Kinga Kowalczyk 1, Piotr Gastoł 1, Małgorzata Baka-Ostrowska 1, Marek Pędich 2
- 1 Klinika Urologii Dziecięcej, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie
2 Zakład Diagnostyki Obrazowej, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie
spermatic cord, varicocele in adolescent, Palomo procedure, laparoscopy, embolization
- Introduction. The main aim of surgical management of varicocele in adolescents is to prevent degenerative changes of the testes and consequently fertility in adulthood.
- Objective. To compare the outcome of different treatment methods: classic Palomo, retroperitoneal mass ligation, high retroperitoneal ligation with artery-sparing procedure, laparoscopic varicocelectomy and retrograde embolization.
- Material and methods. Between 1990 and 2004, 255 patients (age 10 - 18) underwent different procedures of varicocelectomy. They were diagnosed with physical examination and Doppler ultrasound. The criteria for surgery were: varicocele, grade II or III (according to Dubbing and Amelar) with \"scrotum discomfort\", testicular volume loss and/or change in consistency. 154 patients were treated with classic Palomo procedure, 26 with artery-sparing high retroperitoneal procedure, 50 laparoscopic varicocelectomy and 25 retrograde embolization.
- Results. In the group of 154 patients who underwent classic Palomo procedure, reoperation was necessary in 3 cases (2%), but recurrent grade I varicocele was found in 28 cases (18%). After artery-sparing procedure reoperation was performed in 5 cases (19%), recurrent grade I varicocele was found in 3 cases (12%). None of the patients operated laparoscopically required reoperation and grade I varicocele occurred in 4 (8%). Reoperation was necessary in 6 cases (24%) after embolization and grade I varicocele was confirmed in 7 cases (28%).
- Conclusions. The classic Palomo procedure turns out to be a little less efficient (2% reoperations) than laparoscopic varicocelectomy (0% reoperations). With the former technique greater percentage of recurrent grade I varicocele (18%) was observed in comparison to the laparoscopic method (8%). Preservation of testicular artery, in the classic surgical technique, increased the rate of reoperation by 17% and formation of hydrocoele to 18%. Occurrence of hydrocoele after laparoscopic method was more frequent (by 8%) than after classic Palomo technique. After retrograde embolization high rate of 24% of recurrence was observed. Unfavorable anatomical conditions identified in phlebography of testicular veins made embolization impossible in 19% of patients.
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