Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
J Urol. 2011 Dec;186(6):2402-7. doi: 10.1016/j.juro.2011.07.116. Epub 2011 Oct 21.
There is wide variation in the reported incidence of hydrocele after varicocelectomy (0% to 29%). We determined the incidence of hydroceles and hydrocelectomy following adolescent varicocelectomy, the time it took for them to manifest, and the results of aspiration and surgical correction.
Our adolescent varicocele registry was reviewed to identify patients with a post-varicocelectomy hydrocele. We evaluated physical examination and ultrasound findings, postoperative interval to development and treatment results.
A total of 400 patients with at least 6 months of postoperative followup underwent 521 varicocelectomies (16 redo, 1 right, 104 bilateral) from 1987 to 2010. Mean followup was 32 months (range 6 to 182). Hydrocele was detected in 80 of 521 (15.4%) at a mean of 2 years after surgery. The incidence of hydrocele was higher in open vs laparoscopic (p <0.001), bilateral vs unilateral (p = 0.013), nonlymphatic sparing vs lymphatic sparing (p = 0.043) and Palomo vs laparoscopic nonlymphatic sparing (p = 0.001) procedures. Eight patients underwent aspiration for a large postoperative hydrocele. In all 8 patients fluid returned to pre-aspiration status. There were 29 patients (5.6%) who underwent Jaboulay bottleneck hydrocelectomy and none had recurrence.
Hydroceles are a common sequela of varicocelectomy, with the fewest hydroceles occurring after laparoscopic lymphatic sparing varicocelectomy. Patients should be followed for at least 2 years after varicocelectomy to examine for the presence of hydroceles. Although there have been reports on the use of aspiration for post-varicocelectomy hydrocele, we have not had success in those with a single aspiration. Jaboulay bottleneck hydrocelectomy had a 100% success rate in this select group.
精索静脉曲张手术后（0%至 29%）发生鞘膜积液的报道存在很大差异。我们确定了青少年精索静脉曲张手术后鞘膜积液的发生率、发生时间、抽吸和手术矫正的结果。
我们回顾了青少年精索静脉曲张登记处，以确定精索静脉曲张手术后有鞘膜积液的患者。我们评估了体格检查和超声检查结果、手术后发生时间和治疗结果。
1987 年至 2010 年，共有 400 例至少有 6 个月术后随访的患者接受了 521 例精索静脉曲张手术（16 例再手术，1 例右侧，104 例双侧）。平均随访时间为 32 个月（6 至 182 个月）。术后 2 年平均发现 521 例中有 80 例（15.4%）发生鞘膜积液。开放手术与腹腔镜手术（p <0.001）、双侧与单侧（p = 0.013）、非淋巴保留与淋巴保留（p = 0.043）和 Palomo 与腹腔镜非淋巴保留（p = 0.001）相比，鞘膜积液的发生率更高。8 例患者因术后大的鞘膜积液而行抽吸术。所有 8 例患者的液体均恢复至抽吸前状态。29 例（5.6%）患者行 Jaboulay 瓶颈式鞘膜积液切除术，无复发。
鞘膜积液是精索静脉曲张手术后的常见后遗症，腹腔镜淋巴保留精索静脉曲张手术后鞘膜积液最少。患者应在精索静脉曲张手术后至少随访 2 年，以检查鞘膜积液的存在。虽然有报道称抽吸术可用于精索静脉曲张术后鞘膜积液，但我们对单次抽吸术的效果并不满意。在这一选择的患者组中，Jaboulay 瓶颈式鞘膜积液切除术的成功率为 100%。
