腹腔镜精索血管高位集束结扎术治疗精索静脉曲张术后睾丸发育评估

目的总结和评估腹腔镜精索血管高位集束结扎术(Palomo术)治疗精索静脉曲张的疗效和术后睾丸发育情况。方法腹腔镜Palomo术治疗31例精索静脉曲张患儿,术前后B超测量患侧曲张静脉的最大直径及两侧睾丸大小,计算睾丸体积,以观察术后静脉恢复情况及术后睾丸体积变化;采用彩色Doppler评估两侧睾丸血液供应,比较术前后睾丸血运。结果腹腔镜Palomo术后1个月精索曲张静脉最大直径较术前明显减小(P<0.01);术后患侧睾丸血液供应无减少;患侧睾丸体积术后增长明显快于健侧(t=2.28 P<0.05),至术后6个月患侧睾丸体积与健侧相仿。结论腹腔镜Palomo术治疗精索静脉曲张安全,简便,患侧睾丸术后有一个补偿性生长过程,无睾丸萎缩和发育不良,手术效果满意。     

双侧高位隐睾腹腔镜下一期下降固定22例

目的探讨双侧高位隐睾腹腔镜下一期睾丸下降固定术的临床疗效。方法回顾性分析22例双侧高位隐睾患儿的临床资料,平均年龄3．9（1．1～11．7）岁,均于腹腔镜下行一期睾丸下降同定术。结果22例中,除3侧睾丸缺如外,其余41侧均顺利完成一期睾丸下降同定,其中26侧行一期Fowler—Stephens手术。术后随访6～40个月,平均随访22个月,下降的睾丸无回缩、无萎缩。结论双侧高位隐睾行腹腔镜下一期睾丸下降固定术是可行的。     

保留睾丸手术治疗睾丸良性肿瘤疗效分析

目的 探讨保留睾丸手术治疗睾丸良性肿瘤的疗效。方法回顾性分析1996～2003年收治睾丸良性肿瘤16例，术中均行冷冻切片活检，病理证实为睾丸良性肿瘤后行保留睾丸手术。对14例患儿进行术后随访，随访时间6个月～7年，平均4．5年。结果术中冷冻切片病理结果均与术后石蜡切片病理结果完全一致，睾丸囊性成熟型畸胎瘤10例，睾丸表皮样囊肿4例，睾丸黏液囊肿2例。随访患侧睾丸大小正常，无肿瘤复发迹象。结论 保留睾丸手术是睾丸良性肿瘤行之有效的治疗方法；该手术保留睾丸组织，对患儿心理发育、内分泌功能及生育能力等方面至关重要。     

保留睾丸的肿瘤剜除术治疗儿童良性睾丸肿瘤

目的评价保留睾丸的肿瘤剜除术治疗儿童良性睾丸肿瘤的临床疗效。方法回顾性分析1998年10月到2009年3月收治的29例保留睾丸的肿瘤剜除术患儿临床资料。患儿平均发病年龄为42．6个月（4个月至12岁）,临床表现均为无痛性阴囊肿块,除1例术前AFP升高外,其余术前AFP均在正常范围。结果均行保留睾丸的肿瘤剜除术,术后病理诊断：21例为成熟性畸胎瘤,2例为表皮囊肿,4例为皮样囊肿,1例为囊肿性病变伴肉芽肿形成,1例为未成熟畸胎瘤（后行睾丸切除术）。25例冰冻切片均诊断为良性病变。21例B超下计算肿瘤体积为（1．25±2．05）mL,患侧睾丸体积（含肿瘤）为（4．56±5．07）mL,肿瘤占睾丸体积比例为（54．3±30．11）％（6．04％～100％）。7例最近1次门诊随访术侧平均睾丸体积为（0．78±0．31）mL,与健侧比较无统计学意义。20例平均获随访34个月（4～72个月）,无一例复发,患侧睾丸发育良好。结论保留睾丸的肿瘤剜除术可作为小儿睾丸良性肿瘤的首选治疗方法。     

