clinical studies are needed to confirm their efficacy in practice.