Microsurgical Varicocele Repair Research Articles

Microsurgical Varicocele Repair on Men with Grade III Lesions and Chronic Dull Scrotal Pain: A Pilot Study

Introduction: The aim of the present study was to evaluate the effectiveness of microsurgical varicocele repair in patients with grade III lesions and chronic dull scrotal pain. Materials and Methods: The study was based on 8 patients with grade III left-sided varicocele and chronic dull scrotal pain for whom a microsurgical subinguinal varicocele repair was performed. The 1-year follow-up included pain assessment and scrotal examination. Results: Of the 8 patients, 7 (88%) reported complete resolution of pain with no palpable varicocele on scrotal examination. No cases of testicular atrophy or hydrocele formation were reported. Conclusion: These results indicated that microsurgical varicocele repair may benefit patients with grade III lesions and chronic dull scrotal pain.

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility.

Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a nonmicrosurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility. A Markov decision-analysis model was developed to estimate costs and pregnancy rates. Within the model, recurrences following MV and NMV were re-treated with PE and recurrences following PE were treated with repeat PE, MV or NMV. Pregnancy and recurrence rates were based on the literature, while costs were obtained from institutional and government supplied data. Univariate and probabilistic sensitivity-analyses were performed to determine the effects of the various parameters on model outcomes. Primary treatment with MV was the most cost-effective strategy at $5402 CAD (Canadian)/pregnancy. Primary treatment with NMV was the least costly approach, but it also yielded the fewest pregnancies. Primary treatment with PE was the least cost-effective strategy costing about $7300 CAD/pregnancy. Probabilistic sensitivity analysis reinforced MV as the most cost-effective strategy at a willingness-to-pay threshold of >$4100 CAD/pregnancy. MV yielded the most pregnancies at acceptable levels of incremental costs. As such, it is the preferred primary treatment strategy for varicocele-associated infertility. Treatment with PE was the least cost-effective approach and, as such, is best used only in cases of surgical failure.

AB61. Advances of surgical treatment in male infertility

Approximately 15% of couples cannot conceive a child after 1 year of regular, unprotected intercourse. Male factor infertility is contributory in another 30% to 40%. Most causes of male infertility are treatable and the goal of many treatments is to restore the ability to conceive naturally. The dramatic recent improvements in the management of male infertility are largely contributable to improved surgical techniques and assisted reproductive technology (ART). Specifically in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) allow us to overcome even the most severe defects in spermatogenesis in which only a few are available.Varicocele repair may be considered as the primary treatment option when a man with a varicocele has suboptimal semen quality and the female partner is normal. varicocele repair can reverse a pathologic condition and halt further damage to testicular function, and improve spermatogenesis. Preferred approaches of most experts are microsurgical inguinal and subinguinal operations. Studies have shown that varicocele repair can improve semen parameters, testicular function and pregnancy rates in couples with male-factor infertility associated with varicocele. Also varicocele repair can result in sperm in the ejaculate of azoospermia men when severe hypospermatogenesis or maturation arrest spermatid stage is present.Obstructive azoospermia may result from epididymal, vasal or ejaculatory duct abnormalities. Microsurgical reconstruction remains the safest and most cost-effective treatment option for these patients (vasovasostomy, vasoepididymostomy). It is controversial that the technique of sperm retrieval (open or percutaneous) or the source of sperm (testicular, epididymal, vasal or seminal vesicular) affects pregnancy rate. Sperm extraction or aspiration for IVF via ICSI is needed in cure of surgically uncorrectable azoospermia or failed microsurgical reconstruction and the majority of patients with congenital bilateral absence of the vas deferens (CBAVD). Also sperm retrieval with IVF/ICSI is preferred to surgical treatment when the advanced female partner age, female infertility requiring IVF.Nonobstructive azoospermia (NOA) is the most challenging type, but no specific treatment was available previously. With advent of ICSI in conjunction with sperm retrieval via testicular sperm extraction (TESE), many of nonobstructive azoospermic patients are able to father own babies. However, 20-50% of NOA patients are not able to have sperm retrieved for ART. Microsurgical TESE is an advanced type of TESE that applies microsurgical techniques. This microsurgical TESE is an effective sperm retrieval from men with NOA for ICSI. The advantages of this technique are minimally invasive technique, removal of minimal amount of testicular tissue and minimalizing negative impact on testicular function. Microsurgical TESE is more effective in men with NOA than conventional TESE.Treatment strategies for male infertility have changed as dramatically over the past decade. These advances are largely contributable to microsurgical varicocele repair, microsurgical reconstructive techniques, and microsurgical techniques for surgical sperm retrieval and ART specifically ICSI.

