‘Preemptive Hydrocelectomy’ in Subinguinal Varicocelectomy

Abstract

Background/Aims: The hydrocele rate is very low after microsurgical subinguinal varicocelectomy, but microsurgical expertise is not always available in pediatric centers. We describe a modified technique to reduce the hydrocele rate after subinguinal varicocelectomy performed without an operating microscope. Methods: A retrospective review was performed of 142 non-microsurgical subinguinal varicocelectomies performed at a single pediatric center. In 96 patients, varicocelectomy was combined with the excision and eversion of the tunica vaginalis (‘pre-emptive hydrocelectomy’) while in the remaining 46 cases the vaginalis was left untouched. Results: Pre-emptive hydrocelectomy allowed a significant reduction in the hydrocele rate in comparison to cases in whom the vaginalis was left untouched, hydrocele rate 4.3 vs. 13% (p = 0.04). In patients undergoing preemptive hydrocelectomy, hydrocele occurred in 3 of 54 (5.5%) cases in whom the vaginalis was only excised and only 1 of 42 (2.4%) in whom it was also everted. No testicular complications were observed. Conclusions: In centers performing subinguinal varicocelectomy without the aid of an operating microscope, preemptive hydrocelectomy with eversion of the vaginalis might be offered as an adjunctive treatment with limited associated morbidity that might be able to reduce the incidence of postoperative hydrocele.

Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel

“…were between 86% and 100% [26,93]. Following laparoscopic varicocelectomy, it was reported between 77% and 100% [20,31], whereas following open varicocelectomy (subinguinal, inguinal, Palomo, microscopic, etc) it was between 62.8% and 97.1% [36,68] reported in six case series. In NRSs, it was demonstrated that all parameters were increased after interventional, microscopic, and laparoscopic treatments [26,47,48,58,61,62], with a mean follow-up between 17.6 mo and 10.6 yr.…”

Avoidance of hydrocele after non microsurgical varicocelectomy by pre-emptive eversion of tunica vaginalis in infertile men with varicocele

“…This result came in accordance to Castagnetti et al who compared 96 cases of subinguinal varicocelectomy plus pre-emptive hydrocelectomy with 46 patients who underwent subinguinal varicocelectomy alone. [19][20][21] The rate of postoperative hydrocele was statistically lower in those who received a pre-emptive hydrocelectomy (4.2% versus 13%; P = 0.04). Pre-emptive surgery can consist of vaginalis excision only or excision and eversion.…”

“…4 All approaches to varicocele surgery are associated with a small risk of wound infection, hydrocele, persistence or recurrence of varicocele and, rarely, testicular atrophy. 5 In non-microsurgical varicocelectomy hydrocele is the most common complication and it affects about 20% of patients secondary to ligation of testicular lymphatics. 6 Several surgical techniques have been done to reduce the incidence of post-varicocelectomy hydrocele which is somewhat difficult to be done.…”

Treatment of varicocele in children and adolescents: A systematic review and meta-analysis from European Association of Urology/European Society for Paediatric Urology Guidelines Panel

“…were between 86% and 100% [26,93]. Following laparoscopic varicocelectomy, it was reported between 77% and 100% [20,31], whereas following open varicocelectomy (subinguinal, inguinal, Palomo, microscopic, etc) it was between 62.8% and 97.1% [36,68] [ ( F i g . _ 4 ) T D $ F I G ] reported in six case series.…”