[Causes of persisting postoperative varicoceles]

We report on 18 patients presenting persisting varicoceles following one or several surgical attempts to ligate the vena spermatica interna. During the last 12 years 519 patients underwent high ligation of the V. spermatica interna (technique of Bernardi) for varicocele in this center. In 5 of them a varicocele persisted after surgery (1 per cent). Phlebography in all operated 18 cases showed: an overlooked branch of the V. serm. int. in 2 cases, collateral veins to the paravertebral plexus in 3 cases and a combination of venous collaterals to neighbouring systems and overlooked branches in 13 cases. Collateral anastomoses as causes for persisting varicoceles were demonstrated to the presacral- and paravertebral plexus, to the V. iliaca and the V. femoralis and via the plexus pampiniformas to the other side. Preoperative Phlebography is preferred to intraoperative radiological diagnosis since the latter may be technically difficult, incomplete and may require a longer incision for ligation of distant anastomoses.