Recurrence rates in pediatric patients undergoing microsurgical subinguinal varicocelectomy with and without testicular delivery.

BACKGROUND/PURPOSE: The purpose of the study was to determine if testicular delivery during microsurgical subinguinal varicocelectomy (MSV) reduces varicocele recurrence rates in pediatric patients. Testicular delivery during MSV enables ligation of the gubernacular veins, which is thought to reduce the likelihood of varicocele recurrence. However, recent studies have suggested that testicular delivery during MSV does not offer any beneficial effect and, therefore, may be optional or unnecessary.

METHODS: A total of 58 pediatric patients with grade II (nine, 15.5%) or III (49, 84.5%) varicocele met inclusion criteria. Of these 58 patients, 25 (43%) underwent MSV with testicular delivery and 33 (57%) underwent MSV without testicular delivery. Varicocele recurrence, testicular size change, and complications including edema, pain, paresthesia, hydrocele, and testicular atrophy were assessed to evaluate the effects of testicular delivery during MSV.

RESULTS: Recurrence rates were 20% and 6.1% in patients who underwent MSV with and without testicular delivery, respectively. Univariate analysis of primary endpoints demonstrated significantly decreased recurrence, scrotal pain, and temporary paresthesia in patients who underwent MSV without testicular delivery compared to those with testicular delivery. Multivariate analysis also demonstrated that recurrence was significantly associated with testicular delivery.

CONCLUSIONS: Testicular delivery to enable ligation of the gubernacular veins during MSV resulted in a higher recurrence rate in pediatric patients. Further investigation including prospective studies with long-term follow-up is needed to determine if testicular delivery during MSV is an unnecessary procedure in pediatric patients.

LEVEL OF EVIDENCE: 2.