Objective: The varicocoele exist in approximately 35-40% of primary male factor infertility while two to 10 percent of cases presents with pain.1 Most surgeons favor subinguinal microscopic varicocoelectomy because it offers superior improvement in semen parameters and reproductive outcome with the least complication rate. This study aimed to show an innovative surgical technique in the management of men with varicoceles. Methods: Subinguinal varicocelectomies were performed by a single surgeon on all patients starting with a standard cystoscope stabilized by a customized mechanical holding system attached to the operating bed. All the presumed vascular channels, vas deferens and lymphatics were isolated and marked with vascular loops and surgical ties. After all the presumed vessels were tagged, the standard operating microscope was brought to the operative field and full microsurgical dissection was carried out. Results: Ten varicocelectomies were performed on six men with a mean age of 30.5 years. 13 arteries, 84 veins, and 20 lymphatics were identified by the cystoscope while 18 arteries, 93 veins, and 29 lymphatics were identified by the standard operating microscope. Comparing the two modalities, 72%, 90%, and 69% of the arteries, veins, and lymphatics, respectively, were correctly identified by the cystoscope when compared to the latter. Conclusion Subinguinal varicocelectomy using a standard cystoscope could be offered as an alternative surgical approach in men with varicoceles as it can identify veins comparable with that of the standard operating microscope. In addition, a standard cystoscope can also identify, to some degree, lymphatics and arteries during surgical dissection. This innovative surgical technique can serve as a valuable option in the treatment of men with varicoceles.
Cystoscopes ; Veins ; Arteries

INTRODUCTION: Advancement in male infertility were evident during the past several decades where ashift to evidence-based management is becoming apparent. However, there is still a knowledge gapamong training urologists in the said field where the Philippines is no exception. This is the first studythat would determine the current trend of practice in male infertility among Filipino urologists andrecommend solutions to this problem. MATERIALS AND METHODS: A 42-item self-administered survey questionnaire was carried out using theSurvey Monkey. This Institutional Review Board (IRB)-approved online survey consisted of 3 parts:demographics, adherenceto the guidelines andclinical practice.The authors contacted thePhilippineUrological Association (PUA) via email and requested for confidential distribution of an online survey.The participants were given 4 weeks from the date of initial mailing until end of the survey process.STATA 15.0 was used for data analysis. RESULTS: A total of 131 respondents participated in the survey. Only 13% responded that they are “veryinterested” in the specialty of male infertility. About 84% of respondents see less than 5 male infertilitycases per month with 67% of them reporting that male infertility constitutes less than 10% of theirpractice. For the treatment, 36% of them prescribe testosterone for empiric medical therapy of maleinfertility which is contraindicated in the treatment of male infertility and only 5% of respondents offerthe gold standard microsurgical varicocoelectomy in patients with varicocoele. Only 8% of respondentsare affiliated with IVF centers, which is troubling with regards to how men with poor reproductivepotential are treated especially in azoospermic men. Two percent of the respondents rated their exposureto male infertility during residency as “excellent” while only 3% of them rated their knowledge asexcellent. With this, responders suggest more exposure to the specialty, more postgraduate courses,lectures, and webinars, more training opportunities, a local guideline for Filipino urologists to follow,and more exposure to professional networks. CONCLUSION Practice of male infertility in the Philippines is inadequate in terms of knowledge andtreatment for these patients. Most respondents follow the male infertility guidelines available, but itdoes not translate into practice, highlighting their own preferences in diagnosis and treatment. Eventhough they consider it as a necessary part of Urology, lack of exposure to cases, surgical loads, andresearch makes it a challenge when faced with these cases in their clinics. A change in the residency,postgraduate, and national level are recommended to have the best clinical outcome and well-beingfor these patients.