Hydrocele formation is the most common complication reported after non-microsurgical varicocelectomy, with an average incidence of about 7% Hydroceles form secondary to ligation of the testicular lymphatics. At least half of all post-varicocelectomy hydroceles grow to a size that produces sufficient discomfort to warrant surgical hydrocelectomy. The effect of hydrocele function on spermatogenesis and fertility is unknown. Theoretically, large hydroceles may impair testicular function by insulating the testis and preventing normal thermoregulation. Use of the operating microscope has essentially eliminated the development of hydroceles following varicocelectomy.
Testicular artery ligation is also a common complication of non-microsurgical varicocelectomy although its true incidence is unknown. Injury or ligation of the testicular artery may cause testicular atrophy, impaired spermatogenesis, or both. Animal studies indicate that testicular atrophy occurs anywhere from 20% to 100% of the time following testicular artery ligation. In humans, Penn, et al. reported a 14% incidence of frank testicular atrophy, when the testicular artery was purposefully ligated during renal transplantation. Optical magnification and/or the use of a fine tipped Doppler probe facilitate identification and preservation of the testicular artery.
The incidence of varicocele recurrence following surgical repair varies from 1% to 45%. The incidence of recurrence depends upon the type of procedure performed and the use of magnification. Venographic studies have shown that recurrent varicoceles are caused by periarterial, parallel inguinal, midretroperitoneal, gubernacular and transcrotal collateral veins.The only approach equipped to deal with these vessels is the inguinal or subinguinal microscopic technique with delivery of the testis. Using the microsurgical technique at Cornell, we have reviewed our results of over 3000 men who underwent microsurgical varicocelectomy, the couples' pregnancy rate was 43 % after one year and 69% after 2 years compared to 17% in couples with men who declined surgery and had hormone treatment or used insemination. There have been only 25 recurrences (0.9%), 5 hydroceles (0.2%) , no testicular atrophy, and a 1% incidence of inadvertent unilateral (one side only) testicular artery ligation.