Varicocoele is defined as dilation and tortuosity of pampiniform plexus veins. It affects about 15% of male population with peak incidence during 2nd and 3rd decades. In 99% left side is affected, probably because left testicular vein is longer and drains to renal vein with right angle. If varicocoele is encountered on the right side careful examination of retroperitoneal space should be performed (varicocele may be secondary to external compression of testicular vein, for example be retroperitoneal tumor). Typically it is clasified according to Dubin and Amelar into 3 grades. Left sided varicocoele
Since varicocoele is so common condition, it does not always require surgical treatment. In adults it is indicated if subfertility is suspected and bacause of cosmetic reasons. In children and adolescents indications for surgery are less clear and obvious. We know that varicocoele is often transient during puberty, but from the other hand in some patients the longer varicocoele exists, the more detrimental effect it has on gonadal function. Usually it is accepted that we offer surgical treatment to adolescent patients with large varicocoele – III grade in Dubin and Amelar classification (gigant, visible dilated veins in the scotum) – and those with testicular growth arrest and testicular softening.
Spermatic vessels in varicocoele vieved laproscopicallySurgical procedure is performed laparoscopically – gonadal vessels are ligated and transsected as high above internal inguinal ring as posssible. Total hospital stay is 3-5 hours, surgical procedure alone 30 minutes. Postoperative pain is irrelevant and easyly controlled with popular analgetics. After 5 days patient can return to normal everyday activity.
Possible complications include varicocoele persistence or recurrence and hydrocoele formation. Hydrocoele is quite common and affects 8% patients but usually is transient. Should not be surgically corrected earlier than 1 year after varicocoelectomy. If we decide to correct recurrence it should be performed with inguinal approach utilizing microsurgical technique.