Kanana A. Improvement of varicocelectomy in men of reproductive age with substantiated pathogenetic type of varicocele taken into account.

The work has been based on the results of complex examination of 265 patients with varicocele operated on during 2005 - 2012 at the age of 15 - 42 years (18 ±1.2 average). The 18 - 35 years old patients prevailed (79.2%). Three groups were formed in dependence of the type of surgical correction. The first (basic) group represented 78 (29.4%) patients who had undergone the well-tried and proposed modification of laparoscopic varicocelectomy using the direct intraoperative determination of hemodynamic type of varicocele. Two others were comparative groups. They consisted of 111 (41.9%) patients who had undergone microsurgical inguinal or subinguinal varicocelectomy and 76 (28.7%) - the Ivanissevich's open operation. It has been stated that the incidence of unsatisfactory results after surgical treatment of patients with varicocele was statistically higher in case of the Ivanissevich?s operation than after microsurgical varicocelectomy - 10.5±3.5% and 3.6±1.7%, respectively, chiefly on the account of the appearing recurrence (9.2±3.3% and 2.7±1.5%, respectively), caused by the discrepancy of the corrective method of varicocele hemodynamic type. The substantiated, by the date of intraoperative determination of hemodynamics, types of pathologic reflux in patients with varicocele are: 1st (reno-testicular) - seen in 74.7± 4.1% of cases, 2nd (ileo-testicular) - in 7.2± 2.4% and 3rd (mixed) - in 18.1± 3.6%. They serve as the basis for choosing the rational tactics of surgical treatment. The proposed laparoscopic varicocelectomy allows during the operation to specify the type of reflux and to make pathogenically substantiated choice for correction and to secure clinical efficacy in 98.7±1.0% of cases, the expediency of this type of operation in bilateral varicocele has been proved. The detected pathospermia in 31.3±5.0% of patients with varicocele gets positive changes after the operative treatment in 84.4± 4.3% of cases, irrespective of the type of surgical intervention.