Microsurgical varicocelectomy versus laparoscopic surgery versus embolization for varicocele: a retrospective cost-effectiveness analysis.

[BACKGROUND] Varicocele is one of the most common causes of male infertility. Although multiple surgical and interventional methods are available, their cost-effectiveness remains insufficiently studied. This study aimed to compare short-term clinical outcomes and cost-effectiveness of microsurgical and laparoscopic varicocelectomy, reporting embolization outcomes as exploratory data owing to the limited number of cases.

[METHODS] A retrospective analysis was conducted on 113 patients with varicocele who were admitted to our hospital between June 2022 and May 2025. Based on the surgical approach, patients were categorized into three groups: microsurgical (n = 42), embolization (n = 8), and laparoscopic (n = 63). Owing to the small size of the embolization cohort, primary comparative and cost-effectiveness analyses were performed for the microsurgical and laparoscopic groups, while embolization outcomes were reported descriptively. Preoperative and postoperative measures, including sperm concentration, percentage of forward-moving spermatozoa (PR%), maximum diameter of the spermatic vein, surgical cost, and postoperative complications, were compared and analyzed. All procedures were performed by senior urologists experienced in varicocele repair, and postoperative complications were recorded. A cost-effectiveness analysis was performed by calculating the cost-effectiveness ratio (CER) and incremental CER based on hospitalization costs and improvements in semen parameters.

[RESULTS] All 113 patients successfully completed surgical treatment. Intra-group comparisons showed that all three surgical approaches led to significant postoperative improvements compared with the preoperative period (P < 0.05). Inter-group comparisons indicated that the improvement in PR% was significantly greater in the microsurgical group than in the laparoscopy group (P < 0.05). Cost-effectiveness analysis revealed that microsurgery yielded the lowest CERs for sperm concentration improvement (CER: 410.13) and PR% improvement (CER: 220.78), with incremental analysis demonstrating that microsurgery was superior to laparoscopic surgery.

[CONCLUSIONS] In this single-center retrospective cohort, microsurgical varicocelectomy was associated with superior short-term improvement in PR% and more favorable cost-effectiveness compared with laparoscopic varicocelectomy. Embolization outcomes were exploratory because of the limited sample size and should be interpreted with caution. Further multicenter studies with larger embolization cohorts and longer follow-up are warranted.