Laparoscopic Varicocelectomy in Adolescents: Artery Ligation and Artery Preservation

To evaluate and compare the perioperative outcomes and improvements of testicular performance between artery preservation (AP) and artery ligation (AL) during laparoscopic varicocelectomy (LV) in adolescents.

Data on 122 adolescents with unilateral varicocele who underwent laparoscopic varicocelectomy by a single urologist at our hospital were retrospectively studied. Age, varicocele grade, and testicular volume were collected, and postoperative data, including the operative time, recurrence, hydrocele, and catch-up growth, were assessed. Pre- and postoperative semen parameters in partial patients were compared between the groups.

The preoperative data were comparable between the groups, and there were no significant intergroup differences in the postoperative recurrence rate, hydrocele rate, or the 12th- and 24th-month catch-up growth rates; however, the 12th-month catch-up growth rate was relatively low in the AL group compared with the AP group. The postoperative semen parameters in terms of concentration, motility, and morphology were (62.5 ± 39.2) million/ml, (52.2 ± 16.6)%, and (11.5 ± 1.5)% in AP group, and (60.4 ± 38.2) million/ml, (49.1 ± 19.9)%, and (10.7 ± 1.5)% in AL group, respectively. The semen parameters were improved in both groups (P < .05) when compared with preoperative data, and there was no statistically significant difference between the two procedures (P > .05).

Considering the short-term impact on testicular restoration of the AL procedure, we suggest the AP procedure with fast and gentle dissection of the artery as the first choice. We also suggest a timely conversion to the AL procedure without hesitation when the first attempt fails.