微型腹腔镜下睾丸下降固定术40例

目的 探讨微型腹腔镜下睾丸下降固定术在儿童隐睾中的应用.方法 2010年6月至2011年6月,我们对40例隐睾患儿施行微型腹腔镜睾丸下降固定术.术中行单侧睾丸下降固定术33例,双侧5例,一期Fowler-Stephens手术4例.术中见睾丸萎缩2例,除2例睾丸萎缩病例外,其余病例均行患侧疝囊高位结扎术,对侧疝囊高位结扎术7例.结果 40例患儿均顺利完成手术,无中转开放手术.单侧手术时间30~45 min,平均38 min,双侧手术时间54~78 min,平均64 min.随访12～24个月,平均18个月,无睾丸回缩、睾丸萎缩、腹股沟疝等并发症.结论 微型腹腔镜下睾丸下降固定术治疗儿童隐睾创伤小,睾丸下降完全,安全有效,并发症少,可作临床推广应用.     

儿童异位睾丸13例诊疗体会

目的探讨异位睾丸患儿的诊断和治疗, 提高临床医生对该疾病的认识。方法回顾性分析2014年9月至2019年7月昆明市儿童医院泌尿外科收治的13例异位睾丸患儿临床资料, 从病变类型、病因、临床诊断与治疗方法及预后等方面总结诊治经验。结果 13例异位睾丸患儿年龄6～84个月, 中位年龄19个月;染色体检查结果均为男性。睾丸横过异位4例, 其中2例为腹膜后横过异位, 1例为经腹腔对侧腹股沟横过异位, 1例为经对侧腹股沟下降至对侧阴囊。睾丸同侧异位9例, 左侧5例, 右侧4例, 异位于腹股沟皮下浅筋膜囊内5例、会阴部皮下组织2例、大腿内侧根部2例。对同侧非横过异位睾丸行开放性异位睾丸探查术;对横过异位睾丸行腹腔镜探查术, 术中证实苗勒氏管残留1例。13例患儿术中均探及异位睾丸, 并无张力固定于阴囊内。术后随访6个月至2年, 术后6个月、12个月患侧睾丸体积分别为(239.5±73.2)mm3、(239.0±79.5)mm3, 均较术前的(145.8±51.7)mm3明显增大(P<0.05);而术后6个月与术后12个月相比, B超显示患侧睾丸体积无明显变化(t=0.331, P=0.749)...     

保留淋巴管的腹腔镜精索静脉高位结扎术12例治疗体会

目的 探讨以亚甲蓝染色、保留精索淋巴管的腹腔镜精索静脉高位结扎术的可行性,并总结治疗经验及手术技巧.方法 回顾性分析2014年2月至2014年9月收治的12例精索静脉曲张患儿的临床资料.12例均为左侧,均以阴囊上方肿物就诊,其中10例伴有明显的阴囊坠胀感.所有患儿通过物理检查及B型超声确诊.其中Ⅱ级精索静脉曲张3例,Ⅲ级9例.B型超声检查表现为阴囊上方不规则血管团块,血管内径明显增宽,与对侧相比患侧睾丸体积均有不同程度缩小.手术年龄7～14岁,平均(11.42±1.78)岁.采用保留淋巴管的腹腔镜精索静脉高位结扎术,手术开始前通过阴囊穿刺在睾丸鞘膜与白膜之间注入亚甲蓝1 ml并轻柔按摩,使精索淋巴管染色.结果 11例患儿淋巴管成功显色并得以保留,10例患儿保留了睾丸动脉.术中出血量少,无1例中转开放手术.手术时间45～90 min,平均(58.33±12.12)min.所有患儿在术后第1天出院,除1例外,余者均无明显阴囊肿胀.随访5个月至1年,无一例发生鞘膜积液,无一例出现明显并发症.结论 通过在睾丸鞘膜囊内注射亚甲蓝能够使精索淋巴管染色,为手术中确切地保留淋巴管提供指引,而通过该方法保留淋巴管对减少术后鞘膜积液发生的意义尚需进一步随访明确.     

