Initial results of microsurgical varicocele treatment in boys and adolescents
Autori:
Dino Papeš, Stanko Ćavar, Ivana Sabolić, Miram Pasini, Ivana Jurca, Anko Antabak, Tomislav Vlahek, Aida Dalipi, Ivan Jelčić, Dora Škrljak Šoša, Tomislav Luetić
Sažetak
Cilj: prikazati metodu i rane ishode prvih 20 dječaka i adolescenata kod kojih je učinjena mikrokirurška varikokelektomija na Zavodu za dječju kirurgiju Kliničkoga bolničkog centra Zagreb. Ova metoda prema literaturnim podatcima ima najmanju učestalost recidiva i komplikacija. Ispitanici i metode: Indikacije za mikrokiruršku operaciju jesu simptomatska varikokela, hipotrofija testisa (zahvaćeni testis volumno manji od zdravog za >20%), te poremećaj spermiograma kod adolescenata u završnom (Tanner 5) stadiju spolnog razvoja. Varikokela i hipotrofija testisa utvrđeni su kliničkim pregledom, ultrazvučnom volumetrijom i dopplerskim pregledom. Operacija se izvodi kroz rez duljine 3 – 4 cm u razini vanjskoga ingvinalnog otvora. Pacijenti su praćeni prospektivno nakon operacije, a prosječno vrijeme praćenja bilo je deset mjeseci (raspon 6 – 12 mjeseci). Rezultati: Prosječno trajanje operacije bilo je 65 minuta. Svi pacijenti su otpušteni kući unutar 24 sata od operacije, a vratili su se svim aktivnostima unutar dva tjedna nakon operacije. Tijekom kontrolnih pregleda nije zabilježen recidiv varikokele, kod svih
pacijenata koji su operirani zbog simptoma došlo je do nestanka tegoba, dok je kod onih koji su operirani zbog lošeg spermiograma došlo do oporavka ejakulata. Od komplikacija, jedan pacijent je imao prolaznu nelagodu kod ejakulacije. Kod jednog pacijenta je intraoperativno neželjeno podvezana testikularna arterija koja je odmah rekonstruirana termino-terminalnom anastomozom uz uredne protoke na kontrolnim dopplerskim pregledima sjemenskog snopa, bez znakova atrofije testisa. Zaključak: Mikrokirurška varikokelektomija je sigurna metoda za liječenje varikokele sa visokom uspješnošću i malim brojem komplikacija.
Summary
Aim: To describe the surgical technique and present outcomes of the first 20 boys and adolescents that underwent microsurgical varicocelectomy at the Department of pediatric surgery, University Hospital Center Zagreb. According to the literature data, this method has the lowest incidence of recurrence and complications. Patients and Methods: Indications for microsurgical varicocelectomy are the same as for other methods of varicocele treatment: presence of symptoms, testicular hypotrophy (affected testicle smaller >20% in volume compared to the contralateral testicle), or abnormal semen analysis in adolescent that reached the final (Tanner 5) stage of pubertal development. The diagnoses of varicocele and testicular hypotrophy were established by clinical examination, ultrasound volumetry and Doppler examination. The surgery was done through a 3–4 cm incision above the external inguinal ring. The patients were followed prospectively, with an average follow-up of 10 months (range 6–12 months). Results: Average surgery duration was 65 minutes. All patients were discharged within 24 hours after surgery, and returned to all preoperative activities within two weeks postoperatively. No recurrences were noted during follow-up, symptoms resolved in all patients operated for symptomatic varicocele, and sperm count normalized in all patients that underwent surgery for abnormal semen analysis. Regarding complications, one patient reported a transitory discomfort during ejaculation. In one patient the testicular artery was inadvertently ligated during surgery, but was immediately reconstructed with an end-to-end anastomosis.
Control Doppler examinations of the spermatic cord showed a patent anastomosis with normal flow. Conclusion: Microsurgical varicocelectomy is a safe method for varicocele treatment with a high success rate and low incidence of complications.
