Varicocele surgery: a decade’s experience at a children’s hospital

Abstract

used by eight different urology faculty members. Microsurgery and attempted artery-sparing were applied to some Palomo, Ivannisevich, and subinguinal cases but not to laparoscopic procedures. RESULTSThe laparoscopic (100%) and Palomo (93%) techniques had significantly higher success rates than the Ivanissevich approach (69%). The success rate with the subinguinal technique (88%) was intermediate between the more successful supra-inguinal and less successful inguinal approaches. There was a higher hydrocele rate (32%) in the laparoscopic approach. Artery sparing significantly lowered hydrocele rates but had no effect on success rates. Incorporating microsurgery also had no effect on success rates but resulted in no hydrocele formation. One case of testicular atrophy occurred in a patient undergoing microsurgical arterysparing subinguinal spermatic vein ligation. There was compensatory growth in 68% of patients operated on for testicular hypotrophy. CONCLUSIONSDuring our 10-year experience the laparoscopic and Palomo approaches were the most successful. The subinguinal approach (usually incorporating microsurgery and artery sparing) had an intermediate success rate. The Ivanissevich approach was least successful. Hydroceles did not occur when microsurgery was used, and were significantly less common with artery sparing. The only case of testicular atrophy was with a microsurgical arterysparing subinguinal approach. When the spermatic vein was ligated for testicular hypotrophy there was compensatory growth in two-thirds of testes. OBJECTIVESTo review our experience at a children's hospital over a 10-year period with the Palomo, Ivanissevich, subinguinal and laparoscopic techniques for varicocele, assessing the success and complication rates according to specific procedure, and the added effect that the modifications of microsurgery and artery-sparing has had on these rates. A second objective was to assess the rate of testicular compensatory growth after surgery for testicular hypotrophy. PATIENTS AND METHODSNinety-two patients with > 1 year of followup between 1996 and 2006 were assessed retrospectively. The median (range) age at surgery was 15 (8-21) years. Patients were stratified based on the surgical technique

Idiopathic Varicocele in Adolescents: Risks of the Inguinal Approach

“…One case of complete testicular atrophy has also been described after microsurgical subinguinal vein ligation. 17 Radiological embolization, therefore, seems to be an interesting technique in children. Although embolization is less reliable than surgical ligation, 18,19 with a success rate ranging from 74 to 95%, no testicular atrophy has been described after radiological embolization.…”

Best practice in the diagnosis and treatment of varicocele in children and adolescents

“…In this report, one case of testicular atrophy occurred in the microsurgical group out of 16 total cases. 42 The microsurgical subinguinal and high inguinal approaches have been shown to have similar success rates in terms of testicular growth (70% and 78%, respectively). The high inguinal approach is typically associated with a significantly shorter length of surgery as it requires fewer divisions of veins and is associated with a larger diameter of the internal spermatic arteries, making them easier to identify and preserve.…”

Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele

“…3,4 Data regarding microsurgical subinguinal and inguinal adolescent varicocelectomy are limited. [5][6][7][8][9][10][11][12][13] However, the associated testicular growth is good, and the complication rates for varicocele (persistent/recurrent) and scrotal hydrocele are low (0.8% and 1.1%, respectively). Notably, many urologists are reluctant to use a microscope, and just 30% of pediatric urologists opt to use one during varicocele surgery.…”