There is still considerable controversy about the optimal surgical treatment of adolescent varicocele. One of the dilemmas is whether or not to preserve the internal spermatic artery (ISA) when carrying out a laparoscopic Palomo procedure. This paper looks at retrospective data on 92 adolescent laparoscopic varicoeletomies (LV) (mean age 13.2 ± 2.1 years) over the course of 13 years, with 50% having the ISA preserved. There was no significant difference between the groups in terms of age, catch-up testicular growth, varicocele grade. Patients with ISA preservation, as would be expected, had a higher recurrence rate (22%) compared to those who had the ISA ligated with the veins (5%). Semen quality was not measured and the paper quotes data in the discussion where others have shown that semen quality (volume, sperm count, motility, morphology and vitality) was significantly superior after ISA preservation. The authors conclude that, although macroscopically testicular catch up is equal, the higher recurrence rate and associated evidence from others suggests that ISA preservation should be attempted in all cases of LV. 

Impact of internal spermatic artery preservation during laparoscopic varicocelectomy on recurrence and the catch up growth rate in adolescents.
Kim K, Lee C, Song SH et al.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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