Microsurgical varicocelectomy and revascularization: a novel approach to varicocele treatment

We have implemented distinct drainage pathways depending on the presence or absence of Nutcracker Syndrome (NCS) in patients with varicocele to promptly establish a physiological venous route. This study aimed to evaluate the efficacy and safety of microsurgical varicocelectomy with revascularization (MVR) as a treatment for varicocele, comparing it with standard microsurgical varicocelectomy (MV) and laparoscopic varicocelectomy (LV). Additionally, the study sought to establish the feasibility of MVR in patients with NCS-associated varicocele. A retrospective analysis was conducted on 209 patients who underwent MVR, 60 patients who received LV, and 44 patients who underwent standard MV. All surgeries were performed by experienced urologists. The study assessed intraoperative details, perioperative outcomes, and long-term follow-up results, including the resolution of testicular pain and improvement in semen parameters. MVR surgery demonstrated a 96.0% success rate in relieving testicular pain and a 92.9% improvement in semen parameters. No severe complications occurred. Comparison with traditional surgeries revealed higher efficacy and fewer complications with MVR. Moreover, the findings suggest that MVR is safe and feasible for patients with NCS-associated varicocele. MVR emerged as a safe and effective treatment approach, offering fewer complications compared to traditional methods. The study underscores MVR as a promising alternative for primary varicocele and NCS-related varicocele, providing valuable insights for clinical practice.