MICROSURGICAL REPAIR OF THE ADOLESCENT VARICOCELE

Purpose: Since clinically apparent varicoceles may affect testicular v olume and sperm production, early repair has been advocated. However, repair of the pediatric varicocele with conventional nonmagnified tech niques may result in persistence of the varicocele after up to 16% of these procedures. Also testicular artery injury and postoperative hydr ocele formation can occur after nonmagnified repair. The microsurgical technique has been successfully completed in a large series of adults with a dramatic reduction in complication and recurrence rates. We re port our experience with the microsurgical technique in boys. Material s and Methods: A total of 30 boys (average age 15.9 years) underwent 4 2 microsurgical varicocelectomies (12 bilateral). All patients had a l arge left varicocele. Indications for repair included testicular atrop hy (size difference between testicles of greater than 2 ml.) in 20 boy s, pain in 5 and a large varicocele without pain or testicular atrophy in 5. Six boys were referred following failure of conventional nonmic rosurgical techniques. All boys were examined no sooner than 1 month p ostoperatively (mean followup 12). Results: Preoperative volume of the affected testis averaged 13.0 ml., and an average size discrepancy be tween testicles of 2.8 ml. was noted before unilateral varicocelectomy . No cases of persistent or recurrent varicoceles were detected, and 1 postoperative hydrocele resolved spontaneously. After unilateral vari cocelectomy the treated testes grew an average of 50.1%, while the con tralateral testes grew only 23%. Overall, 89% of patients with testicu lar atrophy demonstrated reversal of testicular growth retardation aft er unilateral varicocelectomy. In contrast, both testes showed similar growth rates after bilateral varicocelectomy (45% left testis, 39% ri ght testis). Conclusions: The meticulous dissection necessary to prese rve arterial and lymphatic supply, and to ligate all spermatic veins i n the pediatric patient is readily accomplished using a microsurgical approach, and results in low recurrence and complication rates. Rapid catch-up growth of the affected testis after microsurgical varicocelec tomy suggests that intervention during adolescence is effective and wa rranted.