A total of 29 patients underwent varicocelectomy, among whom six underwent retroperitoneal high ligation, nine underwent laparoscopic varicocelectomy, and 14 underwent MSV. Patients who underwent retroperitoneal high ligation, laparoscopic varicocelectomy, and MSV had a median age of 12 (
IQR: 11.25–12.75) years, 11 (
IQR: 11–12) years, and 12.5 (
IQR: 12–13.75) years, respectively. All varicoceles requiring treatment were located on the left side. Among the included patients, 8, 17, and 2 had grade III, II, and I varicoceles, respectively. Scrotal ultrasonography was used to objectively determine discrepancies in testicular size. Indications for varicocelectomy included (i) clinical varicoceles associated with ipsilateral testicular asymmetry (21 patients); (ii) scrotal pain related to a clinical varicocele (two patients); and (iii) parental preference (six patients). The median operative time for retroperitoneal high ligation, laparoscopic varicocelectomy, and MSV was 71 (
IQR: 59–82.5) min, 131 (95–151) min, and 125.5 (112–134.25) min, respectively, with the retroperitoneal high ligation group having a significantly shorter operative time than the MSV group (
p < 0.0001). The internal spermatic artery was preserved in 5, 4, and 12 patients who underwent retroperitoneal high ligation, laparoscopic varicocelectomy, and MSV, respectively. Lymphatic sparing was performed in all patients who underwent MSV. Other surgical procedures were performed without the intention to preserve lymphatics. Patients who underwent retroperitoneal high ligation, laparoscopic varicocelectomy, and MSV had a median postoperative follow-up period (
IQR) of 11 (7.5–52), 11 (28–36), and 14 (11.25–23.75) months, respectively. All cases whose surgical indication was orchialgia achieved pain abrogation. During the follow-up period, postoperative complications developed in three patients: varicocele recurrence (two patients) and hydrocele (one patient). All postoperative complications occurred in
patients who underwent laparoscopic varicocelectomy. None of the patients developed postoperative testicular asymmetry. All patients who underwent retroperitoneal high ligation and laparoscopic varicocelectomy were discharged the day after surgery. Among those who underwent MSV, 12 (85.7%) and 2 (14.3%) were discharged the day after surgery and on the second postoperative day, respectively. Two patients who were discharged on postoperative day 2 had their discharge postponed due to nausea (Table
1).
Table 1
Demographic and clinical characteristics of the patients
Age, median (IQR) | 12 (11.25–12.75) | 0.0935 | 11 (11–12) | 0.0078 | 12.5 (12–13.75) |
Varicocele grade | | | | | |
Grade 1 (n) | 2 | – | 0 | – | 0 |
Grade 2 (n) | 3 | – | 4 | – | 1 |
Grade 3 (n) | 0 | – | 4 | – | 13 |
Unknown (n) | 1 | – | 1 | – | 0 |
Indication for surgery (n) | | | | | |
Asymmetry (n) | 2 | 0.0031 | 5 | 0.0142 | 14 |
Parental preference (n) | 3 | 0.0175 | 3 | 0.1423 | 0 |
Scrotal pain (n) | 1 | 0.3 | 1 | 0.1423 | 0 |
| | | | 0.7717 | |
Operative time, median (IQR) (min) | 71 (59–82.5) | < 0.0001 | 131 (95–151) | 0.0657 | 125.5 (112–134.25) |
Preservation of artery (n) | 5 | 1 | 4 | < 0.0001 | 12 |
Preservation of lymphatic vessel (n) | 0 | < 0.0001 | 0 | 0.3913 | 14 |
Complication | 0 | – | 1 (hydrocele) | 0.1423 | 0 |
Recurrence of varicocele (%) | 0 | – | 2 (22.2%) | 0.1423 | 0 |
Length of a hospital stay after surgery | 1 day: 6 | – | 1 day: 9 | | 1 day: 12 2 days: 2 |
Median follow-up period (IQR) (month) | 11 (7.5–52) | 0.1815 | 11 (28–36) | 0.3913 | 14 (11.25–23.75) |