Aim: To evaluate the practicability of isosulphan blue-based lymphatic vessel preservation during open 
varicocelectomy and its impact on the complication rate.
Methods: Two groups of 25 consecutive patients each were randomized. The indications for surgery included 
scrotal pain and fertility problems. All the patients underwent either standard open varicocelectomy using the 
high and the subinguinal approach (group A) and the other group had additional isosulphan blue dyeassisted open varicocelectomy (group B). After surgery, the patients were assessed at 3, 6 and 12 months for 
varicocele recurrence, hydrocele formation, testicular atrophy, pain or other complications.
Results: There were no intraoperative complications. There were no unfavorable reactions, scrotal 
haematomas, wound infection or testicular atrophy. At 3 months after surgery, the incidence of hydrocele in 
group A was 24% whereas in group B no hydroceles were detected (P0.02); at 6 months the 16% still had 
hydroceles. Two patients in group A had varicocele recurrence associated with persistent pain while, in group 
B only one patient had recurrence.
Conclusions: Varicocelectomy using isosulphan blue helps to identify and preserve the testicular lymphatic 
drainage. It prevents secondary hydrocele formation, the most common complication, with no supplementary 
risk to the patient. Also, postoperative testicular oedema can be avoided.