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An Analysis of Major Causes of Surgical Failure Using Bähren System in Intraoperative Venography During Varicocelectomy

 Kyung Tak Oh  ;  Sang Woon Kim  ;  Sung Ku Kang  ;  Sung Hoon Kim  ;  Cho Nyeong Lee  ;  Sang Won Han  ;  Yong Seung Lee 
 YONSEI MEDICAL JOURNAL, Vol.62(10) : 928-935, 2021-10 
Journal Title
Issue Date
Humans ; Male ; Phlebography ; Retrospective Studies ; Spermatic Cord* / diagnostic imaging ; Spermatic Cord* / surgery ; Testis ; Varicocele* / diagnostic imaging ; Varicocele* / surgery ; Veins / diagnostic imaging ; Veins / surgery
Varicocele ; laparoscopes ; phlebography
Purpose: In young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV).

Materials and methods: We retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bahren system.

Results: One hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%).

Conclusion: Remnant collateral veins of the internal spermatic vein (ISV) (Bahren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bahren type 4) and is unidentifiable without venography.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Sung Ku(강숭구) ORCID logo https://orcid.org/0000-0002-3143-507X
Kim, Sang Woon(김상운) ORCID logo https://orcid.org/0000-0002-5790-1948
Lee, Yong Seung(이용승) ORCID logo https://orcid.org/0000-0003-3778-9888
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
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