The use of titanium ligation clips in microsurgical subinguinal varicocelectomy.

The aim of this study is to evaluate the use of titanium ligation clips for dilated spermatic veins in microsurgical subinguinal varicocelectomy. In this retrospective study, eighty-four men with clinical varicocele underwent microsurgical varicocele repair. The patients were divided into two groups according to the ligation materials used for the varicocelectomy (silk sutures vs. titanium clips). Group 1 included 43 patients; these patients underwent microsurgical subinguinal varicocelectomy with the titanium clips. The 41 patients included in Group 2 underwent microsurgical subinguinal varicocelectomy with silk sutures. Microsurgical subinguinal varicocelectomy was performed in all patients. The two study groups were compared in terms of intra-operative and postoperative parameters. The mean age of the patients was 28.6±4.6 years, and the mean follow-up was 12.3±2.7 months. The two groups exhibited comparable improvements in sperm motility and/or concentration: 79.1% and 82.9% in Group 1 and Group 2, respectively (p>0.05). The operation time in Group 1 (titanium clip) was significantly shorter than in Group 2 (silk sutures). None of the patients experienced any intra-operative complications. There were no significant differences between Group 1 and Group 2 with regard to postoperative recurrences, ligated veins, postoperative complications and hydrocele formation, hospitalization time, the requirement for postoperative analgesia or the time until the patient could return to work. Titanium ligation clips can be used for the ligation of dilated vessels during microsurgical subinguinal varicocelectomy, and the operation time is significantly reduced with the use of titanium ligation clips.

The Effect of Microsurgical Varicocelectomy on Semen Parameters in Men with Non-Obstructive Azoospermia

Introduction: The aim of this study was to evaluate the effect of microsurgical subinguinal varicocelectomy on semen parameters in azoospermic men with clinical varicocele and to determine the predictive parameters of postoperative improvement. Methods: Twenty-three men with non-obstructive complete azoospermia and varicocele underwent subinguinal open microsurgical varicocele repair. The outcome was assessed in terms of improvement in semen parameters after surgical repair for varicocelectomy. Results: Bilateral varicocelectomy was performed on 15 patients and unilateral (left) varicocelectomy was performed on 8 patients. In the post-operative period, of the 23 patients, 7 (30.4%) had motile sperm in the ejaculate. The mean sperm concentration of these patients was 1.34 ± 2.6 × 10⁶/ml and the mean total sperm motility was 37.5 ± 15.5%. Conclusion: Infertile men with non-obstructive azospermia can have improvement in semen analysis after subinguinal microsurgical repair of varicoceles. Motile sperm in ejaculate were detected after microsurgical varicocele repair.

Macroscopic and microsurgical varicocelectomy: what’s the intraoperative difference?

