Recurrent varicoceles: causes and treatment using angiography and magnification assisted subinguinal varicocelectomy.
OBJECTIVE
To investigate the causes of varicocele recurrence and assess the use of embolization and subinguinal varicocelectomy in its treatment in patients with angiography and subinguinal varicocelectomy.


METHODS
The present study involved 15 patients with recurrent varicoceles. The mean patient age was 21.2 years (range: 12-42 years). Preoperative angiography was performed in 11 patients. Embolization was used in patients with patent internal spermatic veins (ISVs). Patients without patent ISVs or preoperative angiography underwent magnification-assisted subinguinal varicocelectomy which included testicular retrieval and ligation of all collateral veins except arteries and deferential veins.


RESULTS
Seven among 11 patients (64%) which had preoperative angiography had patent ISVs and underwent embolization and 8 patients underwent subinguinal varicocelectomy. Of those 8 patients, 6 had dilated ISVs and external spermatic veins (ESVs), one had dilated ISVs and gubernacular veins, and one had dilated ISVs, ESVs and gubernacular veins. No patient experienced recurrence or testis atrophy.


CONCLUSIONS
Patent ISVs or collateral veins may be the cause of recurrence after varicocelectomy. Angiographic embolization was successful in 64% of recurrent varicoceles patients with patent ISVs. However, microscope-assisted subinguinal varicocelectomy may be the best overall treatment for patients with recurrent varicoceles.
Deptartment of Urology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
Kyung Hyun
KH
Moon
Suk Ju
SJ
Cho
Kun Suk
KS
Kim
Seonghun
S
Park
Sungchan
S
Park
D000293:Adolescent; D000328:Adult; D000792:Angiography; D002648:Child; D006801:Humans; D008297:Male; D013085:Spermatic Cord / Q000000981:diagnostic imaging / Q000601:surgery; D013519:Urogenital Surgical Procedures; D014646:Varicocele / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult