Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital, New York Presbyterian, New York, New York 10032, USA.
J Urol. 2010 Oct;184(4 Suppl):1716-21. doi: 10.1016/j.juro.2010.03.123. Epub 2010 Aug 21.
Varicocelectomy after previous inguinal surgery poses a potential risk of testicular volume loss. To assess the extent to which varicocelectomy can be done without the complication of ipsilateral testis atrophy we present outcomes in adolescent patients with a history of inguinal surgery who underwent ipsilateral varicocelectomy.
We retrospectively reviewed patient data from a single urologist practice. Testicular volume was recorded preferentially by ultrasound or, when unavailable, by ring orchidometry. Testicular asymmetry was calculated using the formula, [(right testis volume - left testis volume)/right testis volume] × 100. Symmetry was defined as less than 10% asymmetry. Catch-up growth was defined as resolution of asymmetry.
We identified 22 adolescent patients who fit study criteria. The patients underwent a total of 25 varicocelectomies since 3 underwent bilateral repair after previous bilateral inguinal surgery. Initial inguinal surgery included inguinal herniorrhaphy, hydrocelectomy and orchiopexy. Varicocelectomy was done laparoscopically in 17 cases and via open technique in 8 with variations in preservation/sacrifice of the lymphatics and artery. Median ± SD followup was 24.2 ± 18.2 months. After varicocelectomy mean testicular asymmetry decreased from 27.6% to 10.5%. There was no incidence of testicular atrophy postoperatively. The incidence of catch-up growth was 43% with no difference between the artery sparing and the nonartery sparing technique.
Varicocelectomy with a history of previous inguinal surgery is safe and provides a significant incidence of testicular catch-up growth. Artery sparing vs sacrificing technique did not make a difference in terms of catch-up growth.
既往腹股沟手术史行精索静脉曲张手术可能存在睾丸体积损失的风险。为评估精索静脉曲张手术而不发生同侧睾丸萎缩的并发症的程度，我们报告了既往接受过腹股沟手术且行同侧精索静脉曲张手术的青少年患者的结局。
我们回顾性分析了单名泌尿科医生手术实践中的患者数据。睾丸体积通过超声记录，若不可用，则通过环睾丸测量法记录。使用公式[(右侧睾丸体积-左侧睾丸体积)/右侧睾丸体积]×100 计算睾丸不对称性。定义对称性小于 10%的不对称性。追赶生长定义为不对称性的解决。
我们确定了 22 名符合研究标准的青少年患者。这些患者总共接受了 25 次精索静脉曲张手术，因为 3 例患者在既往双侧腹股沟手术后接受了双侧修复。初始腹股沟手术包括腹股沟疝修补术、鞘膜积液切除术和睾丸固定术。17 例采用腹腔镜手术，8 例采用开放手术，保留/牺牲淋巴管和动脉的方法存在差异。中位随访时间为 24.2±18.2 个月。精索静脉曲张手术后，平均睾丸不对称性从 27.6%下降至 10.5%。术后无睾丸萎缩发生。追赶生长的发生率为 43%，保留动脉和不保留动脉技术之间没有差异。
既往腹股沟手术史行精索静脉曲张手术是安全的，并提供了显著的睾丸追赶生长发生率。保留动脉与不保留动脉技术在追赶生长方面没有差异。
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