睾丸横过异位8例临床分析

目的探讨睾丸横过异位(TTE)的临床特点、诊断方法和治疗效果。方法回顾性分析2004年5月至2018年11月新乡市中心医院泌尿外一科、郑州大学第一附属医院小儿外科收治的8例TTE患儿的临床资料, 分析总结其临床特点、诊断方法、手术治疗效果及随访结果等。结果 8例TTE患儿, 年龄1岁5个月至5岁。左侧6例, 右侧2例。均因阴囊空虚就诊。合并苗勒管永存综合征(PMDS)3例, 合并尿道下裂1例。5例术前明确诊断, 其中超声诊断4例, 磁共振成像诊断1例。2例患儿行腹腔镜探查, 其中1例行腹腔镜下阴囊内固定术, 另1例因精索发育差而中转为开放手术(行跨阴囊纵隔睾丸固定术)。行开放手术探查的6例患儿中, 1例因精索黏连紧密行双睾丸同侧阴囊固定术, 另5例行跨阴囊纵隔睾丸固定术。3例PMDS患儿术中均切除苗勒管残留物。所有患儿术后未发生伤口感染和血肿, 1例行跨阴囊纵隔睾丸固定术患儿术后11个月发生睾丸附睾炎, 并波及对侧, 予抗炎治疗后好转。术后随访3个月至4年, 患儿超声检查均提示双侧睾丸大小及血供正常, 均未发生睾丸萎缩。结论对于单侧隐睾合并对侧腹股沟肿物患儿应考虑TTE的可能, 超声检...     

小儿非嵌顿性腹股沟斜疝对精索、睾丸影响的临床研究

目的：研究非嵌顿性腹股沟斜疝对精索、睾丸的影响。方法：阴囊外手法测定163例无嵌顿史、单侧腹股沟斜疝患儿睾丸体积,作为对照同时测定131例同年龄段正常儿双侧睾丸体积;患儿组有97例、对照组有82例,同时采用B超阴囊外测定。将采用不同方法测定的患儿睾丸体积分别进行统计学处理;同时将患儿组双侧睾丸体积差和对照组双侧睾丸体积差进行统计学处理。患儿组均手术治疗,术中观察精索静脉,术后3个月、6个月及6－12个月随访测定患睾体积的变化。结果：患儿组双侧睾丸体积有明显差异（P＜0．05）,患侧大于健侧;术后6个月内患睾与健睾仍存在较明显差异（P＜0．05）,术后6－12个月后双侧无明显差异（P＞0．05）。结论：非嵌顿性腹股沟斜疝对精索、睾丸的发育有不良影响,应重新认识腹股沟斜疝及其并发症。     

腹腔镜治疗不可触及型隐睾222例

目的探讨腹腔镜在未触及睾丸的隐睾患儿中的诊治作用。方法对2005年8月-2011年1月在本科诊治的222例未触及睾丸的隐睾患儿行腹腔镜探查(229个睾丸)。年龄12个月～16岁(平均56个月)。术前常规行阴囊腹股沟和盆腔超声检查。术后随访2～72个月(平均32个月)。随访内容包括触诊睾丸位置,判断是否有回缩,超声测量睾丸大小,判断睾丸是否有萎缩。结果经腹腔镜、腹股沟探查及术后病理证实睾丸缺如158个;睾丸残余11个;腹股沟型高位隐睾5个;睾丸位于腹腔55个。其中低位型隐睾20个,高位型隐睾35个。并卵黄管退化不全4例;真两性畸形1例,条索状性腺1例。行常规腹股沟开放手术15个睾丸,腹腔镜辅助下一次性睾丸固定术10个睾丸,Fowler-Stephens(F-S)分期睾丸固定术25个睾丸,F-S一期睾丸固定术8个睾丸,2个发育不良睾丸行腹腔镜下睾丸切除术。卵黄管退化不全者行始基子宫切除,条索状性腺行性腺切除术,两性畸形性腺活检一侧为睾丸,一侧为卵巢。术后随访患侧睾丸萎缩4个,包括行F-S一期睾丸固定术2个睾丸,腹股沟切口睾丸一次固定术1个睾丸,F-S分期固定术1个睾丸;睾丸回缩2个,均为腹股沟切口睾丸一次固定术。结论腹腔镜能够准确诊断未触及睾丸并进行相应治疗。对于腹腔内低位隐睾,腹腔镜辅助下一次性睾丸固定术效果好,明显优于常规手术。腹腔内高位隐睾适合行F-S分期手术。     

Laparoscopic treatment of varicoceles in children. Multicentric prospective study of 90 cases.