Many authors reported that microsurgical varicocelectomy was among the best treatment modalities for varicocele. However, the difference in intraoperative anatomic detail between macroscopic and microsurgical varicocele repair in the same spermatic cord has not been critically discussed. Between August 2010 and February 2011, 32 men with 42 sides' grade 2-3 varicocele were enrolled in this study. One surgeon firstly mimicked the modified open varicocelectomy by identifying, isolating, and marking the presumed internal spermatic veins, lymphatics, and arteries. Another surgeon then checked the same spermatic cord using operating microscope to investigate the number of missed veins, to be ligated lymphatics and arteries in the "imitative" open varicocelectomy. There were significant differences in the average number of internal spermatic arteries (1.67 vs. 0.91), internal spermatic veins (6.45 vs. 4.31), and lymphatics (2.93 vs. 1.17) between microscopic and macroscopic procedure (P < 0.001, P < 0.001, P < 0.001, respectively). Meanwhile, an average of 2.14 ± 1.26 internal spermatic veins was missed; among them, 1.63 ± 1.32 internal spermatic veins adherent to the preserved testicular artery were overlooked. The number of 0.69 ± 0.84 lymphatics and 0.74 ± 0.74 arteries were to be ligated in "macroscopic varicocelectomy." A number of 1.07 ± 1.11 lymphatics were neither identified nor ligated. In addition, in 2 cases, the vasal vessels of the vas deferens were to be ligated at macroscopic procedure. Microsurgical varicocelectomy could preserve more internal spermatic arteries and lymphatic and ligate more veins which may interpret the superiority of microsurgical varicocele repair.

1990 MACROSCOPIC AND MICROSURGICAL VARICOCELECTOMY WHAT'S THE INTRAOPERATIVE DIFFERENCE?

You have accessJournal of UrologyInfertility: Therapy1 Apr 20121990 MACROSCOPIC AND MICROSURGICAL VARICOCELECTOMY WHAT'S THE INTRAOPERATIVE DIFFERENCE? Yan Zhang, Xiaopeng Liu, Hao Zhang, Xingxing Ruan, Hengjun Xiao, Wentao Huang, Liaoyuan Li, and Xin Gao Yan ZhangYan Zhang Guangzhou, China, People's Republic of More articles by this author , Xiaopeng LiuXiaopeng Liu Guangzhou, China, People's Republic of More articles by this author , Hao ZhangHao Zhang Guangzhou, China, People's Republic of More articles by this author , Xingxing RuanXingxing Ruan Guangzhou, China, People's Republic of More articles by this author , Hengjun XiaoHengjun Xiao Guangzhou, China, People's Republic of More articles by this author , Wentao HuangWentao Huang Guangzhou, China, People's Republic of More articles by this author , Liaoyuan LiLiaoyuan Li Guangzhou, China, People's Republic of More articles by this author , and Xin GaoXin Gao Guangzhou, China, People's Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2151AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many authors reported that microsurgical varicocelectomy was among the best treatment modalities for varicocele in term of the spontaneous pregnancy outcomes and complication rates. However, the “cause” or the “mechanism” of the “outcome”, the difference of intraoperative anatomic detail between macroscopic and microsurgical varicocele repair in the same spermatic cord has not been critically discussed. In order to investigate the intraoperative difference, we first mimicked the “traditional open inguinal varicoceletomy” by identifying, isolating and marking but not ligated any vessel and then checked the “results” with operating microscope. METHODS Between August 2010 and February 2011, thirty-two men with forty-two side grade 2-3 varicoceles were included in the study. Among the patients, 21(66%) had scrotal pain, 9(28%) had infertility and both for 2(6%). The modified inguinal varicocelectomy were performed by X.L. (macroscopic technique) and Y.Z. (microsurgical technique) respectively. One doctor (X.L.) mimicked the traditional inguinal open varicocelectomy by identifying and isolating the presumed internal spermatic veins, lymphatic and artery, then marked and encircled them respectively, but the encircled presumed veins was not ligated. Another doctor (Y.Z.) checked the same spermatic cord under 8× to 10×power magnification with operating microscope to investigate how many veins were missed, how many lymphatic and artery were to be ligated because of incorrect identification in the “imitative” open varicocelectomy. RESULTS There were significant differences in the average number of internal spermatic artery (1.67 vs. 0.91), internal spermatic vein (6.45 vs. 4.31) and lymphatic (2.93 vs. 1.17) between microscopic and macroscopic procedure (P<0.001, P<0.001, P<0.001, respectively). Meanwhile, an average of 2.14±1.26 internal spermatic veins were missed, among them 1.63±1.32 internal spermatic veins adherent to the preserved testicular artery were overlooked. The number of 0.69±0.84 lymphatic and 0.74±0.74 arteries was to be ligated in “macroscopic varicocelectomy”. A number of 1.07±1.11 lymphatic were neither identified nor ligated. In addition, in 2 cases the vasal vessels were to be ligated at macroscopic procedure. CONCLUSIONS Microsurgical inguinal varicocelectomy techniques can preserve more internal spermatic artery and lymphatic; ligate more internal spermatic veins which can interpret the mechanism of the superiority of microsurgical technique in the varicocele repair. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e803 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yan Zhang Guangzhou, China, People's Republic of More articles by this author Xiaopeng Liu Guangzhou, China, People's Republic of More articles by this author Hao Zhang Guangzhou, China, People's Republic of More articles by this author Xingxing Ruan Guangzhou, China, People's Republic of More articles by this author Hengjun Xiao Guangzhou, China, People's Republic of More articles by this author Wentao Huang Guangzhou, China, People's Republic of More articles by this author Liaoyuan Li Guangzhou, China, People's Republic of More articles by this author Xin Gao Guangzhou, China, People's Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

