BACKGROUND: Optimal surgical treatment of the adolescent varicocele remains indeterminate. We reviewed our experience at Children's Hospital with the Palomo, Ivanissevich, subinguinal and laparoscopic techniques and studied success and complication rates according to procedure as well as the added impact of microsurgery and artery sparing.
METHODS: Seventy-six patients with > 1 year followup between 1996 and 2006 were studied. Their median age at surgery was 15 years (range = 8 to 21). Patients were stratified based on surgical technique employed by eight different urology faculty. Microsurgery and attempted artery sparing were applied to some high and low inguinal and all subinguinal cases but no laparoscopic procedures.
RESULTS: Rates of success and postoperative hydrocele are shown in table 1. Impact of microsurgery as well as artery sparing on success and hydrocele rates are shown in tables 2 and 3. Importantly, one patient undergoing subinguinal microsurgical artery sparing experienced testicular atrophy.
Table 1.

Surgical Technique	N	Success Rate (%)	Hydrocele (%)
High inguinal	24	92	8
Low inguinal	25	72	12
Subinguinal	16	88	6
Laparoscopic	9	100	22
p	0.22	0.10	0.59

Table 2.

Microsurgery	Success Rate (%)	Hydrocele (%)
Yes	78	0
No	90	15
p	0.27	0.01

Table 3.

Artery Sparing	Success Rate (%)	Hydrocele (%)
Yes	82	6
No	96	22
p	0.16	0.10

CONCLUSIONS: Some important trends are apparent. The low inguinal (Ivanissevich) approach strongly appears to be the least successful and is associated with the second highest hydrocele rate. The high success rate of laparoscopic surgery is mitigated by the highest hydrocele rate postoperatively. Neither microsurgery nor artery sparing resulted in a significant difference in success, but they resulted in significantly lower hydrocele rates. In our experience the high inguinal and subinguinal approaches had comparably high success and low hydrocele rates, but the case of testicular atrophy supports caution when using the subinguinal approach.