Is adolescent varicocelectomy safe after previous inguinal surgery?
OBJECTIVE
Varicocelectomy after previous inguinal surgery poses a potential risk of testicular volume loss. To assess the extent to which varicocelectomy can be done without the complication of ipsilateral testis atrophy we present outcomes in adolescent patients with a history of inguinal surgery who underwent ipsilateral varicocelectomy.


METHODS
We retrospectively reviewed patient data from a single urologist practice. Testicular volume was recorded preferentially by ultrasound or, when unavailable, by ring orchidometry. Testicular asymmetry was calculated using the formula, [(right testis volume - left testis volume)/right testis volume] × 100. Symmetry was defined as less than 10% asymmetry. Catch-up growth was defined as resolution of asymmetry.


RESULTS
We identified 22 adolescent patients who fit study criteria. The patients underwent a total of 25 varicocelectomies since 3 underwent bilateral repair after previous bilateral inguinal surgery. Initial inguinal surgery included inguinal herniorrhaphy, hydrocelectomy and orchiopexy. Varicocelectomy was done laparoscopically in 17 cases and via open technique in 8 with variations in preservation/sacrifice of the lymphatics and artery. Median ± SD followup was 24.2 ± 18.2 months. After varicocelectomy mean testicular asymmetry decreased from 27.6% to 10.5%. There was no incidence of testicular atrophy postoperatively. The incidence of catch-up growth was 43% with no difference between the artery sparing and the nonartery sparing technique.


CONCLUSIONS
Varicocelectomy with a history of previous inguinal surgery is safe and provides a significant incidence of testicular catch-up growth. Artery sparing vs sacrificing technique did not make a difference in terms of catch-up growth.
Woldu
Solomon L
SL
Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital, New York Presbyterian, New York, New York 10032, USA.
Van Batavia
Jason P
JP
Poon
Stephen A
SA
Raimondi
Peter M
PM
Glassberg
Kenneth I
KI
D000293:Adolescent; D001284:Atrophy / Q000209:etiology; D002648:Child; D006801:Humans; D007264:Inguinal Canal; D008297:Male; D009929:Organ Size; D012189:Retrospective Studies; D013737:Testis / Q000473:pathology*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods; D014646:Varicocele / Q000601:surgery*