BILATERAL MICROSURGICAL VARICOCELE REPAIR VERSUS THE NON-SURGICAL APPROACH FOR MALE-FACTOR INFERTILITY IS ASSOCIATED WITH A HIGHER NATURAL PREGNANCY RATE AND LOWER ART UTILIZATION

You have accessJournal of Urology1 Apr 2009BILATERAL MICROSURGICAL VARICOCELE REPAIR VERSUS THE NON-SURGICAL APPROACH FOR MALE-FACTOR INFERTILITY IS ASSOCIATED WITH A HIGHER NATURAL PREGNANCY RATE AND LOWER ART UTILIZATION Abdulaziz Baazeem, Keith A Jarvi, and Armand Zini Abdulaziz BaazeemAbdulaziz Baazeem More articles by this author , Keith A JarviKeith A Jarvi More articles by this author , and Armand ZiniArmand Zini More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)62042-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "BILATERAL MICROSURGICAL VARICOCELE REPAIR VERSUS THE NON-SURGICAL APPROACH FOR MALE-FACTOR INFERTILITY IS ASSOCIATED WITH A HIGHER NATURAL PREGNANCY RATE AND LOWER ART UTILIZATION." The Journal of Urology, 181(4S), p. 732 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 732 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Abdulaziz Baazeem More articles by this author Keith A Jarvi More articles by this author Armand Zini More articles by this author Expand All Advertisement PDF downloadLoading ...

Use of subinguinal incision for microsurgical testicular biopsy during varicocelectomy in men with nonobstructive azoospermia

To describe a subinguinal technique of microsurgical testicular biopsy performed during subinguinal varicocelectomy in men with nonobstructive azoospermia. Prospective clinical study. Andrology laboratory at tertiary care hospital. Male infertility section, department of urology, at tertiary care hospital. Ten azoospermic men with clinical varicocele. Subinguinal microsurgical testicular biopsy and microsurgical varicocele repair. Safety, feasibility, and effectiveness of subinguinal testicular biopsy during varicocele repair. All testes were easily delivered through the subinguinal incision, and testicular biopsies were successfully performed under microscopic view. After a median follow-up of 9 months, none of the patients had any discomfort, pain, or presented with testicular atrophy. No intraoperative or postoperative complications were observed. There was no incidence of wound infection or scrotal hematoma. The subinguinal approach is a safe and effective option for testicular biopsy during varicocele repair in men with nonobstructive azoospermia. This technique may be an attractive alternative to traditional biopsy because it obviates scrotal violation.

