ADOLESCENT VARICOCELECTOMY: SUCCESS AT WHAT COST? CLINICAL OUTCOME AND COST COMPARISON OF SURGICAL LIGATION AND PERCUTANEOUS EMBOLIZATION
Azadeh Wickham, MSN, FNP-BC1, Ahmad El-Arabi, MD2, Dan Vu, BS2, John Gatti, MD1.
1Children's Mercy Kansas City, Kansas City, MO, USA, 2University of Kansas Medical Center, Kansas City, KS, USA.
Objectives: To evaluate clinical outcome, recurrence, morbidity and cost associated with surgical ligation vs. percutaneous embolization of adolescent varicocele.
Materials and Methods: We reviewed the records of 59 consecutive adolescent males, age 18 years and younger, between 2006 and 2016 with the clinical diagnosis of varicocele who underwent either surgical ligation or percutaneous embolization. Varicocele grade and testicular volumes determined by scrotal ultrasound were reviewed. Patient demographics, operative time, postoperative complications, recurrence of varicocele, and hospital charges were abstracted.
Results: Mean age of the entire cohort was 14.2 ± 2.1 years, with 51 (86%) patients having undergone surgical ligation and 8 (14%) underwent percutaneous embolization. Of the entire cohort, 46 (78%) patients were offered intervention on the basis of left testicular hypotrophy (mean ± SD; 27.4% ± 15.6%) whereas the other 13 (22%) were offered intervention for pain symptomology. Median follow-up was 17.5 months (range 1 to 65 months). Of those who underwent surgery, 2 (4%) patients developed a postoperative hydrocele (1 with subsequent hydrocelectomy) and 6 (12%) patients had recurrence of their varicocele. There were no cases of hydrocele or recurrence of varicocele in patients who underwent percutaneous embolization. Twenty surgical patients had postoperative scrotal ultrasound demonstrating catch-up growth by a reduction in difference in testicular volume from 27.3% ± 14.7% (pre-operatively) to 11.2% ± 13.6% (post-operatively) (p < 0.001). There was significant difference in mean operative time between the groups (surgical ligation 41.3 minutes vs percutaneous embolization 117.9 minutes, p < 0.001) and hospital charges for the procedure (surgical ligation $3,983 vs percutaneous embolization $18.165, p < 0.001).
Conclusions: Percutaneous embolization has seemingly lower rates of postoperative hydrocele and varicocele recurrence in comparison to surgical ligation but with 3 times the exposure to general anesthesia and at 4 times the price. Given these findings, embolization may be better reserved for failures of surgical repair. Our results are limited by a small cohort and uneven distribution between groups, but provide the impetus for a prospective randomized comparison.
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