Blue venography in adolescent varicocelectomy: a modified surgical approach

Conventional varicocelectomy is often complicated by postoperative recurrences. When failure occurs, it is likely to be caused by incomplete interruption of the testicular vein, which is divided into multiple branches, or by the parallel collaterals, and to incompetence of the cremasteric vein(s). Occasionally it is caused by reversed flow in the deferential vein(s).

The author reports his experience with 172 consecutive corrections of varicocele in adolescents (mean age, 13.4 years) by means of a personally modified technique. This technique is characterized by ileoinguinal access to all venous areas such as the retroperitoneum and the inguinal canal; ligature and transection of the internal and external spermatic veins, the parallel collaterals, and the deferential vein(s), if dilated and tortuous, with spermatic artery preservation; control of the interruption of flow in these veins by injection of methylene-blue solution in a vein of the pampiniform plexus (blue venography). Optical magnification (4x) and papaverine solution were also used. The rationale for this surgical approach is twofold: interruption of all testicular veins incompetent and potentially incompetent; easy and effective intraoperative control of venous interruption.

No varicocele recurrences or postoperative controlateral varicoceles were detected (follow-up, 6 to 24 months). The complications include a postoperative testicular atrophy by intraoperative methylene-blue extravasation with large hematoma of the cord and three postoperative hydroceles.

The surgical approach reported here is a simple, safe, artery-sparing technique.