Shunt-Type and Stop-Type Varicocele in Children

Abstract

Purpose Varicocele can be classified into 2 groups of shunt-type and stop-type. In stop-type, only the internal spermatic (testicular) vein is dilated. In shunt-type however, a kind of venous bypass from internal to external spermatic (cremasteric) veins exists which causes dilation of both venous systems. The shunting of venous retrograde flow can predispose patients for larger varicocele. Since varicocele in children may restrict the testicles to grow through puberty and cause irreversible infertility, diagnosis of even subclinical cases and retreatment of recurrent or persistent afflictions seem to be essential. We will introduce the effect of shunt-type varicocele on testicles growth and to evaluate the post-operative recurrence in shunt-type varicocele in children. Material and Methods A total of 29 pediatric patients with mean age of 13 (10-17) and clinical varicocele of grade II and III were further examined by routine scrotal U/S and color Doppler ultrasound. CDU was used as a noninvasive approach to evaluate the shunting of retrograde venous flow from the internal spermatic to external spermatic vein. Results Nineteen patients (65%) had shunt-type varicocele according to CDU findings. Testes volume and size in the shunt-type patients were compared with those with stop-type with regard to the age of the patients. The rate and severity of testicular atrophy was significantly higher in the shunt-type patients. The incidence of post-operative varicocele recurrence (persistence) was also evaluated. The recurrence (persistence) was significantly more common in shunt-type varicocele. Conclusions Color Doppler US provides a noninvasive approach to evaluate the shunting of retrograde venous flow from internal to the external spermatic veins. Understanding the pathophysiology of shunt-type varicocele can light up the way toward better diagnosis, treatment and follow- up the patients.