Ligation of the Testicular Artery and Vein in Adolescent Varicocele

Parrott, Thomas S.; Hewatt, Lou

doi:10.1016/s0022-5347(17)32711-8

Cited by 57 publications

(38 citation statements)

References 18 publications

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“…However, patients who developed hydroceles after bilateral varicocelectomy were more likely to require hydrocelectomy (P=0.013, Fisher's exact test), implying that hydroceles developing after bilateral repair tend to be larger. Of the hydroceles, two were detected in the first 6 months after surgery, nine at 6-12 months, three at [13][14][15][16][17][18] [4], the inguinal approach of Ivanissevich [5], and more recently microsurgical and laparoscopic approaches, have been described [6,7]. The most common complications are persistence or recurrence of the varicocele and hydrocele development.…”

Section: Results Of the 67 Palomo Varicocelectomies 19 (24%)mentioning

confidence: 99%

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

et al. 2001

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Objective To determine, in adolescent boys after varicocelectomy, the incidence of hydroceles, when they develop and whether the development is procedure‐related.Patients and methods The records were retrospectively reviewed of 77 boys who underwent 95 varicocelectomies and had an examination at 6 months after surgery. 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 (10–22) years and the mean follow‐up 25.5 (6–84) months.Results Of the 67 Palomo varicocelectomies 19 (24%) were complicated by hydroceles after surgery, compared with four of 28 (14%) Ivanissevich procedures (P = 0.034). Of the Ivanissevich repairs, none of the 14 unilateral repairs developed hydroceles. Three hydroceles (one bilateral and one left) developed in two of seven patients after bilateral varicocelectomy. Of the Palomo repairs, 12 of 45 unilateral repairs were complicated by hydroceles, and seven developed in five of 11 patients after bilateral varicocelectomy. Although more hydroceles developed after bilateral varicocelectomy, there was no significant difference from the unilateral group. However, patients who developed hydroceles after bilateral varicocelectomy were more likely to require hydrocelectomy (P = 0.013, Fisher's exact test), implying that hydroceles developing after bilateral repair tend to be larger. Of the hydroceles, two were detected in the first 6 months after surgery, nine at 6–12 months, three at 13–18 months, five at 19–24 months and four at > 2 years after surgery. Three patients had late varicocele recurrence, i.e. 15, 37 and 76 months after surgery; these patients had not had varicoceles on palpation after surgery at 3, 14 and 63 months, respectively.Conclusion Hydroceles are detected infrequently within 6 months of varicocelectomy, with most occurring after 6 months and even appearing after 3 years. They occur significantly more often after a Palomo repair. More hydroceles develop after bilateral repair regardless of the technique used, but not significantly so. Because hydroceles often develop, a lymphatic‐sparing procedure should be used, especially for bilateral repair. Recurrent varicoceles may appear as late as 76 months after varicocelectomy in patients where none had been detected at a mean of 27 months after surgery.

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Section: Results Of the 67 Palomo Varicocelectomies 19 (24%)mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

et al. 2001

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“…It has been reported most frequently in association with antegrade sclerotherapy of varicocele in which all venous outflow has been occluded [17,18]. Chan et al [19] and Goldstein et al [7] [20,21]. At the 1-year follow-up 68% of the present patients had compensatory growth to a size comparable with the contralateral testis.…”

Section: Discussionmentioning

confidence: 63%

“…The median (range) age at surgery was 15 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) years. Patients were stratified based on the surgical technique…”

Section: Methodsmentioning

confidence: 99%

“…In all, 92 patients undergoing surgical spermatic vein ligation at Children's Hospital Boston between 1996 and 2006, and with > 1 year of followup, were evaluated. The median (range) age at surgery was 15 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) years. Before and after surgery, the varicocele grade (according to Dubin and Amelar [3]), testicular volume and testicular consistency were determined by the attending urologist.…”

Section: Methodsmentioning

confidence: 99%

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Varicocele surgery: a decade’s experience at a children’s hospital

et al. 2009

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used by eight different urology faculty members. Microsurgery and attempted artery-sparing were applied to some Palomo, Ivannisevich, and subinguinal cases but not to laparoscopic procedures. RESULTSThe laparoscopic (100%) and Palomo (93%) techniques had significantly higher success rates than the Ivanissevich approach (69%). The success rate with the subinguinal technique (88%) was intermediate between the more successful supra-inguinal and less successful inguinal approaches. There was a higher hydrocele rate (32%) in the laparoscopic approach. Artery sparing significantly lowered hydrocele rates but had no effect on success rates. Incorporating microsurgery also had no effect on success rates but resulted in no hydrocele formation. One case of testicular atrophy occurred in a patient undergoing microsurgical arterysparing subinguinal spermatic vein ligation. There was compensatory growth in 68% of patients operated on for testicular hypotrophy. CONCLUSIONSDuring our 10-year experience the laparoscopic and Palomo approaches were the most successful. The subinguinal approach (usually incorporating microsurgery and artery sparing) had an intermediate success rate. The Ivanissevich approach was least successful. Hydroceles did not occur when microsurgery was used, and were significantly less common with artery sparing. The only case of testicular atrophy was with a microsurgical arterysparing subinguinal approach. When the spermatic vein was ligated for testicular hypotrophy there was compensatory growth in two-thirds of testes. OBJECTIVESTo review our experience at a children's hospital over a 10-year period with the Palomo, Ivanissevich, subinguinal and laparoscopic techniques for varicocele, assessing the success and complication rates according to specific procedure, and the added effect that the modifications of microsurgery and artery-sparing has had on these rates. A second objective was to assess the rate of testicular compensatory growth after surgery for testicular hypotrophy. PATIENTS AND METHODSNinety-two patients with > 1 year of followup between 1996 and 2006 were assessed retrospectively. The median (range) age at surgery was 15 (8-21) years. Patients were stratified based on the surgical technique

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Varicocele and its Treatment,

Hutson¹

1892

JAMA

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also inadequate. Moreover, the quotations and other sentences are not selected with reference to their ele¬ gance of expression and beauty of sentiment, which render them suitable for memorizing ; nor do they seem to be selected with special reference to the use¬ ful knowledge they convey.The vocabulary should be sufficiently extensive to present not only all words used in our general litera¬ ture, but also in the sciences. The following exam¬ ples will illustrate my meaning :

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Ligation of the Testicular Artery and Vein in Adolescent Varicocele

Cited by 57 publications

References 18 publications

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

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

Varicocele surgery: a decade’s experience at a children’s hospital

Varicocele and its Treatment,

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