Evaluation of different methods of varicocelectomy in adolescents
Article published in Urologia Polska 2006/59/3.

authors

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

keywords

spermatic cord, varicocele in adolescent, Palomo procedure, laparoscopy, embolization

summary

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.

references

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correspondence