Laparoscopic surgery versus antegrade scrotal sclerotherapy: Retrospective comparison of two different approaches for varicocele treatment.
OBJECTIVE
Both laparoscopic surgery and antegrade sclerotherapy are effective treatment options in the management of varicoceles. However, very limited data comparing these two approaches are available in the literature. We present our experience regarding outcome and complications with each treatment modality.


METHODS
During a 10-year period, 122 cases of laparoscopic varicocelectomy (LV) and 108 cases of antegrade sclerotherapy (AS) were performed in our institution. Diagnosis and postoperative results were established clinically and using Doppler ultrasonography. Data regarding failure rate, complications, operative time and length of hospital stay of each procedure were retrospectively evaluated.


RESULTS
Median follow-up was 59 months (5-130). Failure rates for LV and AS were 4.9% and 15.7%, respectively (p < 0.01). Complications occurred in 13.1% after LV, including 13 cases (10.7%) of hydrocele formation, and 4.6% after AS. Hydroceles following LV were significantly more frequent in patients with compared to patients without previous inguinal surgery (27.8% vs. 8.5%; p < 0.05). There was no significant difference between LV and AS regarding operative time (36 vs. 34 min, p > 0.05) and hospital stay (2.2 vs. 2.1 days, p > 0.5).


CONCLUSIONS
In our experience, LV was more effective than AS in correcting varicoceles. Complications other than hydroceles were higher after AS. The higher incidence of postoperative hydrocele formation following LV warrants strategies such as the lymphatic sparing approach, especially in patients with previous inguinal surgery.
May
Matthias
M
Department of Urology, Carl-Thiem Hospital, Cottbus, Germany. M.May@ctk.de
Johannsen
Manfred
M
Beutner
Sabine
S
Helke
Christian
C
Braun
Kay P
KP
Lein
Michael
M
Roigas
Jan
J
Hoschke
Bernd
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000009:adverse effects; D012611:Scrotum / Q000000981:diagnostic imaging / Q000601:surgery*; D006848:Testicular Hydrocele / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods; D014646:Varicocele / Q000000981:diagnostic imaging / Q000628:therapy*