Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery vs Scrotal Antegrade Sclerotherapy in Adolescent Varicocele

Abstract

Purpose:Varicocele is a common condition in adolescence and the most common correctable cause of infertility. This study aimed to analyze and compare the outcomes of scrotal antegrade sclerotherapy and laparoscopic Palomo surgery in a tertiary referral center.Materials and Methods:Patients with left grade 3 varicocele indicated for surgery were prospectively enrolled and randomly allocated to the scrotal antegrade sclerotherapy and laparoscopic Palomo surgery groups, with their respective contralateral normal testes taken as controls. The primary outcome measures were clinical varicocele recurrence, testicular catch-up growth, and postoperative hydrocele. All patients were evaluated clinically and using Doppler ultrasound by radiologists.Results:From 2015 to 2020, 113 patients completed the study and were statistically analyzed (scrotal antegrade sclerotherapy, n = 57; laparoscopic Palomo surgery, n = 56). All patients had significantly smaller testes preoperatively; the testicular volume differences with control testes were −23% in scrotal antegrade sclerotherapy and −19% in laparoscopic Palomo surgery. At 12-month follow-up, there were no statistically significant differences in clinical recurrences between the 2 groups (scrotal antegrade sclerotherapy = 5.3% vs laparoscopic Palomo surgery = 5.4%, P > .05, noninferiority test). Testicular catch-up growths were observed in both groups; the mean testicular volume difference between the treatment and control testes decreased from −23% to −8.1% in scrotal antegrade sclerotherapy (P < .001) and from −19% to −9.3% in laparoscopic Palomo surgery (P < .001) at 12-month follow-up. There was no postoperative hydrocele in the scrotal antegrade sclerotherapy group compared to 7 cases in the laparoscopic Palomo surgery group (0% vs 13%, P = .006).Conclusions:Both scrotal antegrade sclerotherapy and laparoscopic Palomo surgery are safe and effective procedures for treatment of adolescent varicocele with significant positive effect on testicular catch-up growth. Scrotal antegrade sclerotherapy is not inferior to laparoscopic Palomo surgery in terms of clinical recurrence rate and has significantly less postoperative hydrocele.

This Month in Pediatric Urology

“…Chung et al (page 600) from Hong Kong described their prospective randomized controlled trial comparing scrotal antegrade sclerotherapy vs a laparoscopic Palomo approach. 2 The primary outcomes were clinical recurrence, catch-up growth, and postoperative hydrocele formation. They enrolled 113 patients and found no differences at 12 months for recurrence.…”

Round up

“…Patients with left Grade-3 varicocele indicated for surgery were prospectively enrolled, with their respective contralateral normal testes taken as controls. [ 14 ] Patients undergoing scrotal antegrade sclerotherapy (SAS, n = 57) and laparoscopic Palomo surgery (LPS, n = 56) were enrolled. At the 12-month follow-up, there was no statistically significant difference in clinical recurrences between the two groups (SAS = 5.3% vs. LPS = 5.4%, P > 0.05, noninferiority test).…”

Laparoscopic vs Sclerotherapy for Varicoceles: Who Prevails?

“…In this issue of The Journal, Chung et al (page 600) report their outcomes in a much-needed randomized controlled trial assessing surgical techniques for adolescent varicoceles. 3 The authors present us with an appropriately powered, unbiased, and well-executed study. While the scrotal antegrade sclerotherapy (SAS) approach has been previously discussed by Tauber and Johnsen, 4 and Mazzoni et al, 5 this is the first report supporting the technique against laparoscopic Palomo surgery.…”

“…These data by Chung et al suggest that SAS can be safely offered to those patients who seek equivalent outcomes without the need for laparoscopic incisions that may cause pain or physical activity limitations. 3 This may also serve as a primary method of treatment since some centers only consider sclerotherapy after failed surgical intervention. However, now with microsurgical varicocelectomy as the gold standard for urologists treating adult men with varicoceles, 7 it is unclear how SAS compares to this standard in adolescent boys.…”

“…This study did not report outcomes beyond 1 year post-therapy. 3 Nonetheless, it is unlikely that any new hydrocele formed after SAS would require therapy, based on their outcomes thus far.…”