Surgical Efficacy in Varicocele Ligation with Ephedrine-Assisted Blood Pressure Control.

Abstract

BACKGROUND Surgery for varicocele has evolved to include microscopy-guided methods for spermatic vein ligation. This retrospective observational clinical study included 52 patients undergoing microscopic spermatic veins ligation (MSVL) for varicocele to compare outcomes in patients with and without medically induced elevation of blood pressure (EBP) aimed at improving identification of the testicular arteries (TAs). MATERIAL AND METHODS Twenty-five patients underwent MSVL and 27 patients underwent MSVL with ephedrine (6.52±1.28 mg) to briefly increase BP to 140-160 mmHg. The duration of the procedure, the number of TAs preserved, the number of spermatic veins ligated, the incidence of arterial injuries, the incidence of complications, the incidence of recurrence, and the preoperative and 6-month postoperative semen parameters were compared between the 2 groups. RESULTS The operative time in the EBP group (36.48±4.53 min) was significantly shorter than that in the non-elevated blood pressure (NEBP) group (50.40±6.46 min) (P<0.001). The number of preserved TAs in the EBP group (1.33±0.48) was significantly higher than that in the NEBP group (0.96±0.45) (P=0.006). Postoperative semen parameters in both the EBP and NEBP groups were significantly improved compared with the preoperative period (both P<0.001). There was no significant difference between the 2 groups in the number of spermatic veins ligated, incidence of arterial injury, incidence of complications, recurrence rate, or semen parameters at 6 months postoperatively (all P>0.05). CONCLUSIONS During MSVL, the use of ephedrine to increase BP to 140-160 mmHg can assist surgeons in safely and effectively identifying and preserving the TAs, thus improving the efficacy of the procedure.