title: Division of lymphatic vessels at varicocelectomy leads to testicular oedema and decline in testicular function according to the LH-RH analogue stimulation test.
abstract: 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.
authors.affiliation: 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
authors.forename: Radim
authors.initials: R
authors.lastname: Kocvara
authors.forename: Jirí
authors.initials: J
authors.lastname: Dolezal
authors.forename: Richard
authors.initials: R
authors.lastname: Hampl
authors.forename: Ctibor
authors.initials: C
authors.lastname: Povýsil
authors.forename: Jan
authors.initials: J
authors.lastname: Dvorácek
authors.forename: Martin
authors.initials: M
authors.lastname: Hill
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Díte
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Stanek
authors.forename: Kvetoslav
authors.initials: K
authors.lastname: Novák
mesh_terms: 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*
chemical_list: D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone