Results of Varicocele Surgery According to Operative Technique

Park, Jung Rae; Park, Choal Hee; Kim, Chun Il; Kim, Kwang Sae; Lee, Sung Choon

Abstract

PURPOSE: A varicocele first develops in early adolescence and can affect testicular growth, function, and histology. Tease gonadotoxic effects, if progressive, may explain why, in adults with infertility, normal fertility returns after varicocele ligation in 20% to 50% of the cases. Therefore, serveral investigators have proposed prophylactic varicocele ligation. Various surgical techniques for varicocelectomy have been described, including high retroperitoneal, inguinal, and laparoscopic approaches. We report our experience using three different operative techniques for surgical correction of varicocele.
PATIENTS AND METHODS
Between February 1990 and May 1998, 107 patients with varicocele underwent surgical correction by the Palomo (N=52), modified Palomo (N=32), or Ivanissevich (N=23) technique. All patients had a thorough physical examination, including supine and standing scrotal examination, preoperatively. The indications for surgery included a left testicular volume loss of 3cc or more compared with the right testis, palpable varicocele, and pain. Outcome parameters were persistent or recurrent varicocele and operative time. Postoperative complications were scrotal edema, hydrocele, and testicular atrophy. The postoperative follow-up ranged from 2 to 58 month with an average of 30.2 month.
RESULTS
In patients treated with the Palomo technique, postoperative recurrence was seen in one patient, and hydroceles developed in five patients. There was no varicocele recurrence or atrophy of the testis. The mean operative time was 48.2 minutes. Among patients treated with the modified Palomo technique, postoperative persistence and recurrence were seen in three and two patients, respectively. There was no atrophy of the testis. The mean operative time was 54.3 minutes. In patients in whom the Ivanissevich technique was used, postoperative persistence and recurrence were seen in one patient each. Testicular edema or hematoma and atrophy of testis occurred in three patients each. The mean operative time was 62 minutes.
CONCLUSIONS
With the Palomo technique, there was only one patient who suffered postoperative recurrence, and there was no significant atrophy of the testis. The mean operative time was shorter than with the other techniques. The Palomo technique is a very effective and relatively fast procedure in our experience.