PURPOSE: The aim of this study was to assess the results of the laparoscopic treatment of varicoceles. MATERIAL AND METHODS: 92 observations were received, however 5 patients underwent a simultaneous associated open surgery; 90 varicoceles were evaluated (3 bilateral varicoceles). The dilated spermatic veins were treated by clips and partial resection in 74.7 %, by coagulation and partial resection in 21 %, and by clips in 4.3 %. The spermatic artery was ligated in 60 varicoceles and preserved in 28; in 2 cases it was not specified. The results were studied with a mean follow-up of 11.1 months (2 to 36 months). RESULTS: The varicocele disappeared in 76 cases (84.4 %) and diminished significantly in 12 cases (13.2 %) where it was large before treatment. Two middle-sized varicoceles were not modified by the treatment. Therefore, the results must be considered good or excellent in 97.6 % of cases. The spermatic artery was preserved in 28 cases and the size of the varicocele was not good in 9 (32.1 %); it was ligated in 60 cases and the size of the varicocele was not good in 5 cases (8.4 %) -- p < 0.01. In 42 cases the testicular size was noted before and after treatment, and likewise the conservation or not of the spermatic artery; the 30 artery ligations produced no testicular atrophy; only 3 hypotrophic testes were noted with a loss of size of between 8.4 and 59 % with regard to the contralateral testis. In 27 cases, the testicular size remained normal or increased if it was hypotrophic before treatment; there was a good result in 90 % of cases with no atrophy. When the spermatic artery was preserved (12 cases), 1 hypotrophy occurred with a loss of size of 16.7 % -- NS. CONCLUSION: The laparoscopic treatment of varicoceles is an efficient technique and the complete ligation of the whole vascular spermatic pedicle above the vas deferens offers excellent success, without atrophy.     

转流术治疗小儿精索静脉曲张

目的 采用转流术治疗小儿精索静脉曲张，重新建立精索静脉通道，使静脉回流受阻立即得到改善，消除因睾丸淤血而造成的损害，以利睾丸的正常发育。方法 对28例30侧(左侧26例，双侧2例)精索静脉曲张与腹壁下静脉进行吻合，通过腹壁下静脉，髂静脉转流，手术在放大镜下应用显微外科技术进行，其中28侧用精索静脉主干，2侧结扎一条属支，用另一条静脉进行吻合。结果 通畅率为100％。术后扩张迂曲静脉团消失，阴囊下坠感消失。术后随访24例，时间为3个月-10年。除1例二次手术证实为一条静脉属支漏扎而复发外，另23例全部治愈。结论 精索静脉曲张转流术效果明显优于结扎术，可减少因睾丸淤血对其造成的进一步损害，且术后复发率低。     

Experience with laparoscopy in nonpalpable testis.