Testicular blood flow measurements and mean resistive index values after microsurgical and high ligation varicocelectomy

Objectives To compare the effects of the two most commonly used surgical methods in the management of varicocele disease, namely, microsurgery and high-ligation varicocelectomy, on testicular blood flow changes and mean residual index values in a prospective randomized study. Methods A total of 56 patients clinically diagnosed with varicocele were randomized into two groups: 28 were selected for high-ligation surgery and 28 for microsurgery. The testicular blood flow was evaluated in all patients before and 7 days after surgery, and the maximal flow velocity (Vmax), minimal flow velocity, and resistive index were measured. The data assessment was performed using the paired t test, and independent t test was used in comparison of the two groups. Results No significant difference was detected between the preoperative resistive index, Vmax, and minimal flow velocity of the two groups. The values of the same parameters measured 7 days postoperatively were also not significantly different. The preoperative and postoperative comparison of the three parameters within the microsurgery group revealed no difference, although the postoperative Vmax was significantly lower than the preoperative Vmax in the high-ligation group. Conclusions Our data have shown that no significant impairment in testicular circulation results after low microsurgical varicocele repair compared with high ligation.

Optimizing the Outcome of Microsurgical Subinguinal Varicocelectomy Using Isosulfan Blue: A Prospective Randomized Trial

Varicoceles are the main cause of correctible male factor infertility. Loss of testicular volume and abnormal seminal parameters are indications for varicocelectomy. We assessed a prospective randomized trial comparing standard microsurgical varicocele repair with the microsurgical approach using isosulfan blue. We determined if the use of isosulfan blue reduces the incidence of postoperative hydroceles following microsurgical varicocele repair. Two groups of 25 consecutive patients each were randomized. Indications for surgery included fertility problems as well as scrotal pain and difference in testicular size. All patients underwent microsurgical repair using the subinguinal approach. Patients in group 1 underwent standard microsurgery. Those in group 2 had additional isosulfan blue administration. All were investigated 3 and 6 months postoperatively regarding varicocele recurrence, hydrocele, atrophy, pain or other complications. There were no intraoperative complications. At 3 months postoperatively the incidence of hydrocele in group 1 was 20% decreasing to 16% at 6 months, whereas in group 2 no hydrocele was detectable. There were 2 patients in each group who reported ongoing pain, and 1 in each presented with recurrent varicocele. No atrophy was seen. In 1 patient blue pigmentation of the left hemiscrotum was seen at 3 months but vanished at 6 months. Microsurgical repair of varicoceles using isosulfan blue helps in identifying and preserving the lymphatic drainage. It prevents postoperative hydrocele, the most common postoperative complication, without any supplementary risk to the patient. Additionally, testicular edema causing impaired spermatogenesis can be avoided.

Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology

Analyze whether testicular histologic patterns from a group of azoospermic men with varicocele is predictive of treatment outcome after subinguinal microsurgical varicocele repair. Seventeen azoospermic men underwent bilateral open single testis biopsy and microsurgical subinguinal repair of clinical varicoceles. Histopathology of testicular biopsies revealed hypospermatogenesis (HYPO) in 6 men, maturation arrest (MA) in 5, and Sertoli cell-only (SCO) in 6. Overall, presence of spermatozoa in the ejaculates was achieved in 47% (8/17) of men after varicocele repair, but only 35% (6/17) of them had motile sperm in their ejaculates. Only men with testicular histology revealing HYPO (5/6) or maturation arrest (3/5) had improvement after surgery. Median (25%-75% percentile) postoperative motile sperm count for both groups were 0.9 x 10(6)/mL (0.1-1.8 x 10(6)/mL) and 0.7 x 10(6)/mL (0.1-1.1), respectively (p = 0.87). The mean time for appearance of spermatozoa in the ejaculates was 5 months (3 to 9 months). One (HYPO) of 8 (12.5%) men who improved after surgery contributed to an unassisted pregnancy. Postoperative testicular biopsies obtained from patients who had no improvement after surgery revealed that testicular histology diagnosis remained unchanged. Successful testicular sperm retrieval for intracytoplasmic sperm injection (ICSI) was achieved in 4 of 9 (44.4%) individuals who did not improve after surgery, including 1 man with testicular histology exhibiting SCO. Microsurgical varicocele repair in nonobstructive azoospermic men with clinical varicoceles can result in sperm appearance in the ejaculate when hypospermatogenesis or maturation arrest is found on testicular histology diagnosis.

