Division of Pediatric Urology, Department of Urology, Morgan Stanley, Children’s Hospital and New York-Presbyterian Columbia University, College of Physicians and Surgeons, New York, NY, USA.
Urology. 2011 May;77(5):1194-8. doi: 10.1016/j.urology.2010.10.013. Epub 2011 Jan 22.
To review outcomes in adolescent patients following redo varicocelectomy surgery.
The composite varicocele registry of a single surgeon was queried to identify patients who had undergone redo varicocelectomy. Variables of testicular asymmetry, testicular volume, presence and degree of retrograde venous flow, and incidence of postoperative hydrocele were evaluated.
Nineteen boys were identified as having had a redo varicocelectomy (16 open, 1 laparoscopic, 2 radiographic embolization) with a minimum postoperative follow-up of 6 months (mean: 23.4; range: 6-53 months). No varicocele was palpable postoperatively among the 17 surgical redoes; one patient's testicle was significantly smaller after surgery, and 3 developed a hydrocele requiring repair. One of two boys who underwent radiographic embolization had a persistent varicocele. Eight of the nine boys who had asymmetry of 10% or greater before redo demonstrated catch-up growth after repair. The consistent intraoperative finding in all redo patients was the presence of large veins within the cord, just proximal to the junction with the vas and in continuity with the dilated veins distal to the internal ring. Post-redo retrograde venous flow was not identifiable in 16 and minimal in three.
Redo varicocelectomy can be accomplished successfully and has a similar chance of achieving catch-up growth as does an initial repair. Postoperatively, there exists a small risk of testicular volume compromise and a significant risk of hydrocele development. Distal collateral veins may have a smaller role in varicocele formation and recurrence than previously thought.
回顾青少年患者行再次精索静脉曲张手术后的结局。
查询一位外科医生的精索静脉曲张综合数据库，以确定接受再次精索静脉结扎术的患者。评估睾丸不对称、睾丸体积、逆行静脉回流的存在和程度，以及术后阴囊水肿的发生率。
19 名男孩被确定为接受了再次精索静脉曲张手术（16 例开放手术，1 例腹腔镜手术，2 例放射栓塞），术后随访至少 6 个月（平均：23.4 岁；范围：6-53 个月）。在 17 例手术再修复中，术后均无法触及精索静脉曲张；1 名患者的睾丸明显缩小，3 名患者出现需要修复的阴囊水肿。2 例接受放射栓塞的男孩中，有 1 例精索静脉曲张持续存在。在再次修复前睾丸体积不对称大于 10%的 9 名男孩中，有 8 名显示出追赶性生长。所有再次修复患者的一致术中发现是在精索内静脉与输精管交界处近端的精索内存在大静脉，与内环远端扩张的静脉连续。16 例术后逆行静脉回流不可识别，3 例术后逆行静脉回流轻微。
再次精索静脉曲张手术可以成功完成，并且与初次修复一样有类似的实现追赶性生长的机会。术后存在睾丸体积受损的小风险和阴囊水肿发展的显著风险。与之前的想法相比，远端侧支静脉在精索静脉曲张形成和复发中的作用可能较小。
