COMPARISON OF OPEN AND MICROSURGICAL VARICOCELECTOMY IN TERMS OF PAIN, OPERATIVE TIME AND SPERM COUNT

Abstract

Background: Varicocele is recognized as one of the leading correctable causes of male infertility and is present in approximately 35–40% of infertile men. The condition negatively affects spermatogenesis through multiple mechanisms including oxidative stress, increased scrotal temperature, reflux of adrenal metabolites, venous stasis, and testicular hypoxia (Su et al., 2021). Surgical correction of varicocele has been associated with improvement in semen quality, spontaneous pregnancy rates, and overall reproductive outcomes (Birowo et al., 2020). Among the available surgical techniques, open sub inguinal varicocelectomy and microsurgical sub inguinal varicocelectomy are commonly performed approaches; however, controversy remains regarding the optimal technique in terms of operative efficiency, postoperative pain, and improvement in sperm parameters.

Objective: To compare open and microsurgical varicocelectomy in terms of postoperative pain, operative time, and postoperative sperm count among patients presenting with unilateral varicocele.

Methodology: This non-randomized controlled trial was conducted at the Armed Forces Institute of Urology (AFIU), Rawalpindi, over a period of four months (November 26, 2025 to March 25, 2026). A total of 334 patients diagnosed with unilateral Grade I–III varicocele and primary infertility were enrolled and equally allocated into two groups: Group A underwent open sub-inguinal varicocelectomy, while Group B underwent microsurgical subinguinal varicocelectomy. Patients aged 18–40 years fulfilling the inclusion criteria were included through consecutive non-probability sampling. Operative time was recorded from skin incision to skin closure. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 6, 12, and 24 hours postoperatively. Postoperative sperm count was evaluated three months after surgery through semen analysis. Data were analyzed using SPSS version 25. Independent sample ttest was applied for comparison between groups, with p-value ≤ 0.05 considered statistically significant. 

Results: The mean age of patients in the open varicocelectomy group was 29.8 ± 5.1 years, while in the microsurgical group it was 30.2 ± 4.8 years. The mean operative time was significantly shorter in the open repair group compared with the microsurgical group (38.6 ± 8.9 minutes vs. 64.4 ± 12.7 minutes; p < 0.001). However, postoperative pain scores were significantly lower among patients who underwent microsurgical varicocelectomy at 6, 12, and 24 hours postoperatively (p < 0.05). Furthermore, the postoperative sperm count showed greater improvement in the microsurgical group (43.1 ± 6.8 million/ml) compared with the open repair group (39.4 ± 6.2 million/ml), demonstrating statistically significant difference (p = 0.002). Microsurgical varicocelectomy also demonstrated better overall patient satisfaction and fewer postoperative complications.

Conclusion: Microsurgical sub-inguinal varicocelectomy provides superior postoperative outcomes in terms of lower pain scores and greater improvement in sperm count compared with open varicocelectomy, although it requires significantly longer operative time. Based on these findings, microsurgical varicocelectomy may be considered the preferred surgical technique for the management of infertile patients with varicocele.