The Surgical Difficulty of Microsurgical Subinguinal Varicocelectomy is Similar Regardless of Age

Abstract

The reason for the low popularity of microsurgical subinguinal varicocelectomy in children has not been thoroughly explored. We investigated whether the lower popularity of microsurgical subinguinal varicocelectomy in children could be due to surgical difficulty. Therefore, we prospectively conducted a comparison of microsurgical subinguinal varicocelectomy in adults and children. This study enrolled 93 male patients (62 children and 31 adults). During microsurgical subinguinal varicocelectomy with testicular delivery the number of internal spermatic, external spermatic, gubernacular and lymphatic vessels was systematically counted. In addition, the difficulty of separating the main internal spermatic artery from the internal spermatic veins was qualitatively graded. These variables were compared between adults and children, and the same comparison was conducted with regard to pubertal status. A multiple linear regression model was used to determine the factors affecting operative time, a surrogate marker for surgical difficulty. Comparison revealed a significantly longer operative time and a greater number of vessels involved in all venous systems in adults. With the exception of the gubernacular vein, which began to enlarge during puberty, an increased number of all venous systems was found after puberty. Regarding the difficulty of separation, no difference was noted based on age. Operative time was significantly affected by the number of ligated external spermatic and internal spermatic veins as well as the difficulty of the separation. These results indicated that the surgical difficulty of microsurgical subinguinal varicocelectomy was similar between adults and children. The lack of gubernacular vein enlargement in prepubertal boys may suggest the sparing of testicular delivery in this population.