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IMPROVEMENT IN VARICOCELE CORRECTION IN TERMS OF CATCH-UP GROWTH IN ADOLESCENTS: LYMPHATIC SPARING MICROSURGICAL VARICOCELECTOMY WITH DERIVERED VERSUS NOT DELIVERED TESTIS PROCEDURE. OUR EXPERIENCE IN 70 ADOLESCENTS.
CLAUDIO SPINELLI, Professor1, Silvia Strambi, MD2, Marga Busetto, MD2.
1University of Pisa, Pisa, Italy, 2University of Pisa, Chair of Pediatric Surgery, Pisa, Italy.

BACKGROUND: The aim of the study is to compare two different surgical procedure: lymphatic sparing microsurgical (3× loupe magnified) inguinal varicocelectomy (LSMV) without delivered testis versus LSMV with delivered testist ligating all external spermatic and gubernacular veins, and to analyze the difference, especially with regard to testicular volume and recurrence during the follw up. This study is supported by histological report in selected cases
METHODS: The study prospectively analyzed date of 70 adolescents presenting monolateral varicocele (mean age 14.5 years) selected in 6 years period. The selection surgical criterion was testicular volume discrepancy greater than 20%. Adolescents were divided in 2 groups: 35 patients (group A) treated with LSMV without delivered testis; 35 patients (group B) treated with LSMV with delivered testis throught incision. In selected cases of group B has been also subjected testicular biopsies during the procedure to define the testicular alterations. Follow-up: all patients were clinically and ultrasonography evaluated at 6 and 12 months after surgery
RESULTS: Recurrences, catch-up growth, post operatory complications at 6 and 12 months are reported in table 1 and 2. Histological analysis: the main histological report observed were peritubular fibrosis, hipoplastic seminiferous tubules, diffuse maturation arrest, presence of only Sertoly cell. Only few testicular biopsy were perfectly normal.
CONCLUSIONS: Delivered testis surgical technique in adolescents results interesting, because it allows to have a time increasing testicular volume, low frequency of recurrence and complications. In selected cases, it permits to perform histological analysis of the testis to predict the potential fertility and to indicate an eventual medical therapy.
6 months follow up
Group A (35 pt)Group B (35 pt)P
Δ VT <20%14 (40,0%)25 (71,4%)<0.01
Δ VT >20%21 (60,0%)10 (28,6%)<0.01
Recurrences1 (2,8%)0 (0%)-
Ipsilateral idrocele0 (0%)0 (0%)-


12 months follow up
Group A (35 pt)Group B (35 pt)P
Δ VT <20%19 (54,3%)30 (85,7%)<0.01
Δ VT >20%16 (45,7%)5 (14,3%)<0.01
Recurrences3 (8,5%)1 (2,8%)-
Ipsilateral idrocele0 (0%)0 (0%)-


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