Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain

OBJECTIVES: The aim of the present study was to assess and compare pre- and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches. METHODS: The study included 144 consecutive patients with left-sided varicocele who had left scrotal pain for more than 3 months. All patients underwent varicocele ligation using either a subinguinal or inguinal approach with or without external spermatic vein ligation. We asked the patients to complete an 'Assessment Questionnaire for Scrotal Pain' both before and after the surgery. RESULTS: The surgery was successful in 101 (83.4%) of the 121 patients available for follow up. Seventy-four (61.1%) patients reported the complete resolution of pain while 27 patients (22.3%) reported partial resolution. Symptoms worsened in a single case and pain persisted postoperatively in 19 cases (15.7%). There were no statistically significant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had external spermatic vein ligation and those who did not, regardless of the surgical approach (inguinal or subinguinal). All patients who reported complete or partial resolution of pain stated that they would recommend surgery to relatives with the same problem. CONCLUSIONS: Varicocelectomy using either inguinal or subinguinal approaches is an effective and reasonable treatment option in this patient group and should include external spermatic vein ligation for a satisfactory outcome.     

LigaSure vessel sealing system in laparoscopic Palomo varicocele ligation in children and adolescents

PURPOSE: We review our experience with laparoscopic Palomo varicocele ligation using the LigaSure device in children and adolescents. MATERIALS AND METHODS: Between June 2003 and December 2004, 25 varicoceles were treated by laparoscopic Palomo varicocele ligation using LigaSure vascular sealing. Patient ages ranged from 10 to 19 years (mean, 14.5 years). Indications for surgery included grade II-III varicocele or ipsilateral testicular hypotrophy. One patient was affected by recurrent contralateral inguinal hernia and 2 presented with an ipsilateral patent processus vaginalis. We placed a 5-mm umbilical port for access, and kept pneumoperitoneum below 15 mm Hg. Under laparoscopic guidance, two additional ports of 3 and 5 mm were inserted in the lower right and left quadrants, respectively. Once the vessels were isolated, the vascular sealant was applied 3-4 times to ensure coagulation of the spermatic vessels; the vessels were then divided with laparoscopic 5-mm scissors. Inguinal hernia and patent processus vaginalis were treated according to Schier's technique. All procedures were performed in our day surgery facility. RESULTS: Mean operative time was 18 minutes, which is significantly less than the time required in a similar group of 12 patients who underwent laparoscopic clip ligation. There were no perioperative complications. Eleven of 16 patients recovered testicular size. Two patients had postoperative hydrocele: the first was treated successfully with scrotal aspiration, while the other patient required scrotal hydrocelectomy. CONCLUSION: Laparoscopic Palomo varicocele sealing can be performed safely and rapidly and is highly successful in correcting varicoceles in young males. We also found it to be the ideal technique to correct the associated inguinal hernia or patent processus vaginalis.     

微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用：附视频

目的 探讨微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用价值.方法 回顾分析2012年1月至2013年1月期间中山大学附属第一医院东院收治的89例精索静脉曲张患者的临床资料.患者均行改良的腹股沟下显微精索静脉结扎术,2012年9月之前术中未应用微型血管多普勒,2012年9月之后术中常规应用微型血管多普勒辨别动脉和静脉.比较两组患者的临床资料.结果 89例患者共138次手术均获成功,术后随访3～6个月,未见睾丸萎缩和鞘膜积液发生.非多普勒组术中有1例精索内动脉被误扎,2例术中精索动静脉辨认不清,术后1例复发;多普勒组术中辨别动脉和静脉准确,无动脉损伤和误扎情况发生,术后无复发.结论 在微型血管多普勒辅助下行显微精索静脉结扎术更安全有效.     

