Should the testicular artery be preserved at varicocelectomy?

A surgical method of varicocelectomy, in which the internal spermatic veins together with the testicular artery are ligated as a whole in the retroperitoneal space, has been proposed as a simple and reliable procedure. We evaluated the effects of ligating the testicular artery at varicocelectomy on fertility. A total of 34 subfertile patients with a left varicocele was randomized into an artery-preserved or artery-ligated group at open varicocelectomy and the change in semen quality was prospectively studied. The artery-preserved group showed improvements in sperm density and total sperm count, while the artery-ligated group showed improvements in sperm density, total sperm count and sperm motility. The results indicated identical improvement in semen quality in both groups of patients. Testicular volume, measured by a punched-out orchidometer, did not change in any of the patients in the ligated group, except for 1 with a grade 3 varicocele, although this decrease could not be detected by sonography. The effects of artery-preserving and artery-ligating varicocelectomy on postoperative pregnancy rates were investigated by examining 116 patients retrospectively. The pregnancy rates of 37.8% and 23.8% in the artery-preserved and artery-ligated groups, respectively, were not significantly different. Despite the theoretical advantage of artery preservation, our study did not show any significant difference between artery-preserving varicocelectomy and the artery-ligating operation when improvements in semen quality and postoperative pregnancy rate were evaluated.