AIM: The aim of this study was to investigate the feasibility and benefits of diagnosis and interventional laparoscopy in those paediatric patients with nonpalpable testes (NPT). PATIENTS AND METHODS: Between 1992 and 1999, 75 patients with NPT (mean age 3 years, range 6 months to 14 years) were treated. 86 testes were evaluated. RESULTS: According to the laparoscopic findings 4 groups of testes were identified: Vanishing testis (n = 32), low abdominal testis (< 2 cm to the internal ring) (n = 26), high abdominal testis (> 2 cm to the internal ring) (n = 24) and intersex patients (n = 4). Of the first group, 19 testes (one bilateral) had blind-ending spermatic cord and vessels and if an atrophic testicular tissue was identified, it was removed laparoscopically. For those with spermatic cord and vessels beyond the internal ring (13 testes), atrophic testes were removed through a high scrotal incision. 19 testes of the second group had a laparoscopy-assisted orchidopexy. In the same group a laparoscopic orchidopexy was performed on 7 testes. 24 testes in the 3rd group had a Fowler-Stephens (FS) stage 1 and 18 testes had a laparotomy performed for FS stage 2 procedure (laparotomy and orchidopexy) after 6 months. At laparotomy there was no evidence of testicular atrophy in all but one testis, which was removed and the FS stage 2 procedure was completed in 17 testes. The follow-up period was between 6 months and 4 years, and two more testicular atrophies were noted after FS stage 2. The results were satisfactory in 15 out of 18 testes (83%). In the intersex group, the patient with testicular feminization underwent laparoscopic orchiectomy. The other patient with bilateral nonpalpable testis was identified as having an uterus and two intraabdominally located gonads on laparoscopy and gonadal biopsies were obtained for diagnosis. Histology demonstrated bilateral ovotestes, confirming the diagnosis of a true hermaphrodite. CONCLUSION: We are of the opinion that laparoscopy decreases the number of laparotomies in NPT, allows a single-stage procedure in low abdominal testis, and facilitates clip ligation of the testicular artery in high abdominal testis. Laparoscopy also provides diagnostic and therapeutic options for vanishing testis and intersex patients.     

Use of laparoscopy as the initial surgical approach of impalpable testes:10-year experience

AIM: To review the experience in the management of impalpable testes using laparoscopy as the initial approach and the need for inguinal exploration.METHODS: From January 2004 to June 2014, 339 patients with undescended testes underwent operation in our institute. Fifty patients(15%) had impalpable testes. All children with impalpable testes underwent initial laparoscopy. A retrospective review was conducted on this group of patients and the outcome was analyzed.RESULTS: Forty children had unilateral impalpable testis. Ten children had bilateral impalpable testes. Thirty-one children(78%) in the unilateral group underwent subsequent inguinal exploration while 4 children(40%) in the bilateral group underwent inguinal exploration(P 0.05). Orchidopexy was performed in 16 children(40%) in the unilateral group and 9 children(90%) in the bilateral group(P 0.05). Regarding the 24 children with unilateral impalpable testis and underwent orchidectomy for testicular nubbin(n = 19) or atrophic testes(n = 2) or has vanishing testes(n = 3); contralateral testicular hypertrophy was noticed in 10(41%). No intra-operative complication was encountered. Two children after staged Fowler-Stephensprocedure and 1 child after inguinal orchidopexy had atrophic testes.CONCLUSION: The use of laparoscopy in children with impalpable testes is a safe procedure and can guide the need for subsequent inguinal exploration. Children with unilateral impalpable testis were associated with an increased need for inguinal exploration after laparoscopy. Orchidopexies could be performed successfully in 90% of children with bilateral impalpable testes.     

A study of warm testicular ischaemia and paternity in rats

The effect of testicular ischaemia on fertility as assessed by paternity rate was studied in seven groups of male Sprague-Dawley pubertal rats. Transient unilateral occlusion of the testicular artery and venous outflow was performed for 30, 60, 90, and 120 min using non-crushing microvascular clamps in groups 1–4 (n = 6). Group 5 (n = 12, Fowler-Stephens) had division of both the testicular artery and vein, whereas group 6 (n = 12, Refluo) had division of the testicular artery only. Group 7 (n = 6) consisted of controls upon whom a sham operation was performed. Testicular biopsy 6 weeks after transient testicular ischaemia of 30, 60, and 90 min showed tubular atrophy in 20%–33% of the testes. Ischaemia of 120 min led to tubular atrophy in 84% of testes. Division of only the testicular artery caused tubular atrophy in 58% of testes. Division of both testicular artery and venous outflow was associated with total tubular destruction and necrosis in 78% of testes and 22% had variable tubular atrophy. A paternity rate of 50%–80% was noted in groups 1–4 following transient unilateral testicular ischaemia and contralateral vasectomy. This compared well with the expected 75% paternity rate for a control rat population. Chronic ischaemia (group 5) together with testicular venous interruption was associated with observably lower fertility and a paternity rate of 18%. However, when venous outflow was preserved (group 6), chronic ischaemia after testicular artery division did not affect the paternity rate (50%) significantly. Offprint requests to: A. Bianchi     