Managing varicoceles in children: results with microsurgical varicocelectomy

Authors from New York present their experience of elective varicocelectomy, using microsurgical techniques, in a large series of children. They found the procedure to be safe and effective, and gave a much lower complication rate than the published rate in open varicocelectomy. The results of urethroplasty in post-traumatic paediatric urethral strictures are presented by authors from Mansoura. They found the overall success of one-stage perineal anastomotic repair of such strictures to be excellent, with very little morbidity. OBJECTIVE: To report our experience of microsurgical subinguinal varicocelectomy in boys aged < or = 18 years. PATIENTS AND METHODS: Boys aged < or = 18 years treated with microsurgical varicocelectomy between 1996 and 2000 at one institution were retrospectively reviewed. Indications for surgery included ipsilateral testicular atrophy, large varicocele or pain. Microsurgery was assisted by an operating microscope (x10-25) allowing preservation of the lymphatics, and the testicular and cremasteric arteries. Patient age, varicocele grade, complications and follow-up interval were recorded. RESULTS: In all there were 97 microsurgical subinguinal varicocelectomies (23 bilateral) in 74 boys (mean age 14.7 years). Left-sided varicoceles were significantly larger (mean grade 2.9) than right-sided (mean grade 1.4) varicoceles. The mean follow-up was 9.6 months. There were four complications: two hydroceles, of which one resolved spontaneously after 4 months; one patient had persistent orchialgia that resolved after 8 months; and one developed hypertrophic scarring at the inguinal incision site. There were no infections, haematomas or intraoperative injuries to the vas deferens or testicular arteries. All boys were discharged home on the day of surgery. CONCLUSIONS: Microsurgical subinguinal varicocelectomy in boys is a safe, minimally invasive and effective means of treating varicoceles. Compared with published results of the retroperitoneal mass ligation technique, which has a 15% overall complication rate and a 7-9% hydrocele occurrence rate, the microsurgical subinguinal approach appears to offer less morbidity, with a 1% hydrocele rate. We consider that microsurgical subinguinal varicocelectomy offers the best results with lower morbidity than other techniques.     

Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume: using the prader orchidometer versus ultrasonography

INTRODUCTION: The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy. The aim of this study was to prospectively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes. PATIENTS AND METHODS: This study included 68 boys with varicoceles, ranging in age from 8 to 19 years. Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography. The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography. A difference of more than 10% or 2 ml in each testicular volume was considered significant. RESULTS: The mean age of the boys was 13.5 +/- 2.3 years. On physical examination, a left unilateral varicocele was diagnosed in 46 boys (67.6%). The other 22 boys (32.4%) had bilateral varicoceles. Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys (8.7%) who were diagnosed by physical examination as having only left unilateral varicoceles (grade 3 in 3 patients and grade 2 in 1 patient). A different of more than 10% or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles (2.2%). The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test (r = 0.997 and p < 0.001 for the left testis; r = 0.998 and p < 0.001 for the right testis). CONCLUSIONS: Although the management of subclinical varicoceles remains controversial, these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles, especially in boys with high-grade left varicoceles. In contrast, scrotal ultrasonography, if considered the gold standard, did not show superiority over the Prader orchidometer in measuring testicular volumes.     

Comprehensive laparoscopic approach to pediatric varicocele based on preoperative color Doppler ultrasound assessment

Background This study aimed to assess whether laparoscopic treatment for any kind of varicocele is possible after preoperative identification of refluxing veins by color Doppler ultrasound (CDUS). Methods At the authors’ institution, 98 patients with a median age of 11.3 years (range, 7.1–16 years) were evaluated for a left varicocele. Preoperatively, all the patients underwent ultrasound scan assessment of testicular volume and CDUS to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. In all the patients, laparoscopic division of the spermatic artery and veins was performed as close as possible to the internal inguinal ring. The other vessels were coagulated and divided if shown to be refluxing on CDUS. Results Color Doppler ultrasound showed reflux only in the ISV in 87 cases (88.7%), but in both the ISV and the deferential in the remaining 11 cases (11.2%). During a median follow-up period of 18 months (range, 6–49 months), none of the authors’ patients experienced varicocele recurrence either clinically or according to CDUS scanning. The median left testicular volume increased significantly postoperatively. Conclusion The proposed technique based on laparoscopic interruption of the ISV and testicular artery very close to the internal inguinal ring, meticulous CDUS assessment to rule out reflux in the deferential vein, and coagulation of refluxing deferential veins allows successful laparoscopic treatment of most varicoceles.     

