Varicocelectomy with primary gubernaculum veins closure: A randomised clinical trial

To evaluate the effect of microsurgical inguinal varicocelectomy with testicular delivery on semen parameters. A total of 416 patients, diagnosed with grade III varicocele, were randomised into two groups. One group underwent microsurgical inguinal varicocelectomy without testicular delivery. For the other group, testicular delivery and ligation of gubernacular and all collateral veins were performed. A semen analysis was performed before and 6 months after the procedure. Mean age of the patients in the case and control groups was 27.3 ± 6.1 years and 25.9 ± 4.6 years respectively (p = .1). The total number of recurrence after 6 months in the conventional and testicular delivery groups was 13 (6.5%) and 3 (1.5%) (p < .05). No case of hydrocele formation was observed in any of the groups. All sperm parameters were improved 6 months after the surgery in both groups. But comparing the mean improved difference between the two groups revealed a significant difference in improvement in sperm motility for patients who had undergone varicocelectomy with testicular delivery (p = .05). Microsurgical inguinal varicocelectomy is a safe and efficient technique with a minimum chance of post-operative complications and recurrence and also may have role in improvement of sperm motility compared with conventional techniques.

Impact of varicocele on biological markers of gonadal function

PURPOSE

The aim of this study is to evaluate the potential effect of varicocele in the hormonal and clinical profile of adolescents.

METHODS

Twenty adolescents at Tanner stage 4-5 with left varicocele were studied and compared with a control group of 20 healthy adolescents. All patients underwent ultrasonographic testicular volumetry as well as hormonal evaluation of inhibin B, testosterone, baseline and gonadotropin-releasing hormone stimulated, follicle-stimulating hormone as well as luteinizing hormone. Statistical analysis was performed using the student's t test with p value <0.05 taken as statistical significant.

RESULTS

Patients with varicocele showed reduced levels of inhibin B compared to controls and a significant reduction in the testicular volume on the affected side. The response of luteinizing hormone to gonadotropin-releasing hormone stimulation was significantly higher in the varicocele group compared to the control group. Furthermore a significant inverse relationship of inhibin B compared to follicle-stimulating hormone was noted.

CONCLUSION

Serum inhibin B levels could represent a useful marker of Sertoli cell damage caused by varicocele.

Magnification-assisted subinguinal varicocelectomy with testicular delivery in children: a preliminary report

PURPOSE

To evaluate the effectiveness of magnification-assisted subinguinal varicocelectomy (MASV) with testicular delivery in children with severe varicocele.

MATERIALS AND METHODS

We retrospectively analyzed the clinical data of 23 children 15 years or younger (mean age, 12.3±1.8 years) who underwent MASV with testicular delivery and ligation of all collateral veins except arteries and deferential veins between January 2010 and January 2014. All patients had grade 3 varicocele on the left side. Varicocelectomy was decided upon due to scrotal hypotrophy (n=14, 60.9%), the existence of mass (n=6, 26.1%, including 1 recurrent case), and discomfort (n=3, 13.0%). The preservation of internal spermatic artery (ISA) was successful in 8 patients (34.8%). The mean follow-up time was 10.8±6.6 months.

RESULTS

The surgical success rate of varicocelectomy was 100%. The overall symptom resolution rate was 91.3%. The scrotal mass and discomfort disappeared, but testicular catch-up growth did not occur in 2 among 14 patients with scrotal hypotrophy. The left testis volume increased from 6.5±4.3 mL to 10.6±7.5 mL (p=0.003). There were no significant inter-group differences in terms of the surgical success rate, symptom resolution, and catch-up growth between the ISA preservation group and the ligation group. None of the subjects demonstrated testicular atrophy or hydrocele after surgery.

CONCLUSIONS

MASV with testicular delivery is an effective and safe method for children with severe varicocele.

Impact of internal spermatic artery preservation during laparoscopic varicocelectomy on recurrence and the catch-up growth rate in adolescents

OBJECTIVE

To investigate the effectiveness of laparoscopic varicocelectomy (LV) in adolescents with varicocele and analyze the impact of internal spermatic artery (ISA) preservation on surgical outcomes.

MATERIALS AND METHODS

Data on 92 adolescents with left varicocele who underwent LV between December 1998 and January 2011 were retrospectively analyzed. The mean age of the patients was 13.2 ± 2.1 years. Age, grade of disease, number of ligation veins, recurrence rates, and catch-up growth were analyzed in patients who underwent ISA preservation and ligation. The median duration of the follow-up was 21 months.

RESULTS

ISA preservation was performed on 50 patients (54%). There were no significant inter-group differences in terms of age, varicocele grade, number of ligation veins, and catch-up growth (93% vs. 90%). The patients who received artery preservation demonstrated a higher recurrence rate (22%) than those who received artery ligation (5%; p = 0.032). Among 13 patients who had persistent or recurrent varicocele, nine were treated with embolization and one was treated with magnification-assisted subinguinal varicocelectomy. None of these 10 patients demonstrated recurrence or testicular atrophy.

CONCLUSIONS

LV with ISA ligation can reduce the recurrence rate and results in the same catch-up growth rate in comparison with LV with ISA preservation.

Clinical characteristics and surgical outcomes in adolescents and adults with varicocele

Purpose

To compare clinical characteristics and surgical results in adolescents and adults with varicocele.

Materials and Methods

We retrospectively analyzed the characteristics of 93 patients, 34 adolescents (mean age, 14.4±2.1 years) and 59 adults (mean age, 30.4±12.4 years), who underwent surgical repair of varicocele between 2006 and 2009. Median follow-up time in all patients was 18.7 months. The most bothersome symptoms, bilaterality, grades, surgical methods, artery-sparing rates, operation times, semen analysis, success rates, and recurrence-free period were compared between the two groups.

Results

The overall success rate of surgical repair was 92.5%. The most bothersome symptoms were scrotal mass, pain, and hypotrophy in adolescents and pain, scrotal mass, infertility, and hypotrophy in adults (p=0.008). There were no significant between-group differences in bilaterality, grades, surgical methods, operation times, pre- or postoperative semen analyses, success rates, or recurrence-free periods. Patients who underwent artery-sparing surgery had higher recurrence rates than did those who underwent surgery that did not spare arteries. In adults, semen density increased significantly after surgery, from 35.6 million/ml to 49.6 million/ml (p=0.046).

Conclusions

There were no significant differences in clinical characteristics or surgical results between adolescents and adults with varicocele, except for the most bothersome symptoms. Semen density increased after surgery in both groups.