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29
th
CONGRESS OF THE ESPU
16:57–17:00
S12-5 (PP)
THE CAUSE OF SURGICAL FAILURE
IN VARICOCELECTOMY – AN ANALYSIS
OF INTRAOPERATIVE VENOGRAPHY
Kyung Tak OH
1
, Sang Won HAN
1
, Yong Seung LEE
1
, Sang Woon KIM
1
, Sung Hoon
KIM
2
and Cho Nyeong LEE
2
1) Yonsei University College of Medicine, Department of Urology and Urological Science Institute, Seoul, REPUBLIC
OF KOREA - 2) Severance Children's Hospital, Department of Pediatric Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
In children and adolescents with varicocele, preservation of the internal spermatic artery may be
advantageous in terms of catch-up growth, but the success rate might be lowered. In order to
overcome this drawback, intraoperative venography is performed to distinguish veins from arteries
and lymphatics. To analyze the cause of surgical failure, we reviewed the pattern of remained veins
through intraoperative venography.
MATERIAL AND METHODS
From January 2005 to December 2016, we retrospectively analyzed patients who underwent vari-
cocelectomy using Palomo approach before 20 years of age and were followed up for more than
6 months. After catheterization of internal spermatic vein(ISV), visually distinct ISVs were ligated.
After ligation, radio contrast was injected through the catheter and retrograde venography was
taken. If there was remained veins, vessel type was classified in Bahren classification.
RESULTS
A total 156 patients underwent venography during the operation. Primary varicocelectomy was
performed in 147 patients(94.2 %) while redo varicocelectomy was in 9 patients(5.8 %). Among
these, open varicocelectomy was performed in 107 patients(68.6 %) by 5 surgeons and lapa-
roscopic varicocelectomy was done in 49 patients(31.4 %) by single surgeon. The mean age at
operation was 13.5±2.5 years. Remaining veins at venography after first ligation was found at
50 patients(32.1 %). Bahren type 3 was observed in 45 cases(90.0 %) while Bahren type 4 was
observed in 5 cases(10.0 %). They were ligated again after venography and were confirmed again
using venography. Varicocele recurrence requiring operation was in 5 patients(3.2 %) including
persistence in 1 patient(0.6 %) and relapse in 4 patients(2.6 %).
CONCLUSIONS
The most common cause of failure in varicocelectomy is to leave the collateral veins of ISV. It may
be overcome as surgery is performed at upper level or as the proficiency of surgery increases. An
external spermatic vein(ESV) that merges with the ISV at the higher level is present at about 3.2 %.
This is considered to be an unidentifiable structure if venography is not performed.