Hydrocele Following Internal Spermatic Vein Ligation: A Retrospective Study and Review of the Literature

Abstract

We reviewed 82 consecutive infertile men with varicoceles and 1 teenage boy with a painful varicocele, all of whom underwent a total of 111 internal spermatic vein ligations (55 unilateral and 28 bilateral) by the suprainguinal approach (Palomo method). Of these patients 3 who underwent unilateral and 3 bilateral internal spermatic vein ligations subsequently suffered a total of 8 hydroceles after an average postoperative interval of 18.2 months. The protein concentration of the hydrocele fluid in the 2 most recent patients was consistent with lymphatic obstruction.

The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long‐term follow‐up

“…ligation at the internal inguinal ring [9], but more recently rates in men were reported as 3.1-13%, with higher ligation tending to cause more hydroceles [10][11][12]. The present results show about twice the frequency (28% vs 14%) of hydrocele formation after a Palomo than after a modified Ivanissevich repair.…”

“…Hydrocele development after a Palomo repair is attributed to the disruption of the lymphatic drainage of the tunica vaginalis after ligation of the lymphatics en bloc with the internal spermatic vessels [11]. Recently, adolescent varicocele has been repaired by microsurgery, in which the arterial and lymphatic supply to the testes is meticulously dissected, to eliminate the risk of varicocele recurrence/persistence and the occurrence of hydroceles [13,14].…”

“…In their review, Szabo and Kessler [11] examined the scrotum at 1, 6 and 12 months after surgery; hydroceles that were self-discovered >1 year after surgery were brought to their attention by the complaints of the patients. The incidence of hydrocele formation after internal spermatic vein ligation was eight of 111 procedures (7.2%).…”

“…The records of 77 adolescent males (mean age 14.1 years, range [10][11][12][13][14][15][16][17][18][19][20][21][22] [8].…”

“…Fifty-six patients underwent a standard Palomo procedure (45 left and 11 bilateral) and 21 a modified Ivanissevich repair (14 left and seven bilateral). The mean (range) age of the patients at surgery was 14.1 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) years and the mean followup 25.5 (6-84) months.…”