腹腔镜下高位隐睾Ⅰ期下降固定术的探讨

目的 探讨高位隐睾腹腔镜I期固定术的应用.方法 回顾性研究2005年1月至2008年3月间所收治的35例高位隐睾患儿,年龄1～15岁,平均年龄2.6岁.左侧20例,右侧12例,双侧3例,总计38侧.根据睾丸位置高低,腹腔镜辅助下行精索松解I期睾丸固定或Fowler-Stephens(FS)I期睾丸固定手术.结果 在35例(38侧)患儿中,有33例(34侧)为低位腹腔内隐睾(89.5%),2例4侧(10.5%)为腹腔内高位隐睾.其中的34侧腹腔内低位睾丸及1侧高位睾丸经过松解精索血管或FSI期手术,将睾丸固定于患侧阴囊内;3侧高位睾丸经过松解精索血管I期将睾丸固定于外环口外与阴囊上极之间.手术成功率为92.1%.随访3～24个月(平均6个月),100%睾丸血运好无萎缩.结论 高位隐睾腹腔镜Ⅰ期固定手术效果良好,手术微创.     

Sub-inguinal interruption of dilated veins in adolescent varicocele: should it be considered a gold standard technique?

AIM: Surgeons of varicocele are at present still searching for a gold standard technique, which can correct varicocele without any recurrences, maintaining optimal testicular function, having got minimal current and future morbidity and being cost effective. We evaluated the presence of these criteria in the technique of sub-inguinal dilated vein interruption. METHODS: Between 1994 and 2001, 142 youngsters and adolescents underwent surgery for varicocele repair at our hospital. Average patient age was 12.4 years (range 8 to 15). One-hundred-six cases (74.7%) were grade III varicocele, while 36 (25.5 ) were grade II. Grade II varicoceles underwent surgery only if associated with scrotal discomfort, testicular softness or hypotrophy of the affected testis (differential volume between the 2 testicles more than 20% or more than 2 ml ). Varicoceles were repaired using a subinguinal ligation of intrafunicular and extrafunicolar dilated veins. The testicular vaginalis was not touched in 46 children (Group A) but it was reversed in 42 and resected in the other 54 cases to prevent postoperative hydrocele. RESULTS: In 126 cases (88.7%) varicocele disappeared after surgery, in 12 (8.4%) a mild residual vein dilatation persisted but without any sign of reflux at color-Doppler ultrasound, in 4 patients a postoperative venous reflux was found. Thus, our recurrence rate is nowadays 2.8%. Average postoperative follow-up was 2.3 years (range 1 to 5 years). No testicular atrophy was observed. Based on our last series, at 1 year follow-up control (26 cases throughout year 2000), mean testicular volume, assessed by ultrasound, increased not significantly after surgery from ml 4.69 (SD+/-1.46) preoperative volume to ml 5.19 (SD+/-1.36) postoperative (p=0.2). CONCLUSION: First of all, we found a recurrence rate of 2.9% similar to the lowest of the other procedures. Regarding morbidity, the main inconvenience consists in postoperative hydrocele. It occurred in 13% of our 1st series (group A), but only in 4.1% of patients after reversion or resection of the vaginalis tunica. Average postoperative testicular volume increases after varicocelectomy in our patients, even if not significantly. About sparing the testicular artery or not it has been demonstrated that ligation of this artery doesn't impair testicular growth up and our own observations confirm this evidence. Thus we believe it to be more useful and safe to interrupt this artery to avoid recurrences due to a periarterial venous network. Finally we can conclude that sub-inguinal ligature of dilated veins, when approached with rigorous understanding of the pathophysiology of varicocele is a very safe procedure and low cost effectiveness.     

