Recidivation of Varicocele, Prophylaxis, and Therapy

The operation method preferred in therapy of idiopathic varicocele in recent years is increasingly the suprainguinal ligature of the v. testicularis, as described first by Bernardi in 1941. Postoperatively, a recidivation of the varicocele or a persistent varicocele can be expected in more than 10% of all cases. The reason for a persistent varicocele in more than 90% of all cases is an incomplete ligature of the branches of the V. testicularis. To reduce this high rate of failure some authors principally demand phlebography before every operation of varicocele [2]. It is questionable, however, if this step can achieve a reasonable reduction of the failure rate, because in phlebography smaller branches of the v. testicularis responsible for the persistence of varicocele cannot be shown in all cases. A much safer method to reduce the high failure rate of more than 10% is to ligate the vasa testiculares completely. This operation method, which was first described by Palomo [8] in 1949, in our opinion, has been wrongly brought into discredit. It is true that an additional ligature of the a. testicularis is not necessary for a good postoperative result [3]. In most cases, however, ligation of the whole vascular bundle of the a. and v. testicularis can prevent the recidivation or persistence of the varicocele after high ligation of the v. testicularis. This can be concluded from the fact that the v. testicularis in 70% of patients consists of two or three veins above the inner inguinal ring [12]. Additionally, in 30% of cases the v. testicularis has a double, in 3% of cases a triple, orifice at the left v. renalis [12].