ADOLESCENT VARICOCELE REPAIR: LONG-TERM RESULTS AND COMPARISON OF SURGICAL TECHNIQUES ACCORDING TO OPTICAL MAGNIFICATION USE IN 100 CASES AT A SINGLE UNIVERSITY HOSPITAL

We review the long-term results of varicocele repair, and compare the complication rates of varicocelectomy techniques according to optical magnification use in adolescents with varicocele at a single university hospital. We prospectively studied 100 males 7 to 19 years old with clinical palpable varicocele. Of the patients 52 (52%) underwent left unilateral varicocelectomy and 48 (48%) underwent bilateral varicocelectomy. Varicocelectomy was performed using a microscope in 49 patients (79 sites), loupe magnification in 25 (35 sites) and no magnification in 26 (34 sites) using either a subinguinal or inguinal approach. Postoperative complications were compared in all patients based on technique. Preoperative and postoperative serum hormone values and semen parameters were compared in 33 patients. Mean postoperative followup was 30.4 +/- 13.06 months (12 to 65). Total motile sperm count increased from 22.6 million +/- 5.16 million to 64.53 million +/- 12.3 million postoperatively, which was statistically significant (p = 0.002). Postoperative recurrence rates were 0% in cases managed by microsurgical varicocelectomy, 2.9% in those where loupe magnification was used and 8.8% in those where no magnification was used. Postoperative hydrocele rates in these cases were 0%, 2.9% and 5.9%, respectively. The highest rates of recurrence and hydrocele were observed in cases where no magnification was used, compared to those managed by microsurgery (p = 0.03 and p = 0.116, respectively). Adolescent varicocele repair improves semen parameters and is a safe method with low recurrence and low complication rates. Our study suggests that the postoperative complication rate significantly decreases with use of higher magnification, such as microscopy. Microsurgical varicocele repair is the best technique with the lowest postoperative rates of recurrence and hydrocele in the treatment of adolescent varicoceles.

1589: Post-Operative Venous Flow Patterns by Testicular Color Duplex Doppler after Microsurgical Varicocele Repair

1589: Post-Operative Venous Flow Patterns by Testicular Color Duplex Doppler after Microsurgical Varicocele Repair

Post-operative venous flow patterns by testicular color duplex doppler after microsurgical varicocele repair

Objective: Many surgeons are utilizing testicular color duplex Doppler in the evaluation of male infertility. The presence of varicoceles in infertile men has been reported to be as high as 65% by ultrasound. Post-operative flow patterns have not been reported. We undertook a study to examine post-operative venous flow patterns in patients who underwent microsurgical varicocelectomies.

COMPLICATION RATE OF MICROSURGICAL VARICOCELE LIGATION WITHOUT DELIVERY OF THE TESTIS

It is commonly assumed that the complication rate of microsurgical varicocele repair is lower than that of nonmicrosurgical techniques, particularly since magnification allows for preservation of lymphatic vessels and, thus, a theoretically lower incidence of hydrocele. However, review of the literature reveals relatively few papers on this subject. The authors reviewed their experience to determine the incidence of complications following microsurgical varicocele repair without delivery of the testicle in the adult population. From 1 July 1997 to 1 September 2001 139 men underwent microsurgical varicocele ligation without delivery of the testicle, with a mean follow-up of 22 months. Of the 139 men, 4 (2.9%) had complications. One (0.7%) had a recurrence, 1 (0.7%) had a wound infection, 1 (0.7%) had epididymitis, and 1 (0.7%) had an unintentional injury of the testicular artery. None of the men developed a hydrocele. The published complication rate for nonmicrosurgical varicocle ligation ranges from 5.4 to 7.2%, with the most common complication being hydrocele formation. In the authors' series, the overall complication rate was 2.9%, with no patient developing a hydrocele. Thus, microsurgical varicocele ligation without delivery of the testicle results in a lower complication rate and a lower incidence of hydrocele than nonmicrosurgical techniques.

