Challenging cases of adherent periarterial vein during subinguinal Fisch technique and subinguinal micro-varicocelecotmy and sclerotherapy: a prospective comparative study.

Amr Elahwany, Nashaat Nabil, Sameh Fayek GamalEl Din, Ahmed Raef Sadek, Ahmed Ewais Sayed, Ahmed Ragab

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Article in Basic and clinical andrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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Evaluation of the efficacy of subinguinal antegrade sclerotherapy and subinguinal micro varicocelectomy versus a combined approach on the semen parameters in infertile patients: a randomized prospective comparative study.Basic and clinical andrology · 2026
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6 authors.

Amr ElahwanyDepartment of Andrology, Sexology and STDs, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.

Nashaat NabilDepartment of Andrology, Sexology and STDs, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt.

Sameh Fayek GamalEl DinDepartment of Andrology, Sexology and STDs, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt. samehfayek@kasralainy.edu.eg.ORCID http://orcid.org/0000-0003-1918-5132

Ahmed Raef SadekDepartment of Andrology, Sexology and STDs, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.

Ahmed Ewais SayedDepartment of Andrology, Sexology and STDs, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt.

Ahmed RagabDepartment of Andrology, Sexology and STDs, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt.

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6 · The paper itself

Abstract

backgroundTo the best of our knowledge, there is a gap in the review of literature about the most suitable varicocelectomy technique in isolating and ligating adherent periarterial vein(s). Consequently, leaving the artery intact or ligating it together with the adherent vein may pose a challenge. We conducted a comparative prospective study to assess the outcomes of the three techniques namely Fisch, sclerotherapy and microvaricoclectomy (MSV).

resultsThe patients who underwent MSV showed the longest operative time (66.29 ± 2.78 min), followed by Fisch technique (56.94 ± 3.07 min) then sclerotherapy (55.45 ± 1.99). Thus, the difference in the operative time between the three techniques was statistically significant (P < 0.001). Regarding the postoperative right vein diameter, MSV group showed the largest diameter (2.14 ± 0.15 mm), followed by Fisch technique (2.13 ± 0.15 mm) then sclerotherapy (1.75 ± 0.42 mm). Regarding the postoperative left vein diameter, MSV group showed again the largest diameter (2.17 ± 0.21 mm), followed by Fisch technique (2.14 ± 0.15 mm) then sclerotherapy (1.75 ± 0.42 mm). Moreover, the patients who underwent sclerotherapy showed the highest postoperative progressive sperm motility percent (25.27 ± 4.00%), followed by Fisch technique (21.56 ± 7.30%) then MSV group (19.85 ± 6.33%). Post hoc pair wise comparisons revealed that sclerotherapy and Fisch technique had a significantly higher effectiveness in reducing operative time than MSV. Additionally, it revealed that sclerotherapy technique had a significantly higher effectiveness in reducing postoperative vein diameters measurement than MSV and Fisch technique. Post hoc pair wise comparisons revealed that sclerotherapy technique had a significantly higher effectiveness in improving the postoperative progressive sperm motility percent than MSV. Patients who underwent the 3 techniques demonstrated statistically significant differences between baseline and post-operative vein diameter, reflux duration, sperm concentration, progressive sperm motility, progressive motile count/ejaculate and sperm abnormal forms.

conclusionThe 3 techniques showed significant improvement in the semen parameters after 3 months in the studied patients. However, sclerotherapy technique showed a significantly higher effectiveness in improving the postoperative progressive sperm motility percent compared to MSV.

Indexed as

Adherent periarterial veinColpi sclerotherapyFisch techniqueMicrosurgical varicocelectomySperm progressive motility

Identifiers

PMID39901069

DOI10.1186/s12610-025-00250-9

PMCPMC11792355

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