Testicular catch-up growth after varicocele correction in adolescents

Abstract

We evaluated retrospectively the outcome of artery-sparing (AS) versus non-artery-sparing (NAS) laparoscopic varicocelectomy and measured any reversal of testicular growth. Twenty patients (13 left and 7 bilateral varicoceles) were evaluated after surgery. A total of 27 varicocelectomies (20 AS and 7 NAS) were performed. The indication for surgery was smaller testicular size on the affected side in all patients and discomfort/pain in 3. The mean age was 12.9 years (range 8-15 years) at surgery. The testicular volumes were determined clinically and by color Doppler sonography (US). The follow-up time was 6-48 months after surgery. There were 4 recurrences out of 27 varicocelectomies (15%), of which 1 has been reoperated. Testicular volumes were equal in both groups after surgery, indicating catch-up growth except in the cases with minor recurrences (2 AS and 2 NAS varicocelectomies). In 12 testes, dilated veins in the pampiniform plexus were revealed by US. No severe intraoperative complications occurred. Three patients had a hydrocele after surgery (11%). These data show that there is testicular catch-up growth after varicocelectomy, but some questions remain unanswered: (1) should the remaining dilated veins detected by Doppler US be tackled; and (2) is an AS operation worthwhile?

The Impact of Internal Spermatic Artery Ligation during Laparoscopic Varicocelectomy on Recurrence Rate and Short Post Operative Outcome

“…Lymphatic obstruction at time of surgery has always been attributed to be the causative factor and attempts to preserve the lymphatic vessels during microsurgical varicocelectomy have resulted in a drop of hydrocele formation to less than 1% (13). On the other hand, Lund et al (14), when comparing the outcome of artery sparing versus non-artery sparing laparoscopic varicocelectomy had an incidence of hydrocele formation in 15% and 0% respectively although complete obliteration of lympatic is expected to occur in the non-artery sparing group.…”

The prevalence of varicocele and varicocele‐related testicular atrophy in Turkish children and adolescents

“…In these studies it was recommended that as varicocele is a progressive disease, it should be treated at an early age, because the testis is still developing [7,8]. In 50±75% of teenagers with varicocele the testicular volume on the affected side was smaller in adolescence [6,9±11].…”

Lymphatic sparing laparoscopic Palomo varicocelectomy for varicoceles in children: intermediate results

“…This method has resulted in a significant decrease in the operative failure rate compared with the artery-sparing procedures, with no increase in the incidence of testicular atrophy [12,13]. However, postoperatively, hydroceles are a potential problem with the standard Palomo procedure because no attempt is made to preserve the lymphatic vessels [14]. Therefore, lymphatic sparing procedures have been reconsidered during varicocelectomy.…”