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Idiopathic varicocele in adolescents: risks of the inguinal approach
Mariette Renaux-Petel1, Pierre-Hugues Vivier, Diane Comte
1Department of Pediatric Surgery, CHU Charles Nicolle, Rouen, France. mariette.renaux-petel@hotmail.fr
Insights
Open inguinal varicocelectomy in adolescents showed concerning complication rates, including recurrence and testicular hypotrophy. This suggests alternative methods like embolization may be safer for young patients.
Area of Science:
- Pediatric Surgery
- Urology
- Adolescent Health
Background:
- Idiopathic varicocele affects children and adolescents.
- Surgical interventions aim to correct varicocele and prevent complications.
Purpose of the Study:
- To evaluate medium-term outcomes and complications of open inguinal varicocelectomy.
- To assess the safety and efficacy of vein ligation, intraoperative venography, and antegrade sclerotherapy in pediatric patients.
Main Methods:
- Retrospective analysis of 64 children treated for idiopathic varicocele between 2000 and 2009.
- Post-surgical follow-up included clinical examination at 6 months and testicular ultrasound scans in a subset of patients.
Main Results:
- Thirty-eight of 50 evaluated patients had good outcomes.
- Complications included varicocele recurrence (3), testicular hypotrophy (7), and testicular atrophy (2).
- Delayed left testicular growth was noted in 13 children.
Conclusions:
- Open inguinal surgical ligation may not be sufficiently safe for young adolescents.
- Potential risk of decreased future fertility exists with this technique.
- Referral to a radiologist for embolization is suggested for untrained teams.
Introduction:
The aim of this study was to evaluate the medium-term results and complications of open inguinal varicocelectomy, including vein ligation, intraoperative venography, and antegrade sclerotherapy.
Materials And Methods:
Sixty-four children were treated between 2000 and 2009 for idiopathic varicocele. Fifty children were examined 6 months after surgery. In 2010, 22 patients were recalled for testicular ultrasound scans (US) to evaluate the medium-term results of the technique.
Results:
The mean age of the children was 12.8 years at first consultation. Of the 50 cases, 35 children were asymptomatic, 13 experienced pain, 3 suffered from discomfort, and 1 had testicular asymmetry. Thirteen children had delayed left testicular growth compared with the right testis. The mean age at surgery was 13.3 years, and follow-up duration was 8.3 months ± 13.9. Thirty-eight patients achieved good results postsurgery; there was varicocele recurrence in 3, testicular hypotrophy in 7, and complete testicular atrophy in 2 patients.
Conclusion:
Naked eye inguinal surgical ligation does not appear to be safe enough to treat young adolescents, with the theoretical risk of a decrease in fertility in the future. In teams which are untrained in microsurgical or laparoscopic varicocelectomy, we suggest referring adolescent patients to a radiologist for embolization.
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