Retroperitoneal high ligation versus subinguinal varicocelectomy: Effectiveness of two different varicocelectomy techniques on the treatment of painful varicocele

In the present study, we compared the retroperitoneal high ligation with subinguinal varicocelectomy on the treatment of painful varicocele. A total of 90 patients who underwent retroperitoneal high ligation (n = 45) and subinguinal varicocelectomy (n = 45) for painful varicocele were included in this prospective study. Varicocele in all patients was diagnosed with by physical examination and coloured Doppler ultrasonography. All the patients underwent a conservative treatment for pain for 4 weeks. Patient ages, varicocele grades, preoperative pain scores, postoperative pain scores at 6 months, duration of surgeries, complications and recurrences were recorded. Complete success rate for chronic scrotal pain was found to be 80% in retroperitoneal varicocelectomy group and 71% in subinguinal varicocelectomy group. Partial success rate was 11% for retroperitoneal varicocelectomy group and 18% for subinguinal ligation group. There was no significant difference between two groups in terms of pain and complications. However, the operation time was significantly lower in the Palomo group. Although microsurgical subinguinal varicocelectomy is the current approach for the treatment of varicocele, retroperitoneal high ligation can achieve the same pain resolution with shorter operative duration compared to loupe‐assisted subinguinal varicocelectomy.     

腹股沟下途径显微技术精索静脉输精管同时结扎1例报告并文献复习

目的：探讨显微技术下同时施行输精管和精索静脉结扎术的安全性和有效性.方法：患者,39岁,因计划生育政策需行输精管结扎,患者合并双侧精索静脉曲张（右侧Ⅱ度,左侧Ⅰ度）以及右阴囊坠胀不适,显微技术下同时施行输精管和精索静脉结扎术.结果：1、3、6个月分别复诊,患者无阴囊不适感;触诊以及阴囊超声未见阴囊及其内容物水肿征象,右侧精索静脉无曲张复发,无睾丸萎缩.3个月辅助检查精液中无精子.结论：显微技术下同时施行输精管结扎和精索静脉结扎术,既保护淋巴管、睾丸动脉,又可以明确保留输精管脉管系统的完整性,保证了睾丸的充分的静脉回流,安全、有效.     

Modified microsurgical subinguinal varicocelectomy without testicular delivery

The aim of this study is to report our experience of modified microsurgical subinguinal varicocelectomy without delivery of the testes. We retrospectively evaluated 138 men treated with microsurgical varicocelectomy who took part in 1-year follow-up between 1997 and 2007. The varicoceles were grade III in 115 (81.6%), grade II in 23 (16.3%), and grade I in 3 (2.1%) men. We used a technical modification of the standard microsurgical subinguinal technique: division of the spermatic cord before microsurgical dissection, and the testes were not delivered. Patient age, varicocele grade, operation time, 1-year follow-up results, including complications, symptom relief, and recurrence, were recorded. We performed 141 varicocelectomies (Left: n = 135; bilateral: n = 3) in 138 men. The patients' mean age was 23.5 ± 2.7 (range: 11-45) years. The mean operation time was 69.6 ± 15.6 (range: 35-140) min. There were three complications (2.2%; post-operative haematomas: n = 2; wound infection: n = 1) and 6 recurrences (4.3%; grade II: n = 1; grade III: n = 5). Among the 86 patients with scrotal pain, 74 (77.9%) reported complete resolution of pain and 13 (12.9%) reported partial resolution. Modified microsurgical subinguinal varicocelectomy without testis delivery is safe and effective.     

Varicocele anatomy during subinguinal microsurgical varicocelectomy in Chinese men

Knowledge of subinguinal microsurgical varicocelectomy is of fundamental importance to ensure that varicocele is resolved and testicular function is preserved. Our study aimed to describe the number of veins, arteries and lymphatics in the subinguinal spermatic cord and to clarify their differences between two sides, between patients with different complaints and between varicoceles with different clinical grades. A total of 102 consecutive patients underwent 162 primary subinguinal microsurgical varicocelectomies, during which the number of vessels with different diameters was recorded. A mean number of 12.9 internal spermatic veins, 0.9 external spermatic veins, 1.8 internal spermatic arteries and 2.9 lymphatics were identified per cord. 88.2% of the internal spermatic arteries were surrounded by a dense complex of adherent veins. The external spermatic vein or veins were found in 49.4% of the cases. The mean number of medium (1–3 mm in diameter) internal spermatic veins on the left was larger than that on the right (P < 0.001). The mean number of medium internal spermatic veins in grade III varicocele was larger than that in grade I or grade II (P < 0.015). There was no significant anatomical difference between the men presenting for infertility, chronic testicular pain and both the two complaints.     

Laparoscopic ligation of varicoceles: an anatomically superior operation.