Complication rate of microsurgical varicocele ligation without delivery of the testis.

It is commonly assumed that the complication rate of microsurgical varicocele repair is lower than that of nonmicrosurgical techniques, particularly since magnification allows for preservation of lymphatic vessels and, thus, a theoretically lower incidence of hydrocele. However, review of the literature reveals relatively few papers on this subject. The authors reviewed their experience to determine the incidence of complications following microsurgical varicocele repair without delivery of the testicle in the adult population. From 1 July 1997 to 1 September 2001 139 men underwent microsurgical varicocele ligation without delivery of the testicle, with a mean follow-up of 22 months. Of the 139 men, 4 (2.9%) had complications. One (0.7%) had a recurrence, 1 (0.7%) had a wound infection, 1 (0.7%) had epididymitis, and 1 (0.7%) had an unintentional injury of the testicular artery. None of the men developed a hydrocele. The published complication rate for nonmicrosurgical varicocle ligation ranges from 5.4 to 7.2%, with the most common complication being hydrocele formation. In the authors' series, the overall complication rate was 2.9%, with no patient developing a hydrocele. Thus, microsurgical varicocele ligation without delivery of the testicle results in a lower complication rate and a lower incidence of hydrocele than nonmicrosurgical techniques.

Multivariate analysis of parameters that predict response to microsurgical varicocele repair.

Multivariate analysis of parameters that predict response to microsurgical varicocele repair.

THE ADOLESCENT VARICOCELE I: LEFT TESTICULAR HYPERTROPHY FOLLOWING VARICOCELECTOMY

Ipsilateral testicular catch-up growth has been reported to occur in approximately 80% of adolescents with varicoceles following unilateral varicocelectomy. We have been observing not only catch-up growth, but hypertrophy (left at least 10% larger than right testicular volume) in some adolescents postoperatively. To our knowledge this phenomenon has not been previously described. We assess the incidence of left testicular hypertrophy following ipsilateral varicocele ligation and whether it is related to age at operation and/or procedure performed. We reviewed the records of 42 patients who underwent unilateral left varicocelectomy for asymptomatic varicoceles. Testicular volume was determined before and after surgery, and all patients were followed for a minimum of 6 months. Indication for surgery was ipsilateral left testicular hypotrophy in 23 cases, grade 2 to 3 varicocele with palpably softer ipsilateral left testicle in 5, grade 3+ varicoceles in 12, an exaggerated response to gonadotropin-releasing hormone stimulation test in 1 and persistent pain in 1. Average patient age at operation was 14.7 years (range 9 to 22) and average followup was 22 months (range 6 to 84). Patients were stratified according to Palomo versus modified Ivanissevich technique and age at operation. Testes were measured using the Takihara ring orchidometer with relative volume of the left testis expressed as a percentage of the right testis. Results were compared in different age groups as well as by procedure performed to correct the varicocele using chi-square analysis. Left testicular hypertrophy developed in 13 of 32 patients (43.8%) who underwent a Palomo repair and in 3 of the 10 (30%) who underwent a modified Ivanissevich repair. When compared by age at operation, 8 of 20 patients (40%) 14.7 years old or younger had left testicular hypertrophy compared to 8 of 22 (36.4%) older than 14.7 years. Differences between these groups were not statistically significant. Ipsilateral testicular hypertrophy occurs in a substantial number of adolescents following varicocele ligation. This phenomenon does not seem to be dependent on age at surgery or type of varicocele repair.