Microsurgical subinguinal varicocelectomy in children and adolescents. Modified technique with lymphatic vessel contrast enhancement

Abstract

A varicocele is one of the most common causes of spermatogenesis and infertility disorders, which can be corrected. With the advent of high-quality optical operating systems, subinguinal microsurgical varicocelectomy has been added to the pediatric urologist’s arsenal. One of the most unresolved problems of using this operation in children is postoperative hydrocele and possible damage to the testicular artery due to its small size, which leads to testicular atrophy. To solve this problem, lymphatic vessel contrast with 1% methylene blue was used to verify lymphatic vessels and indirectly visualize the testicular artery. Purpose - to develop a modified technique of microsurgical subinguinal varicocelectomy with intraoperative contrast of lymphatic vessels in children; to evaluate the results of surgical treatment of varicocele using this technique. Materials and methods. The study included 65 boys aged 11 to 17 years with a confirmed diagnosis of grade III varicocele and recurrent testicular pain or testicular hypotrophy. Patients were randomized into 2 clinical groups for classical or modified varicocelectomy. The success of treatment was evaluated after 6 months. The Group I included 34 patients who underwent classical subinguinal microsurgical varicocelectomy; the Group II included 31 patients who underwent modified surgery. Results. No cases of complications and recurrence of the disease in the late postoperative period were recorded in the group using the modified technique, while in the group with the standard technique, such cases were detected in 17.6% of patients. In addition, it was found that intraoperative contrasting of lymphatic vessels made it possible to clearly identify the testicular artery in all cases in the group with the modified technique, while in the group with the standard technique it was visualized only in half of the cases. No intraoperative complications, hypersensitivity, or allergies were noted during the operation. Conclusions. A modified varicocele treatment with intraoperative lymphatic vessel contrast may be more effective and safe for patients with this disease due to vein visualization, as the artery and ductus deferens remain the only unchanged structures due to the use of a compression test and lymphatic vessel contrast. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent was obtained from the patients for the research. No conflict of interests was declared by the authors.