Yonsei Med J.  2012 Jul;53(4):723-728. 10.3349/ymj.2012.53.4.723.

Recurrent Varicoceles: Causes and Treatment Using Angiography and Magnification Assisted Subinguinal Varicocelectomy

• Moon KH
• Cho SJ
• Kim KS
• Park S
• Park S

• KMID: 1716869
• DOI: http://doi.org/10.3349/ymj.2012.53.4.723

Abstract

PURPOSE
To investigate the causes of varicocele recurrence and assess the use of embolization and subinguinal varicocelectomy in its treatment in patients with angiography and subinguinal varicocelectomy.
MATERIALS AND METHODS
The present study involved 15 patients with recurrent varicoceles. The mean patient age was 21.2 years (range: 12-42 years). Preoperative angiography was performed in 11 patients. Embolization was used in patients with patent internal spermatic veins (ISVs). Patients without patent ISVs or preoperative angiography underwent magnification-assisted subinguinal varicocelectomy which included testicular retrieval and ligation of all collateral veins except arteries and deferential veins.
RESULTS
Seven among 11 patients (64%) which had preoperative angiography had patent ISVs and underwent embolization and 8 patients underwent subinguinal varicocelectomy. Of those 8 patients, 6 had dilated ISVs and external spermatic veins (ESVs), one had dilated ISVs and gubernacular veins, and one had dilated ISVs, ESVs and gubernacular veins. No patient experienced recurrence or testis atrophy.
CONCLUSION
Patent ISVs or collateral veins may be the cause of recurrence after varicocelectomy. Angiographic embolization was successful in 64% of recurrent varicoceles patients with patent ISVs. However, microscope-assisted subinguinal varicocelectomy may be the best overall treatment for patients with recurrent varicoceles.

Keyword

Varicocelectomy; recurrence; cause; treatment

MeSH Terms

Adolescent
Adult
Angiography
Child
Humans
Male
Spermatic Cord/radiography/surgery
Urogenital Surgical Procedures
Varicocele/*radiography/*surgery
Young Adult

Figure

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  Fig. 1 Angiographic findings from a varicocele recurrence patient. Note that there is no patent internal spermatic vein and no reflux of contrast from the left iliac vein into the left pampiniform plexus.

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  Fig. 2 Angiography failed to demonstrate gonadal vein in left renal vein.

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  Fig. 3 Surgical findings. Cremasteric and internal spermatic fascia were opened in the longitudinal direction. Note that the dilated internal and external spermatic veins (cremasteric veins) are clearly identifiable.

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