Does Combined Hydrodissection and Papaverine During Varicocelectomy Improve Results? A Randomized Clinical Trial

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Abstract
Background: There are many reports about incomplete ligation of veins and inadvertent injury to the spermatic artery and lymphatic vessels during varicocelectomy, regardless of the surgical approach or advanced devices utilized. Objectives: Given that varicocelectomy risks arterial injury and vascular spasm, which compromise surgical success, this study aims to evaluate papaverine and hydrodissection as a means to enhance vessel exposure and ultimately improve sperm parameters. Methods: A randomized clinical trial was performed from April to July 2023 at Shahid Beheshti Specialty Hospital and Ofogh Clinic in Hamadan, Iran. Using convenience sampling, 114 patients eligible for varicocelectomy were recruited and randomized into three groups (A, B, and C) through a block randomization method with an equal allocation ratio (1:1:1). Group A underwent varicocelectomy only, Group B was administered papaverine, and Group C received papaverine combined with hydrodissection. The primary outcomes — sperm parameters and arterial preservation — were evaluated three months after surgery, whereas the secondary outcomes, namely operating time and surgical difficulty, were also assessed. Statistical analysis was performed using SPSS version 16, applying ANOVA, chi-square, Fisher’s exact test, and linear regression. Results: Three months after surgery, the mean score of motile sperm in the hydrodissection plus papaverine group was significantly higher compared to the other groups [69.34 (60.00) vs 62.70 (5.39) and 54.77 (14.48), P < 0.001]. Also, the three groups showed significant differences in the mean count of sperm. The highest count of sperm was observed in the papaverine plus hydrodissection group. This difference was statistically significant [65.96 (56.20) vs 39.25 (30.52) and 26.83 (21.65), P = 0.0001]. No significant difference was observed between the groups (P = 0.07) regarding sperm morphology. The mean arterial pressure in the papaverine plus hydrodissection group was superior to the other groups [0.59 (0.04) vs 0.46 (0.14) and 0.50 (0.02), P < 0.001). Conclusions: Papaverine plus hydrodissection provides benefits for semen parameters and preservation of the artery; this method is superior to the standard varicocelectomy procedure and allows for easier differentiation of vessels from each other.

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