Since December 1991, 25 consecutive symptomatic male patients with 26 varicoceles were treated by laparoscopic ligation of internal spermatic veins under general anaesthesia. Twenty-one patients had either scrotal discomfort or painful swelling and four patients presented with infertility. The mean follow-up period is 5 months (range 3 weeks to 9 months). The procedure has provided a satisfactory outcome in 19 out of 21 patients (90.5%) with scrotal symptoms. Of the four patients presenting with infertility due to oligospermia, three had significantly elevated sperm counts at 3 months which resulted in one pregnancy. So far there has been no recurrence of the varicocele. The main potential advantage of the laparoscopic approach is better visualisation of the anatomy, especially the testicular artery and the collateral venous circulation at the level of the internal inguinal ring. In addition to being less invasive with implied benefits, the endoscopic procedure has enabled identification of multiple veins in 22 out of 26 (84.6%) varicoceles in our series.     

Antegrade scrotal sclerotherapy in the treatment of varicocele: a prospective study

OBJECTIVE: To assess the results of our experience in correcting primary varicocele using a modified technique of antegrade scrotal sclerotherapy. PATIENTS AND METHODS: From December 1997 to February 2000, 201 patients with primary varicocele underwent antegrade scrotal sclerotherapy. Before treatment all patients were evaluated by a physical examination, colour Doppler ultrasonography of the spermatic cord, and abdominal and scrotal ultrasonography. Sperm samples were analysed only in patients aged > 18 years. The treatment was administered using a special venous catheter system with a Y-adapter. Complications after treatment and the rate of persistence of reflux were assessed 3 and 6 months after the antegrade scrotal treatment, by clinical examination and colour-Doppler ultrasonography of the spermatic cord. RESULTS: The mean operative duration was 15 min; there were no significant complications during treatment and all patients were discharged within 4 h. Complications after treatment occurred in 10 of the 201 patients (5%); four patients had epididymo-orchitis, three a scrotal haematoma, one a surgical wound infection, one persistent scrotal pain and one persistent flank pain on the same side as the surgery. Reflux was persistent in 12 patients (6%). CONCLUSIONS: Antegrade scrotal sclerotherapy is a simple, minimally invasive and highly effective technique for blocking spermatic vein reflux, with a low rate of complications. The technical changes simplified the cannulation of the spermatic vein and facilitated antegrade phlebography and sclerotherapy using the air-block technique.     

显微镜辅助下精索静脉曲张结扎术与腹腔镜下精索静脉曲张结扎术疗效分析(附60例报告)

目的 比较显微镜辅助下经外环口精索静脉曲张结扎术与腹腔镜精索静脉结扎术治疗精索静脉曲张的疗效差异.方法 60例精索静脉曲张合并精液质量异常患者,随机分为两组,经外环口显微镜辅助下精索静脉结扎术组(显微镜组,30例)和腹腔镜精索静脉结扎术组(腹腔镜组,30例),两组手术前各指标差异无统计学意义.比较两组手术时间、住院费用、住院天数、术后并发症的发生、精液质量的变化.结果 两组在手术时间、术后住院天数、住院费用、术后腹胀、阴囊肿胀均具有显著性差异(P＜0.05),术后复发、术后附睾炎、睾丸萎缩、术后精液质量变化无显著性差异(P＞0.05).结论 经外环口位置行显微镜下精索静脉结扎术治疗精索静脉曲张是一种安全、有效、简便、经济及便于推广的手术治疗方式.     

Microsurgical treatment of varicocele in outpatients using the subinguinal approach.

BACKGROUND: The aim of this study is to analyze the results of a group of patients who underwent subinguinal microsurgical varicocelectomy using local anaesthesia in one-day-surgery. METHODS: From 1997 to 1998 150 patients were selected from the whole group of patients who underwent surgical treatment for varicocele. The varicocele was always on the left side and the mean age was 27.1 years (range: 16-43). The diagnosis was based on clinical features (testicular pain or scrotal sensation), physical examination and Doppler ultrasound. Where there was infertility with abnormal semen analysis and/or patient's intolerance to the symptoms, surgery was suggested. The patients underwent varicocelectomy by sub-inguinal approach using local anaesthesia. The microsurgical technique of dissection was performed. RESULTS: All operations were performed on an outpatient basis (post-operative stay: 3-7 hours) and the operating time was 20 to 45 minutes. Follow-up was performed by physical examination, doppler ultrasound and semen analysis. Immediate and long-term complications were: 7 (4.7%) transient pain, 3 (2.0%) ecchymosis, 1 (0.7%) transient hydroceles and 1 (0.7%) permanent hydroceles, 2 (1.3%) palpable recurrence, 2(1.3%) doppler recurrence and 1 (0.7%) long-term recurrence, 0 testicular atrophy. 120/150 (80%) patients showed an improvement of semen analysis and 19/41 (46.3%) patients with infertility achieved a pregnancy with the partner. CONCLUSIONS: Microsurgical treatment of varicocele in outpatients by subinguinal approach is a safe and reliable procedure. It is performed in local anaesthesia, preserves the lymphatics, spermatic artery and vas and in our experience showed an improvement of semen analysis and pregnancy rates with minimal morbidity.     

