Idiopathic Varicocele in Adolescents: Risks of the Inguinal Approach

Abstract

Introduction The aim of this study was to evaluate the medium-term results and complications of open inguinal varicocelectomy, including vein ligation, intraoperative venography, and antegrade sclerotherapy.

Materials and Methods Sixty-four children were treated between 2000 and 2009 for idiopathic varicocele. Fifty children were examined 6 months after surgery. In 2010, 22 patients were recalled for testicular ultrasound scans (US) to evaluate the medium-term results of the technique.

Results The mean age of the children was 12.8 years at first consultation. Of the 50 cases, 35 children were asymptomatic, 13 experienced pain, 3 suffered from discomfort, and 1 had testicular asymmetry. Thirteen children had delayed left testicular growth compared with the right testis. The mean age at surgery was 13.3 years, and follow-up duration was 8.3 months ± 13.9. Thirty-eight patients achieved good results postsurgery; there was varicocele recurrence in 3, testicular hypotrophy in 7, and complete testicular atrophy in 2 patients.

Conclusion Naked eye inguinal surgical ligation does not appear to be safe enough to treat young adolescents, with the theoretical risk of a decrease in fertility in the future. In teams which are untrained in microsurgical or laparoscopic varicocelectomy, we suggest referring adolescent patients to a radiologist for embolization.

Keywords

varicocele - adolescents - inguinal approach - peroperative phlebography

• References

• 1 Fontaine E, Benoit G, Jardin A, Beurton D. La varicocèle de l'adolescent. Prog Urol 2000; 10 (6) 1099-1107
• 2 Salzhauer EW, Sokol A, Glassberg KI. Paternity after adolescent varicocele repair. Pediatrics 2004; 114 (6) 1631-1633
• 3 Glassberg KI, Korets R. Update on the management of adolescent varicocele. F1000 Med Rep 2010; 2: 25
• 4 Bertschy C, Liard A, Bawab F, Bachy B, Le Dosseur P, Mitrofanoff P. Idiopathic varicocele in children and adolescents—which therapeutic choice?. Eur J Pediatr Surg 1997; 7 (6) 341-344
• 5 Zucchi A, Mearini L, Mearini E, Fioretti F, Bini V, Porena M. Varicocele and fertility: relationship between testicular volume and seminal parameters before and after treatment. J Androl 2006; 27 (4) 548-551
• 6 Haans LC, Laven JS, Mali WP, te Velde ER, Wensing CJ. Testis volumes, semen quality, and hormonal patterns in adolescents with and without a varicocele. Fertil Steril 1991; 56 (4) 731-736
• 7 Diamond DA, Zurakowski D, Bauer SB , et al. Relationship of varicocele grade and testicular hypotrophy to semen parameters in adolescents. J Urol 2007; 178 (4 Pt 2) 1584-1588
• 8 Papanikolaou F, Chow V, Jarvi K, Fong B, Ho M, Zini A. Effect of adult microsurgical varicocelectomy on testicular volume. Urology 2000; 56 (1) 136-139
• 9 Kass EJ, Belman AB. Reversal of testicular growth failure by varicocele ligation. J Urol 1987; 137 (3) 475-476
• 10 Gershbein AB, Horowitz M, Glassberg KI. The adolescent varicocele I: left testicular hypertrophy following varicocelectomy. J Urol 1999; 162 (4) 1447-1449
• 11 Ayechu-Díaz A, Oscoz-Lizarbe M, Pérez-Martínez A, Pisón-Chacón J, Esparza J, Bento L. [Treatment of adolescent varicocele: is percutaneous embolization better?]. Cir Pediatr 2009; 22 (3) 134-138
• 12 Storm DW, Hogan MJ, Jayanthi VR. Initial experience with percutaneous selective embolization: A truly minimally invasive treatment of the adolescent varicocele with no risk of hydrocele development. J Pediatr Urol 2010; 6 (6) 567-571
• 13 Atassi O, Kass EJ, Steinert BW. Testicular growth after successful varicocele correction in adolescents: comparison of artery sparing techniques with the Palomo procedure. J Urol 1995; 153 (2) 482-483
• 14 Cohen RC. Laparoscopic varicocelectomy with preservation of the testicular artery in adolescents. J Pediatr Surg 2001; 36 (2) 394-396
• 15 Cayan S, Shavakhabov S, Kadioğlu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl 2009; 30 (1) 33-40
• 16 Kalkan M, Yalcinkaya S, Etlik O, Sahin C. Is microsurgery necessary in grade 3 varicocele?. Urol J 2011; 8 (4) 298-301
• 17 Diamond DA, Xuewu J, Cilento Jr BG , et al. Varicocele surgery: a decade's experience at a children's hospital. BJU Int 2009; 104 (2) 246-249
• 18 Piñera JG, Fernández-Córdoba MS, Anselmi EH , et al. [Results of the percutaneous retrograde embolization as the first choice in the treatment of varicocele]. Cir Pediatr 2009; 22 (3) 128-133
• 19 Granata C, Oddone M, Toma P, Mattioli G. Retrograde percutaneous sclerotherapy of left idiopathic varicocele in children: results and follow-up. Pediatr Surg Int 2008; 24 (5) 583-587