A 28-year-old man presents with infertility. Examination reveals a left-sided, grade III varicocele that increases with Valsalva. Semen analysis shows oligoasthenoteratozoospermia. Which surgical technique is considered the gold standard for varicocele repair?

• A Laparoscopic ligation of the testicular vein
• B Radiographic embolization of the gonadal vein
• C Open inguinal (Ivanissevich) approach
• D Microsurgical subinguinal varicocelectomy ✓

Explanation

Microsurgical subinguinal varicocelectomy is the gold standard, with the lowest recurrence rate (around 1%) and complication rate. The operating microscope allows identification and preservation of lymphatics and arteries while ligating all venous channels. Laparoscopic and inguinal approaches have higher recurrence. Embolization has radiation exposure and higher recurrence.

Reference: Campbell-Walsh-Wein Urology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.