Microsurgical varicocelectomy in children and adolescents: prospective comparison of laparoscopic and open subinguinal repair
Authors:
Radim Kočvara 1; Josef Sedláček 1; Zdeněk Dítě 1; Jaroslav Zvěřina 2; Jana Zvárová 3; Jan Dvořáček 1
Authors‘ workplace:
Urologická klinika 1. LF UK a VFN, Praha
1; Sexuologický ústav 1. LF UK a VFN, Praha
2; EuroMISE centrum, Ústav informatiky AV
ČR v. v. i., Praha
3
Published in:
Ces Urol 2010; 14(3): 148-155
Category:
Original article
Overview
Aim:
To compare outcome of microsurgical varicocelectomy performed by laparoscopy or open using microscope.
Material and methods:
Patients (< 18 years old) with unilateral varicocele grade II–III have been randomly assigned to laparoscopic microsurgical repair (Group L) or to subinguinal microscopic repair (Group M). The research protocol contained age, pubertal stage, testicular size, blood level of LH, FSH and testosterone; spermiogram; surgical details and postoperative course were studied. For final evaluation, patients with minimal follow up of one year were selected (57 in group L, 69 in group M).
Results:
After ∅ 2-year follow up, clinical, hormonal and spermiologic parameters from both groups did not differ significantly. Testicular hypoplasia persisted in 59.4% of patients in Group L and in 50% in Group M. In the laparoscopic repair, length of surgery was ∅ 75 min, in the microscopic repair ∅ 110 min. (after technical modification 99 min) (p = 0.0001); number of divided veins was ∅ 6 and ∅ 13, respectively (p = 0.0001), and periarterial venous network was found in 74% and 94% of patients, respectively. Parenteral analgesia (mostly one injection) was required in 42% of patients in Group L and in 15% of Group M (p = 0.00106). Varicocele persisted in 5.8% (after modification in 3.3%) in Group M, in no patient in Group L.
Conclusion:
Clinical and andrological outcome of both microsurgical repairs is comparable. The laparoscopic repair is shorter with lower number of veins to be divided. The microscopic repair faces higher incidence of periarterial venous network, that must be dissected very safely, the postoperative analgesia is less. It is on the surgeon experience, which type of repair to use.
Key words:
varicocele in children and adolescents, lymphatic sparing varicocelectomy, microsurgical varicocelectomy, laparoscopic varicocelectomy.
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Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2010 Issue 3
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