Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns.

OBJECTIVE

To investigate different varicocele hemodynamic patterns (shunt type vs. stop type) as predictors of new-onset testicular hypotrophy or recurrence after varicocelectomy.

DESIGN

Prospective clinical study.

SETTING

Department of pediatric urology, children's hospital medical center.

PATIENT(S): Seventy-four children and adolescents with varicocele.

INTERVENTION(S): Based on ultrasound findings, patients were classified into shunt-type or stop-type varicocele groups. All patients with stop-type varicocele and testicular volume discrepancy of ≥20% underwent retroperitoneal varicocelectomy and internal spermatic vein ligation. Patients with shunt-type varicocele and ≥20% testicular asymmetry were randomly divided to undergo either retroperitoneal varicocelectomy (ligation of internal spermatic vein) or inguinal varicocelectomy with ligation of both internal and external spermatic veins. Patients with testicular volume discrepancy of <20% were put on conservative management.

MAIN OUTCOME MEASURE(S): Occurrence of new-onset asymmetry among untreated patients and recurrence rate among operated patients.

RESULT(S): Patients with shunt-type varicocele who did not undergo surgery revealed a higher risk of developing asymmetry during follow-up (odds ratio 10.5). Ligation of both internal and external spermatic veins in shunt-type patients was associated with significantly decreased rate of recurrence (6.3%) compared with retroperitoneal approach (30.8%).

CONCLUSION(S): Shunt-type varicocele is associated with a higher risk of testicular hypotrophy among untreated patients. In addition, recurrence rate in shunt-type patients who underwent inguinal varicocelectomy was lower compared with retroperitoneal approach.