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Microsurgical Subinguinal Varicocelectomy (Marmar Technique)

A microsurgical varicocele repair technique performed through a small subinguinal incision under operating microscope visualization, allowing precise ligation of internal spermatic veins while sparing the testicular artery, lymphatics, and vas deferens to maximize fertility outcomes.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Microsurgical Subinguinal Varicocelectomy (Marmar Technique)?

Microsurgical subinguinal varicocelectomy is performed through a 2 to 3 cm incision below the external inguinal ring, with delivery of the spermatic cord and microscopic dissection at 6 to 25x magnification.

All internal spermatic and external spermatic veins are individually ligated, while the testicular artery (identified by Doppler), lymphatic vessels, and the vas deferens with its accompanying vessels are meticulously preserved.

Compared with retroperitoneal (Palomo) and laparoscopic varicocelectomy, the microsurgical subinguinal approach has the lowest rates of postoperative hydrocele (less than 1 percent), recurrence (less than 2 percent), and testicular artery injury, with superior improvement in semen parameters and pregnancy rates.

Symptoms

Clinical varicocele (palpable cord vein dilation) on physical examination in a man with infertility
Abnormal semen parameters: oligospermia, asthenospermia, teratospermia, or elevated DNA fragmentation
Chronic dull testicular or scrotal pain that worsens with standing or activity
Testicular hypotrophy (more than 20 percent volume difference) on ultrasound in adolescents and young adults
Hypogonadism (low total testosterone) attributable to varicocele in selected men

Risk Factors

Adolescent and young adult males with grade 2 or 3 left-sided varicocele
Subfertility with abnormal semen analysis and palpable varicocele on examination
Bilateral varicoceles, even of lower grade, in men with infertility
Persistent or recurrent varicocele after embolization or non-microsurgical repair
Significant chronic scrotal pain affecting quality of life that does not respond to conservative measures

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Couples with primary or secondary infertility — semen analysis and physical examination for clinical varicocele
  • Adolescent with painful or bulky scrotal varicocele or significant testicular asymmetry
  • Adult with chronic testicular pain that worsens with activity and is associated with palpable varicocele
  • Persistent symptoms or abnormal semen parameters after varicocele embolization or other repair
  • Hypogonadism with low testosterone in a man with bilateral varicocele as part of fertility evaluation

Treatment Methods

01
Preoperative scrotal Doppler ultrasound, semen analysis, and hormonal evaluation (total testosterone, FSH, LH)
02
Microsurgical subinguinal incision with cord delivery and dissection under operating microscope at 6 to 25x magnification
03
Doppler-guided identification and preservation of testicular artery, lymphatics, and vas deferens with selective ligation of all internal and external spermatic veins
04
Outpatient or short-stay procedure with rapid return to normal activity in 1 to 2 weeks and follow-up semen analysis at 3 to 6 months
05
Reassessment of semen quality and continued infertility evaluation: 60 to 70 percent of patients show improved semen parameters and 30 to 40 percent achieve spontaneous pregnancy at 12 months

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.