Microsurgical Subinguinal Varicocelectomy: Comparison of Pediatric and Adult Patients / 대한비뇨기과학회지

ABSTRACT

PURPOSE: We compared the intraoperative microanatomy, recurrence rate and complications of the pediatric and adult patients with varicocele and who underwent microsurgical subinguinal varicocelectomy and who were followed for at least 6 months. MATERIALS AND METHODS: Twenty-seven boys(mean age 13.2 years) and 31 men(mean age 27.8 years) underwent left microsurgical subinguinal varicocelectomy with delivery of the testis and they were prospectively evaluated. During the surgery, the detailed intraoperative microanatomy of the spermatic cord and gubernacula was recorded for each group and then compared. RESULTS: External spermatic and gubernacular veins greater than 2mm were significantly more common in the adult group compared to the pediatric group(35.5% vs. 7.4%, 71.0% vs. 29.6%, respectively). Multiple internal spermatic arteries(more than two) were identified in 63.0% of the boys and in 58.1% of the men. In most cases, the internal spermatic arteries were surrounded by a dense complex of adherent veins. There were no significant differences between the pediatric and adult groups for the number of preserved lymphatics(4.6 vs. 5.3, respectively), the ligated internal spermatic veins(8.9 vs. 9.3, respectively), the preserved cremasteric arteries(1.4 vs. 1.7, respectively) and the ligated cremasteric veins (2.3 vs. 2.6, respectively). The mean operative times were 95.6 minutes for the pediatric group and 93.5 minutes for the adult group(p>0.5). During the follow-up period there were no cases of persistent or recurrent varicocele. CONCLUSIONS: Microsurgical subinguinal varicocelectomy was an equally safe, effective means of treating varicoceles both in children and adults. The surgical microanatomy was not much different in the two groups.