Shunt-Type and Stop-Type Varicocele in Children

ESPU Programme 2010 S83

S17: VARICOCELE

# S17-1 (PP)

Waleed EASSA, Mohamed EL SHERBINY, Roman JEDNAK and John Paul CAPOLICCHIOMcGill University Health Center, Pediatric Urology, Montreal, CANADA

PURPOSE

To present our initial experience with dye-assisted lymphatic sparing laparoscopicvaricocelectomy (LSLV) in children.

MATERIAL AND METHODS

Between May 2006 and May 2009, 15consecutive cases of left, unilateral LSLVwere performed (mean age of 15years). Aleft scrotal, sub-dartos injection of 2ml 1%isosulfan blue/ patent blue dye was donefollowed by a 5mm, 3 port transperitonealapproach. The spermatic vessels includingstained lymphatics were identified after

posterior peritoneotmy. At least onelymphatic was spared and the rest of thespermatic vessels were mass ligated anddivided. Clinical data was collected froma retrospective chart review.

RESULTS

Varicocele was grade-2 in 4(27%) and grade-3in 11(73%). Indications for intervention werepain in 5(33%), testicular hypotrophy in9(60%) and family preference in 1(7%).Lymphatics spared were 3 in 1case, 2 in3cases and only 1 in the last 11cases. Overalltime of the procedure varied from 30 min to140 min (mean 88 �33). All patients were

discharged on the same operative day. Noperioperative complications were recorded.Mean follow up was 12� 4.2. At last visit, 2(13%) had minimal residual varicocele andnone had secondary hydrocele. No patientrequired re-intervention.

CONCLUSIONS

This initial experience demonstrates thatdye assisted LSLV is easily accomplished.Single lymphatic sparing is as effective asmultiple to prevent secondary hydrocele.The initial outcomes appear promising, yetlonger follow up and a larger cohort arerequired.

# S17-2 (PP)

Hossein FARZI, Mohammad Javad MOHSENI, Hamid NAZARI and A.M. KAJBAFZADEHPediatric Medical Center of Excellence, Pediatric Urology Research Center, Department of Urology, Tehran, ISLAMIC REPUBLIC OF IRAN

PURPOSE

Varicocele can be classified into 2 groups ofshunt-type and stop-type. In stop-type, onlythe internal spermatic (testicular) vein isdilated. In shunt-type however, a kind ofvenous bypass from internal to externalspermatic (cremasteric) veins exists whichcauses dilation of both venous systems.The shunting of venous retrograde flow canpredispose patients for larger varicocele.Since varicocele in children may restrict thetesticles to grow through puberty and causeirreversible infertility, diagnosis of evensubclinical cases and retreatment ofrecurrent or persistent afflictions seem to beessential. We will introduce the effect ofshunt-type varicocele on testicles growthand to evaluate the post-operativerecurrence in shunt-type varicocele inchildren.

MATERIAL AND METHODS

A total of 29 pediatric patients with meanage of 13 (10-17) and clinical varicocele ofgrade II and III were further examined byroutine scrotal U/S and color Dopplerultrasound. CDU was used as a noninvasiveapproach to evaluate the shunting ofretrograde venous flow from the internalspermatic to external spermatic vein.

RESULTS

Nineteen patients (65%) had shunt-typevaricocele according to CDU findings. Testesvolume and size in the shunt-type patientswere compared with those with stop-typewith regard to the age of the patients. Therate and severity of testicular atrophy wassignificantly higher in the shunt-type

patients. The incidence of post-operativevaricocele recurrence (persistence) was alsoevaluated. The recurrence (persistence) wassignificantly more common in shunt-typevaricocele.

CONCLUSIONS

Color Doppler US provides a noninvasiveapproach to evaluate the shunting ofretrograde venous flow from internal to theexternal spermatic veins. Understanding thepathophysiology of shunt-type varicocelecan light up the way toward betterdiagnosis, treatment and follow- up thepatients.