ESPU Congress 2018 - Abstract Book

104 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.