Journal List > Korean J Urol > v.47(10) > 1069766

Shin and Lim: Surgical Repair of Varicocele: a Comparative Study of the Retroperitoneal Approach of Palomo, the Modified Palomo Technique and the Microsurgical Inguinal Approach of Ivanisseivich's Technique

Abstract

Purpose:

We wanted to compare our experience and results with three different methods of treatment for varicocele.

Materials and Methods:

Between January 1995 and December 2005, 154 patients with varicocele were retrospectively assigned into three groups according to the method of treatment. Group 1 included 73 patients who were treated by the retroperitoneal approach of Palomo's technique. Group 2 consisted of 37 patients who were treated by the retroperitoneal approach and who also underwent the internal spermatic artery preserving technique, and in group 3, 44 patients were treated by the microscopic inguinal approach of Ivanissevich's technique. We analyzed the operation time, recurrence, complications, the effect of surgical treatment and the results according to the surgical techniques.

Results:

The mean operative time of group 3 was significantly longer among the three groups. The recurrence rate at follow-up was not significantly different among the three groups. The recurrence rate increased progressively with the increase of varicocles size from grade I to grade III for all the groups. The overall incidence of postoperative complications was significantly lower among the patients in group III. The postoperative spermiogram showed an increase in motility and sperm count for all the groups. There were no differences in the three techniques for resolution of pain, the duration of recovery and the spermiogram results.

Conclusions:

There was no significant difference in the rate of relapse after the surgery between the three different treatment techniques, and the factors involved in relapse were more related to the size and severity of the varicocele. Microsurgical varicocelectomy had a disadvantage of a prolonged operation time. However, there was a low rate of postoperative complications for all three techniques. (Korean J Urol 2006;47:1086-1092)

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Table 1.
Characteristics of the patients by groups
Characteristics Group Total
1 2 3
No. of patients 73 37 44 154
No. of varicoceles 73 38 45 156
Age (yr) 20±7 19±7 23±8 21±7
Laterally
    Left 72 (98.6) 35 (94.5) 43 (97.7) 150 (97.4)
    Right 1 (1.4) 1 (2.7) 0 2(1.3)
    Bilateral 0 1 (2.7) 1 (2.3) 2(1.3)
Grade
    I 16 (21.6) 12(31.6) 14(31.1) 42 (26.9)
    II 29 (39.7) 14 (36.8) 16 (35.6) 59 (37.8)
    III 28 (38.4) 12 (31.6) 15 (33.3) 55 (35.3)
Indication of treatment
    Scrotal Pain 32 (43.8) 17 (46.0) 16 (36.3) 65 (42.2)
    Testicular hypotrophy 23 (31.5) 10 (27.0) 15 (34.1) 48 (31.2)
    Subinfertility 18 (24.7) 10 (27.0) 13 (29.5) 41 (26.6)
Follow-up period (month) 32±16 28±11 19 土 8 27±12

Data are presented as the mean value土SD. Numbers in parentheses are percentages.

Table 2.
Summary of the results at follow-up
Characteristics Group p-value
1 2 3
No. of patients 73 37 44  
No. of varicoceles 73 38 45  
Recurrence rate 7 (9.6) 5 (13.2) 4 (8.9) NS
Operation time (min) 48±12 50±13 80±18 <0.05∗
Return to normal daily activities (days) 6.5±3.9 5.8±4.2 4.9±3.5 NS
Post op complications
    Epididymitis 5 2    
    Hydrocele 2      
    Wound problem 1      
    Persistent scrotal pain 1 3 1  
    Total 9 (12.3) 5 (13.2) 1 (2.2) <°.05∗

NS: not significant, numbers in parentheses are percentages, ∗: Group 3 vs each of group 1 and 2

Table 3.
Recurrence rate vs. the grade of varicocele
Group Recurrence/No. of varicoceles p-value∗
Grade I Grade II Grade III
1 1/16 (6.3) 3/29 (10.3) 4/28 (14.3) <0.05
2 0/12 (0) 2/14 (14.3) 3/12 (25) <0.05
3 0/14 (0) 1/16 (6.3) 3/15 (20) <0.05

: the recurrence rate was significantly correlated to grade of varicocele, and the recurrence increased progressively as size of varicocele increased from grade I to grade III in all groups by using chi-spuare test.

Table 4.
The scrotal pain resolution rate
  Group1 (n=32) Group2 (n=17) Group3 (n=16)
Complete resolution 25/32 (78.1) 12/17 (70.6) 12/16 (75)
Partially resolution 6/32 (18.8) 2/17(11.8) 3/16 (18.8)
Unchanged 1/32 (3.1) 3/17 (17.6) 1/16 (6.3)

Comparison between all three groups

Table 5.
Spermiogram of the subinfertile patients at follow-up (mean土 SD)
  Group 1 Group 2 Group 3
Preoperative (n=18) Postoperative (n=7) Preoperative (n=10) Postoperative (n=9) Preoperative (n=13) Postoperative (n=6)
Count (million/ml) 22.5±4.3 33.7±7.2 19.2±5.4 31.6±8.1 17.6±4.5 36.4±7.6
Motility (%) 37.5±11.2 51.6 土 9.6 32.7±7.2 49.6±8.2 33.7±6.5 47.0±10.3
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