Adolescent varicocelectomy: postoperative catch-up growth is not secondary to lymphatic ligation.
OBJECTIVE
The major indication for adolescent varicocelectomy is testicular asymmetry with the left testicle smaller than the right. Catch-up growth following surgery is one of the parameters used to assess efficacy of surgery. However, it is not clear whether this represents true tissue growth or increased interstitial fluid secondary to lymphatic obstruction. The purpose of this study was to compare catch-up growth in patients who underwent varicocelectomy with and without lymphatic preservation.


METHODS
We retrospectively analyzed the outcomes of 136 boys (mean age 15.1years) who had 10% or greater preoperative testicular asymmetry and underwent varicocelectomy between 1997 and 2006. Surgery was either a laparoscopic nonlymphatic sparing or laparoscopic lymphatic sparing varicocelectomy. All patients had pre- and postoperative ultrasound volume measurements at least 6months following surgery. The groups were compared for incidence of postoperative catch-up growth, achieving less than 10% testicular asymmetry.


RESULTS
After a mean follow up of 24.7months, catch-up growth was achieved in 62.8% of patients. There was no significant difference between the groups in regard to catch-up growth (51.7% vs 66.3%, P=0.193).


CONCLUSIONS
Since no significant difference was found between the laparoscopic nonlymphatic sparing and laparoscopic lymphatic sparing varicocelectomies, we conclude that lymphatic obstruction is not the cause of catch-up growth.
Poon
Stephen A
SA
Department of Urology, Division of Pediatric Urology, The Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, College of Physicians and Surgeons, New York 10032, USA. sap2003@columbia.edu
Kozakowski
Kristin A
KA
Decastro
G Joel
GJ
Gjertson
Carl K
CK
Glassberg
Kenneth I
KI
D000293:Adolescent; D003251:Constriction, Pathologic / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008026:Ligation / Q000379:methods; D042601:Lymphatic Vessels / Q000473:pathology / Q000601:surgery*; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D014646:Varicocele / Q000601:surgery*