Division of lymphatic vessels at varicocelectomy leads to testicular oedema and decline in testicular function according to the LH-RH analogue stimulation test.
OBJECTIVE
To study the andrological outcome of the division of testicular lymphatic vessels at varicocelectomy in children and adolescents.


METHODS
Testicular size and basal and stimulated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) values were determined prospectively in 86 patients with left unilateral varicocele grades II-III. 22 patients underwent lymphatic non-sparing surgery (LNS group), 10 of them with artery sparing (LNS/AS) and 12 without artery sparing (LNS/ANS), 23 patients underwent lymphatic sparing repair (LS group) and 41 patients were treated conservatively (NT group).


RESULTS
The LNS group demonstrated significantly greater left testicular enlargement at six weeks and one year following repair, left testicular hypertrophy developed in 31.8% and hydrocele in 22.7% of patients. Marked oedema of intertubular tissue and a varying degree of tubular injury was observed in boys surgically treated for hydrocele. In the LS group, neither hypertrophy nor hydrocele developed postoperatively, the LH stimulated values were lower than in LNS/ANS group (p<0.05) and the NT group (p<0.04), the FSH stimulated values were lower than in the LNS/ANS group (p<0.001).


CONCLUSIONS
Division of lymphatic vessels at varicocelectomy is associated with an excessive increase in testicular volume due to oedema, and with a reduced testicular function according to higher LH and FSH stimulated values. Preservation of lymphatics is strongly advised in varicocelectomy in adolescents to ensure better andrological outcome.
Kocvara
Radim
R
Department of Urology, General University Hospital and 1st Medical School, Charles University, Ke Karlovu 6, 128 08 2, Prague, Czech Republic. radim.kocvara@lfl.cuni.cz
Dolezal
Jirí
J
Hampl
Richard
R
Povýsil
Ctibor
C
Dvorácek
Jan
J
Hill
Martin
M
Díte
Zdenek
Z
Stanek
Zdenek
Z
Novák
Kvetoslav
K
D000293:Adolescent; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D004487:Edema / Q000209:etiology* / Q000503:physiopathology; D005640:Follicle Stimulating Hormone / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood*; D008208:Lymphatic System / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013733:Testicular Diseases / Q000209:etiology* / Q000503:physiopathology; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D014646:Varicocele / Q000175:diagnosis* / Q000601:surgery*
D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone