ĐÁNH GIÁ KẾT QUẢ VI PHẪU THUẬT THẮT TĨNH MẠCH THỪNG TINH TẠI BỆNH VIỆN ĐA KHOA TÂM ANH THÀNH PHỐ HỒ CHÍ MINH (2021–2025)

Abstract

Background: Varicocele affects 15–20% of adult males and 35–40% of men with primary infertility. Microsurgical inguinal varicocelectomy is recommended by the EAU guidelines because of its low complication rate.

Objectives: To evaluate the outcomes of microsurgical varicocelectomy regarding pain (VAS), semen parameters (WHO 2021), scrotal colour Doppler ultrasound findings and complication rates.

Methods: A retrospective descriptive study with single-point prospective follow-up of 68 patients operated on between January 2021 and December 2025. Pain group, n = 25; infertility group, n = 43, all azoospermic at baseline, confirmed on at least two centrifuged semen specimens per WHO 2021. Post-operative semen analysis was performed at ≥ 3 months. Pre- and post-operative values were compared using the Wilcoxon signed-rank test for continuous variables and the McNemar test for the binary outcome; proportions are reported with 95% confidence intervals (CI).

Results: (1) VAS decreased from 5.36 ± 1.38 to 2.88 ± 1.45 (p < 0.001); 48.0% achieved ≥ 50% reduction. (2) Of 43 azoospermic patients, sperm appeared post-operatively in 72.1% (31/43; 95% CI 57.3–83.3; McNemar p < 0.001): cryptozoospermia 37.2%, density < 16 × 10⁶/mL 20.9%, ≥ 16 × 10⁶/mL 14.0%; 27.9% remained azoospermic; peak density reached 52 × 10⁶/mL. (3) Doppler (n = 68): vein diameter 3.51 → 2.17 mm; Valsalva reflux 3.26 → 1.46 s; left testicular volume 12.45 → 13.97 mL (all p < 0.001). (4) Complications: recurrence 4.4%; hydrocele 1.5%; no surgical site infection or testicular atrophy.

Conclusion: Microsurgical varicocelectomy is safe, provides significant pain relief, improves Doppler parameters and induces sperm appearance in 72.1% of azoospermic patients. It is a valuable treatment option; larger prospective studies are warranted.