Varicocele is a common and potentially correctable cause of male infertility and chronic scrotal pain. Standard treatment options include subinguinal microscopic varicocelectomy (MV) and percutaneous angioembolization (AE) [1], each with distinct procedural profiles. There is growing interest in how patient-related factors—particularly body mass index (BMI)—affect clinical, functional, and reproductive outcomes [2,3]. This study aimed to compare MV and AE in terms of semen quality, complications, pain resolution, and operative parameters while evaluating the influence of BMI on these outcomes.

A retrospective review was conducted on 280 patients undergoing MV or AE for varicocele. After excluding patients lost to follow-up (MV: n=3; AE: n=13), 264 men were included (MV: n=214; AE: n=50). Data collected included age, BMI, indication (infertility vs pain), operative time, postoperative complications, pain persistence, testicular atrophy, and semen parameters before and after treatment. Patients were grouped into normal BMI (<25 kg/m²) and overweight/obese (≥25 kg/m²). Statistical tests included Mann–Whitney U, Wilcoxon Signed-Rank, chi-square, and effect size calculations.

Mean age and BMI were 28.7 ± 9.3 years and 27.0 ± 6.1 in the MV group, and 31.5 ± 11.1 years and 26.7 ± 6.5 in the AE group. Infertility was more prevalent in MV (46.3%) than AE (31.7%). MV had a longer operative time (83.4 ± 29.6 min vs. 72.3 ± 25.6 min). Pain persisted in 32.6% of MV and 39.4% of AE patients postoperatively.

Complications occurred only in the MV group (14.08%), including hydrocele (7.04%), hematoma (4.69%), epididymitis (1.41%), and wound infection (0.94%). No complications were reported in AE. Testicular atrophy occurred in 3 MV patients (1.41%); none in AE.

BMI did not significantly affect complication rates (p=0.238). However, elevated BMI was strongly associated with infertility (53.0% vs 26.8%, p<0.001) and poorer preoperative semen quality—lower total motile sperm count (TMSC), concentration, motility, and semen volume (all p<0.05, small-to-moderate effect sizes).

MV led to significant postoperative improvements in sperm concentration (Z=–4.17, p<0.001), motility (Z=–3.65, p<0.001), and TMSC (Z=–2.52, p=0.012). AE showed no significant improvement in any semen parameter.

Microscopic varicocelectomy produced superior functional and reproductive outcomes, including significant improvements in semen quality and pain resolution. BMI was associated with fertility impairment and semen deficits, but not with complications or surgical duration. While AE offered a minimally invasive approach with zero procedural complications, it did not yield measurable gains in fertility parameters.

Subinguinal microscopic varicocelectomy appears to provide broader clinical benefits than angioembolization, particularly in men with elevated BMI and fertility concerns. Though AE remains a safe and less invasive option, MV should be prioritized in patients seeking meaningful reproductive and functional improvements.

Bounasr A, Halila M, Kaoutar M, Hicham E, Adil D, Rachid B. Embolization of varicocele: technique and results in 37 patients. Pan Afr Med J. 2017;26:3. doi:10.11604/pamj.2017.26.3.10116
Mak D, Jarvi KA, Buckspan M, Lo K, Grober ED, Zini A. Microsurgical varicocelectomy significantly improves total motile sperm count and pregnancy rates in men with secondary infertility. Can Urol Assoc J. 2010;4(3):266-270. doi:10.5489/cuaj.842
Yamamoto M, Hibi H, Katsuno S, Miyake K. Effects of the body mass index on the results of varicocelectomy in infertile men. Int J Urol. 2000;7(9):321-324. doi:10.1046/j.1442-2042.2000.00231.x