Laparoscopic spermatic vessel ligation in the treatment of varicocele: report of 129 procedures

With the improvement of laparoscopic techniques in the hands of urologists, a minimally invasive therapy can be offered to patients. We report retrospectively our experience in the laparoscopic treatment of varicoceles. A total of 93 patients with 129 varicoceles were treated by a laparoscopic approach, the mean age was 29 years (12-47), with 57 left varicoceles and 36 bilateral varicoceles. Indications for treatment were infertility in 51 patients and pain in 42 cases. The mean duration of the operation was 40 min (25-85) for bilateral varicoceles, and 24 min (15-65) for left varicoceles. All our patients were operated the day of their admission and 52 patients left the hospital 8 h after the intervention. We report 2 incidents with conversion to open surgery in one case. The pregnancy rate after surgery in patients with infertility was 21%, the recurrence rate was 4%. Laparoscopic spermatic vein ligation in the treatment of varicocele is a minimally invasive procedure, simple, fast and is not a contraindication for other procedures in case of recurrence.     

Lymphatic sparing laparoscopic Palomo varicocelectomy for varicoceles in children: intermediate results

Objectives

Varicocele is a relatively rare disorder in children that can lead to testicular atrophy and infertility. The ideal surgical treatment for varicoceles is still a matter of controversy because of the frequency of postoperative complications. Here, we report our series of children who underwent lymphatic sparing laparoscopic Palomo varicocelectomy.

Patients and Methods

A total of 46 boys, 9 to 14 years old, underwent laparoscopic repair for varicoceles between January 2002 and December 2007. All of them had a left-sided varicocele. The varicocele was diagnosed by physical examination and Doppler ultrasonography. The laparoscopic procedure included obligatory dissection and preservation of the lymphatic vessels, followed by double ligation of the spermatic vessels. Follow-up for these children included physical examination and Doppler ultrasonography.

Results

Lymphatic sparing laparoscopic Palomo varicocelectomy was feasible in all 46 (100%) of the children. Mean operative time was 34.2 minutes (range, 25-42 minutes). There were no intraoperative complications. One patient recurred because of incomplete ligation of spermatic vein. Mean follow-up was 20 months (range, 7-32 months). Hydrocele formation, testicular atrophy, and testicular hypertrophy were not observed postoperatively. However, 2 preoperative hypotrophic testes were noted with 10.4% and 12.5% decreases in size.

Conclusions

Our study reveals that lymphatic sparing laparoscopic Palomo varicocelectomy in children is safe, effective, and the reliable treatment of pediatric varicocele. However, long-term follow-up is required to best characterize ultimate outcome.     

Laparoscopic treatment of pediatric varicocele: a multicenter study of the italian society of video surgery in infancy

PURPOSE: We report preliminary results of a multicenter study of the Italian Society of Video Surgery in Infancy on the laparoscopic treatment of pediatric varicocele. MATERIALS AND METHODS: A total of 161 children 6 to 16 years old (median age 12.5) underwent laparoscopic treatment of varicocele at 6 pediatric surgery divisions. Varicocele was on the left side in 159 cases (98.7%) and bilateral in 2 (1.3%). Two boys had recurrent left varicocele. All children were treated with laparoscopy, including ligation of the spermatic veins only in 28 (17.3%), and ligation of the testicular veins and artery in 133 (82.7%). In 10 boys (6.2%) an additional procedure was done simultaneously, including closure of an apparently patent peritoneal vaginal duct on the right side in 7 and resection of epiploic adhesions between the intestinal loops and abdominal wall from previous appendectomy in the remaining 3. RESULTS: Average operative time was 30 minutes and hospitalization was about 24 hours. At followup there were 13 minor complications (8%), including left hydrocele in 9 children who underwent the Palomo technique, minor scrotal emphysema in 2 and umbilical granuloma in 2. In our series varicocele recurred in 1 boy (3.5%) who underwent ligation of the spermatic veins only and in 3 (2.2%) treated with the Palomo technique. CONCLUSIONS: Our preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. However, the important advantages of laparoscopy over the open approach are its minimal invasiveness and precision of intervention. Moreover, laparoscopy allows treatment of other intra-abdominal pathological conditions using the same anesthesia, as in 10 patients in our series. We believe that ligating the testicular veins and artery is preferable to ligating the testicular veins only, even if the incidence of hydrocele is not negligible after the Palomo procedure.     

