Testicular Size And Catch-Up Growth After Lymphatic-Sparing And Lymphatic Non-Sparing Varicocele Repair In Children And Adolescents

Abstract

PURPOSE To study the testicular growth in relation to the pubertal stage and to the preservation of the lymphatic vessels. MATERIAL AND METHODS 174 children and adolescents with primary unilateral grade II-III varicocele were prospectively studied between 1997 and 2007. Laparoscopic high ligation was used in 37 patients (pubertal stage-PS 2.6) (LNSgroup). Microsurgical repair (both laparoscopic and microscopic) was used in 137 patients (PS 3.3) (LSgroup). Testicular size was assessed by ultrasound. RESULTS Before repair, mean left testicular size (LTS) was 7.2cc; atrophy index (AI) 19.7% and difference in testicular size (DTS) 1,7cc in LS group, and 5.4 cc, 21.1% and 1,4cc in LNS group, resp. After follow-up of 2.1 y in LS and 3.7 y in LNS group, the LTS reached 12.2cc; AI 11.2% and DTS 1.3cc in LS group and 16.3cc; -6.8% and -0.9cc in LNS group, resp. Similar highly significant differences were found in each pubertal stage, as well as in 104 patients older than 17 years. In these patients, testicular hypoplasia was detected in 41 (51.2%) before and in 26 (33.3%) at follow-up in LS group, in 14 (51.9 %) and 4 (14.8%) in LNS group, resp; testicular hypertrophy in 2 (2.6%) and 7 (25.9%) in LS and LNS group, respectively. CONCLUSIONS After lymphatic non-sparing repair, higher increase in testicular size has been found in all pubertal stages, exceeding mostly the size of the right testis and reflecting the intratesticular oedema. Real catch-up growth can be assessed in microsurgical lymphatic-sparing repairs only, absolute differences between the both testes remain in most patients.