Single Infrapubic Versus Bilateral Subinguinal Microsurgical Varicocelectomy

Single Infrapubic Versus Bilateral Subinguinal Approaches for Bilateral Microsurgical Varicocelectomy: A Prospective Randomized Controlled Trial

Bilateral varicocele is commonly treated by microsurgical varicocelectomy. The conventional bilateral subinguinal approach usually requires two separate skin incisions, one on each side. A single midline infrapubic approach may allow bilateral microsurgical repair through one incision and may reduce access-related morbidity.

This prospective randomized controlled trial will compare single infrapubic microsurgical bilateral varicocelectomy with conventional bilateral subinguinal microsurgical varicocelectomy in adult men with clinically palpable bilateral varicocele. The study will evaluate postoperative pain, analgesic requirement, time to return to normal daily activity, operative time, scar satisfaction, wound complications, recurrence, and other safety outcomes during follow-up.

Inclusion Criteria:

• Male patients aged 18 to 45 years.
• Clinically palpable bilateral varicocele, grade II or grade III.
• Diagnosis confirmed by color Doppler ultrasound.
• Infertility for at least 12 months and/or abnormal semen analysis.
• Female partner evaluation performed or planned to exclude major uncorrected female-factor infertility.
• Patient fit for surgery and anesthesia.
• Written informed consent provided by the participant.

Exclusion Criteria:

• Subclinical varicocele detected only by Doppler ultrasound.
• Unilateral varicocele.
• Recurrent varicocele after previous surgery, embolization, or sclerotherapy.
• Previous inguinal, scrotal, pelvic, or penile surgery likely to distort surgical anatomy.
• Associated inguinal hernia, hydrocele, spermatocele, epididymal cyst, or other scrotal condition requiring simultaneous surgery.
• Azoospermia, especially suspected non-obstructive azoospermia.
• Active urinary tract or genital infection.
• Coagulopathy or anticoagulant therapy that cannot be safely interrupted.
• Severe obesity, defined as body mass index greater than 40 kg/m², or any anatomical condition preventing safe exposure by either surgical approach.
• Refusal to participate or inability to complete follow-up.