Intratesticular varicocele in adolescents: a reversible anechoic lesion of the testis

PURPOSE: We describe ultrasonographic and clinical findings in adolescents with intratesticular varicocele. MATERIALS AND METHODS: Three adolescent boys 12 to 16 years old each had a large intratesticular multicystic lesion on scrotal Doppler ultrasound for a large extratesticular varicocele. The presence of active Doppler flow within the anechoic lesions supported the diagnosis of intratesticular varicocele. RESULTS: All 3 boys underwent spermatic vein ligation for varicocele. In each case scrotal Doppler ultrasound at 3 months postoperatively demonstrated resolution of the intratesticular anechoic lesions and Doppler flow, confirming the diagnoses of intratesticular varicocele. CONCLUSIONS: Intratesticular varicocele is a clinically occult lesion that may occur in conjunction with extratesticular varicocele. This entity is apparent on scrotal Doppler ultrasound as an intratesticular anechoic lesion with active Doppler flow, and has been shown to resolve following spermatic vein ligation. Its clinical significance has not yet been defined.     

不同手术方式治疗精索静脉曲张的疗效比较

目的 比较高选择性精索静脉高位结扎术、经腹股沟管入路精索静脉结扎术和腹腔镜下改良Palomo术3种方法治疗精索静脉曲张的效果. 方法回顾性分析Ⅱ度以上原发性精索静脉曲张患者1075例,685例获随访.根据手术方式分3组:A组为高选择性精索静脉高位结扎术组,369例;B组为经腹股沟管人路精索静脉结扎术组.218例;C组为腹腔镜下改良Palomo术组,98例.对比观察3组术后阴囊水肿,睾丸、局部皮肤疼痛、麻木,睾丸萎缩,复发等远、近期并发症及精液改善和生育情况. 结果 A、B、C 3组复发率分别为3.3%(12/369)、7.3%(16/218)、5.1%(5/98),A、B组间比较差异有统计学意义(P<0.05);术后3个月睾丸萎缩发生率分别为0.5%(2/369)、17.9%(39/218)、9.2%(9/98),3组间比较差异有统计学意义(P<0.05);术后阴囊水肿发生率分别为1.4%(5/369)、17.4%(38/218)、16.3%(16/98),A组与B、C组间比较差异有统计学意义(P<0.05).A组≤30岁患者术后3～6个月精液质量提高率和术后1～2年配偶自然怀孕率高于其他2组≤30岁患者(P30岁者(P<0.05). 结论 高选择性精索静脉高位结扎术简单且术后阴囊水肿和睾丸萎缩发生率低,术后精液质量提高率和术后1～2年内配偶自然怀孕率高,值得临床推广.     

Efficacy of Indocyanine Green Angiography on Microsurgical Subinguinal Varicocelectomy

Objectives: Microsurgical subinguinal varicocelectomy is one of the best treatment modalities for varicoceles related to male infertility and scrotal pain. However, the difficulty in identifying testicular arteries, which should be spared, is a limitation of this technique. To visualize and identify the testicular arteries in spermatic cord during the operation, we examined the efficacy of intraoperative indocyanine green angiography (ICGA), which is regularly used in microsurgical neurosurgery. Methods: After the exposure of the spermatic cord blood vessels, ICG was injected intravenously under a surgical microscope for observing infrared fluorescence in patients to identify and isolate the testicular artery. Results: The testicular artery was clearly identified by ICGA and was able to separate under ICGA view. Thereafter, the varicose veins were repeatedly ligated, while preserving a few lymphatic vessels and the spermatic duct. The preserved arteries were confirmed by repeated ICGA at the end of microsurgical operation. The number of arteries identified by ICGA was greater than the number detected by preoperative computed tomography angiogram. Conclusions: Microsurgical subinguinal varicocelectomy using intraoperative ICGA facilitated safe and quick surgery by enabling the visualization of the spermatic cord blood vessels. This is the first report to indicate the usefulness of vessel visualization by ICGA during microsurgical subinguinal varicocelectomy.