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28
TH
CONGRESS OF THE ESPU
S9: TESTIS
Moderators: Luis Braga (Canada), Marcel Drlik (Czech Republic)
ESPU Meeting on Thursday 20, April 2017, 13:50–14:29
13:50–13:53
S9-1 (PP)
★
ANDROLOGICAL OUTCOME OF MICROSURGICAL
VARICOCELECTOMY IN CHILDREN AND ADOLESCENTS
ACCORDING TO AGE AND TYPE OF SURGERY –
PROSPECTIVE RANDOMISED STUDY
Zuzana VALOVÁ
1
, Radim KOCVARA
1
, Josef SEDLÁCEK
2
, Marcel DRLÍK
1
,
Zdenek DÍTE
1
, Jaroslav ZVERINA
3
, Tomas HANUS
1
and Jaromír BELACEK
4
1) General Faculty Hospital and 1
st
. Medical School of Charles University, Urology, Prague 2, CZECH REPUBLIC -
2) General Faculty Hospital and 1
st
. Medical School of Charles University, Prague 2, CZECH REPUBLIC - 3) General
Faculty Hospital and 1
st
. Medical School of Charles University, Institution of Sexuology, Prague 2, CZECH REPUBLIC
- 4) General Faculty Hospital and 1
st
. Medical School of Charles University, Department of Edcuation, Prague 2,
CZECH REPUBLIC
PURPOSE
To compare andrological outcome after lymphatic and artery sparing varicocelectomy (VCE) per-
formed by laparoscopic or microscopic subinguinal technique in relation to age of surgery.
MATERIAL AND METHODS
During2004-2009,112 patients under 18y, unilateral varicocele grade II-III were prospectively
randomised,assigned to microsurgical laparoscopic(Group L-56) or subinguinal microscopic
VCE(Group M-56). Entry and control(after 17y of age;minimally 1 year after surgery) testicular ultra-
sound performed in all; volume asymmetry determined by atrophy index. 57 patients were operated
at 11.5-14.9y (mean13.8-Group 1); 55 operated at 15-17,9 y (mean 16.5-Group 2). Spermiogram
performed in 49 patients from Group 1(23L,26M) and 48 from Group 2(27L,21M). Analysed by
chi-square,t- test,3-Way ANOVA.
RESULTS
Atrophy index decreased more in Group 1(22…8%) than in Group 2(19... 13%)(p=0.00426). After
laparoscopic VCE we found higher sperm concentration(65 vs. 52 mil/ml;p=0.0026), higher progres-
sive motility (43 vs.37%;p=0,0268)and less asthenozoospermia (in 7/50-14% versus 16/47-34%)
than after microscopic VCE. These results were more prominent in Group1, where pathological
spermiogram was present in microscopy group only (9/26-35%). These patients had lower entry
atrophy index(15%vs.28%;p=0.0401), larger refluxing veins(3.5mm vs.2.5mm;p= 0.0431); and
at the control,lower right testicular volume(12.4 vs.16.2 cc;p=0.0272),lower sperm concentra-
tion(29 vs.65 mil/ml;p=0.0026), worse progressive motility(21vs.45%; p=0.0002) than patients with
normal spermiogram.
CONCLUSIONS
Earlier operated patients had better catch-up growth, but a better andrological outcome was
achieved in the laparoscopy than microscopy group. The initial testicular asymmetry may be related
to a right testicular hypertrophy and represent favourable prognostic sign. These conclusions give
new arguments for early adolescent surgery and also necessity of studying long-term outcome of
individual types of repair.