Varicocelectomy in Adolescents - Which Method of Treatment is the Best?

Purpose We compare the outcome of different surgical methods of varicocele management: 1. classic Palomo, retroperitoneal mass ligation, 2. high retroperitoneal ligation with artery-sparing procedure, 3. laparoscopic varicocelectomy, 4. retrograde embolization. Material and Methods 255 patients (age 10 – 18) underwent different procedures of varicocelectomy. The criteria for surgery were: varicocele, grade II or III with “scrotum discomfort”, testicular volume loss and/or change in consistency. 154 patients were treated with classic Palomo procedure, 26 with artery-sparing retroperitoneal procedure, 50 laparoscopic varicocelectomy and 25 retrograde embolization. In 6 (19% from all qualified to embolization) patients embolization was impossible because of unfavorable anatomical conditions during phlebography. Results In the group of 154 patients after Palomo procedure, reoperation was necessary in 3 cases (2%), recurrent grade I varicocele was found in 28 cases (18%). After artery-sparing procedure reoperation was performed in 5 cases (19%), recurrent grade I varicocele was found in 3 cases (12%). None of the patients operated laparoscopically required reoperation and grade I varicocele occurred in 4 (8%). Reoperation was necessary in 6 cases (24%) after embolization and grade I varicocele was confirmed in 7 cases (28%). Hydrocoele was found in 19 patients (12%) after Palomo technique, but preservation of the testicular artery increased the rate of hydrocoele to 30%. After laparoscopy hydrocoele occurred in 11 cases (22%) and after embolization in 2 patients (8%). Conclusions The Palomo procedure is little less efficient (2% reoperations, 18% of I° varicocele) than laparoscopic varicocelectomy (0% reoperations, 8% of I° varicocele). Preservation of testicular artery, increased the rate of reoperation by 17% and formation of hydrocoele to 18%. Occurrence of hydrocoele after laparoscopic method was more frequent (by 8%) than after classic Palomo technique. After retrograde embolization high rate of 24% of recurrence was observed. Unfavorable anatomical conditions made embolization impossible in 19 % of patients.