Esposito Ciro, Valla Jean Stephanie, Najmaldin Azad, Shier Felix, Mattioli Girolamo, Savanelli Antonio, Castagnetti Marco, McKinley Gordon, Stayaert Henry, Settimi Alessandro, Jasonni Vincenzo, Guys Jean Michael
Pediatric Surgery Units, Magna Graecia University, Catanzaro, Italy.
J Urol. 2004 Mar;171(3):1271-3. doi: 10.1097/01.ju.0000112928.91319.fe.
Hydrocele seems to be the most frequent complication in children who undergo surgery for varicocele and the issue of the optimal management of hydrocele remains controversial. In this retrospective study we evaluated the incidence and management of hydrocele following surgical treatment of varicocele in children treated at 8 European centers of pediatric surgery.
In a 5-year period 278 children between 7 and 17 years old underwent surgical treatment for unilateral left varicocele, including 187 using video surgery and 91 via an open inguinal approach.
At an average followup of 24 months (range 12 to 60) 34 children (12.2%) had a left hydrocele. Of the 278 children 14 (5%) were lost to followup. The hydrocele appeared between 1 week and 44 months (median 2 months) after surgery. Concerning hydrocele management 16 of 34 children (47%) were treated with scrotal puncture while under local anesthesia, which led to hydrocele regression after a median of 3 punctures (range 1 to 5), 12 (35.3%) underwent clinical observation since the hydrocele reduced spontaneously within a median of 12 months after its appearance and 6 (17.7%) were treated with open surgery. In 4 cases the hydrocele disappeared and in 2 it recurred after surgery and was successfully treated with punctures.
This study shows that the median incidence of hydrocele after varicocele surgery is about 12% but it seems higher after artery nonsparing vs sparing procedures (17.6% vs 4.3%). On the contrary, no difference was found when the procedure was performed using video surgery or with the open approach. Hydroceles generally develop a few months later but may also appear several years after the surgical repair of varicocele. Noninvasive procedures (scrotal punctures or clinical observation) seem to induce total hydrocele regression in more than 82% of cases. Children who undergo surgery for varicocele should undergo long-term followup to detect a possible hydrocele. In fact, the 5.4% of children lost to followup in our study may potentially have had a hydrocele. Surgery is not always successful for this condition, as shown in the 2 cases of recurrent hydrocele after surgical repair.
鞘膜积液似乎是精索静脉曲张手术患儿最常见的并发症，鞘膜积液的最佳处理问题仍存在争议。在这项回顾性研究中，我们评估了欧洲8个小儿外科中心治疗的精索静脉曲张患儿手术后鞘膜积液的发生率及处理情况。
在5年期间，278例7至17岁的患儿接受了单侧左侧精索静脉曲张手术治疗，其中187例采用腹腔镜手术，91例采用腹股沟开放手术。
平均随访24个月（范围12至60个月），34例患儿（12.2%）出现左侧鞘膜积液。278例患儿中有14例（5%）失访。鞘膜积液在术后1周与44个月之间出现（中位时间2个月）。关于鞘膜积液的处理，34例患儿中有16例（47%）在局部麻醉下接受阴囊穿刺治疗，中位穿刺3次（范围1至5次）后鞘膜积液消退；12例（35.3%）进行临床观察，因为鞘膜积液在出现后中位12个月内自行消退；6例（17.7%）接受开放手术治疗。4例鞘膜积液消失，2例术后复发，经穿刺成功治疗。
本研究表明，精索静脉曲张手术后鞘膜积液的中位发生率约为12%，但在不保留动脉与保留动脉手术相比时似乎更高（17.6%对4.3%）。相反，采用腹腔镜手术或开放手术进行该操作时未发现差异。鞘膜积液通常在数月后出现，但也可能在精索静脉曲张手术修复数年之后出现。非侵入性操作（阴囊穿刺或临床观察）似乎能使超过82%的病例鞘膜积液完全消退。接受精索静脉曲张手术的患儿应进行长期随访以发现可能出现的鞘膜积液。事实上，我们研究中5.4%失访的患儿可能潜在地出现了鞘膜积液。如手术修复后2例鞘膜积液复发所示，手术治疗这种情况并非总是成功的。