Testicular catch-up growth after varicocele correction in adolescents

We evaluated retrospectively the outcome of artery-sparing (AS) versus non-artery-sparing (NAS) laparoscopic varicocelectomy and measured any reversal of testicular growth. Twenty patients (13 left and 7 bilateral varicoceles) were evaluated after surgery. A total of 27 varicocelectomies (20 AS and 7 NAS) were performed. The indication for surgery was smaller testicular size on the affected side in all patients and discomfort/pain in 3. The mean age was 12.9 years (range 8–15 years) at surgery. The testicular volumes were determined clinically and by color Doppler sonography (US). The follow-up time was 6–48 months after surgery. There were 4 recurrences out of 27 varicocelectomies (15%), of which 1 has been reoperated. Testicular volumes were equal in both groups after surgery, indicating catch-up growth except in the cases with minor recurrences (2 AS and 2 NAS varicocelectomies). In 12 testes, dilated veins in the pampiniform plexus were revealed by US. No severe intraoperative complications occurred. Three patients had a hydrocele after surgery (11%). These data show that there is testicular catch-up growth after varicocelectomy, but some questions remain unanswered: (1) should the remaining dilated veins detected by Doppler US be tackled; and (2) is an AS operation worthwhile?     

Effects of laparoscopic division of spermatic vessels on histological changes of testes: long-term observation in the model of prepubertal rat

Laparoscopic Fowler-Stephens and Palomo procedures are now commonly performed in children with high positioned intra-abdominal cryptorchidism and varicocele, respectively. During the procedures, the spermatic vessels are ligated and therefore the question of risk related to testicular atrophy is often raised. The long-term follow-up of the histology after the procedures is rare. In this study, we simulated a laparoscopic spermatic vessels clipping and division (SVCD) in a prepubertal rat model, and examined the histological alterations of the testes with regard to spermatogenic arrest between prepuberty and middle age. Thirty-day-old Wistar rats divided randomly into three groups underwent laparoscopic sham operation, unilateral SVCD and unilateral SVCD with additional contralateral orchiectomy, respectively. Histological investigations observed on semithin and paraffin sections were performed at seven different postoperative intervals between day 9 and day 540. We defined partial, most and complete spermatogenic arrest of the seminiferous tubules to correspond with mild, severe spermatogenic arrest and atrophy, respectively. Laparoscopic SVCD induced testicular spermatogenic arrest in a total of 85% of the operated testes with different severity; 27% of operated testes with mild or severe spermatogenic arrest were seen between puberty and middle age (day 45–540 postoperative), and their size was only slightly reduced. Of the operated testes, 51% showed atrophic signs with a striking decrease in size, and their contralateral testes revealed in all cases mild or severe spermatogenic arrest started as early as day 45 postoperatively. Parallel to the spermatogenic arrest, Leydig cell hyperplasia developed frequently in impaired testes, especially in those without contralateral testes, finally reaching a typical adenoma size. Laparoscopic SVCD in prepubertal rats could disturb spermatogenesis with differing severity in most cases. This impairment could persist from peripuberty to middle age, and even involve the contralateral testes, in the case of operated testes and show complete spermatogenic arrest. This study showed that laparoscopic SVCD may have high risk in compromising the operated testis.     

Impact of internal spermatic artery preservation during laparoscopic varicocelectomy on recurrence and the catch-up growth rate in adolescents

ObjectiveTo investigate the effectiveness of laparoscopic varicocelectomy (LV) in adolescents with varicocele and analyze the impact of internal spermatic artery (ISA) preservation on surgical outcomes.Materials and methodsData on 92 adolescents with left varicocele who underwent LV between December 1998 and January 2011 were retrospectively analyzed. The mean age of the patients was 13.2 ± 2.1 years. Age, grade of disease, number of ligation veins, recurrence rates, and catch-up growth were analyzed in patients who underwent ISA preservation and ligation. The median duration of the follow-up was 21 months.ResultsISA preservation was performed on 50 patients (54%). There were no significant inter-group differences in terms of age, varicocele grade, number of ligation veins, and catch-up growth (93% vs. 90%). The patients who received artery preservation demonstrated a higher recurrence rate (22%) than those who received artery ligation (5%; p = 0.032). Among 13 patients who had persistent or recurrent varicocele, nine were treated with embolization and one was treated with magnification-assisted subinguinal varicocelectomy. None of these 10 patients demonstrated recurrence or testicular atrophy.ConclusionsLV with ISA ligation can reduce the recurrence rate and results in the same catch-up growth rate in comparison with LV with ISA preservation.