MICROSURGICAL VARICOCELCTOMY FOR NON OBSTRCUTIVE AZOOSPEMRIA

A 35 patient with anejaculation and erectile dysfunction came to us for evaluation.

He underwent essential androlocal evaluation.He was a case of diabetes mellitus and had developed peripheral neuropathy. His FSH was bordeline high and testicles were bormal in size with bilateral grade 3 varicocele. His colour doppler penis with papavarine injection(pharmcopenile doppler) revealed arterial insufficiency.

He underwent testicular biopsy which revealed hypospermatogenesis.

He was counselled for penile implant and bilateral microsurgical varicocelctomy (In view of getting better yield of sperms on TESA in future during IVF and ICSI).Varicocelectomy can be effective even in men with azoospermia. Matthews and Goldstein have reported that 55% of azoospermic men had motile sperm observed in their ejaculate after repair.

we have done microsurgical varicocelctomy for Non obstrcutive azoospemria and we have succeeded in getting sperm in the ejcaulate in about 25% of the cases.

He is planned for a three piece penile implant(by MENTOR COLOPLAST) at a later date. The procedure was done under microscopic guidance. The magnification was kept at 15 X.there were 3 veins on both sides. These veins were ligated and cut.The arteries,lymphatics and nerves were carefully isolated and preserved.

The introduction of microsurgical technique to varicocelectomy has resulted in a substantial reduction in the incidence of postoperative hydrocele formation and testicular atrophy. The use of magnification enhances the ability to identify and preserves the 0.5 - 1.5-mm testicular arteries, thus avoiding the complications of azoospermia.

Microsurgery only should be the choice for varicocele patient.