15-Year varicocelectomy outcomes in pediatric age: Beware of genitofemoral nerve injury. Issue 4 (August 2021)

• Record Type: Journal Article
• Authors: Soares-Aquino, Carolina; Vasconcelos-Castro, Sofia; Campos, José Miguel; Soares-Oliveira, Miguel
• Is Part Of: Journal of pediatric urology. Volume 17:Issue 4(2021)
• Page Start: 537.e1
• Page End: 537.e5
• Publication Date: 2021-08
• Subjects: Varicocele -- Varicocelectomy -- Laparoscopy -- Adolescent; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2021.05.009
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Background: Varicocele affects 15% of adolescents. The main postoperative complications are recurrence and hydrocele; nerve injury is rarely reported. Objective: The aims of this study are: to assess the complications after laparoscopic varicocelectomy, namely nerve injury; and to assess if nerve injury is more frequent using "hot" or "cold" ligation. Study design: Retrospective study of varicocele cases submitted to laparoscopic correction in our department from April 2006 to March 2020. Parameters analyzed were: age, clinical findings, surgical indication, operative technique, and outcomes. Comparison was done between the "cold" versus "hot" vessel section technique. Results: 110 patients, with median age 14-years-old, were included. Most cases were on the left side and grade 3. Fifty patients (45%) presented complications: 21% recurrence; 18% hydrocele; and 3% genitofemoral nerve injury. Nerve injury was independent of the technique used. Discussion: Genitofemoral nerve injury is a complication with unknown cause and all cases are related to laparoscopic technique. It was suggested that "hot" methods of ligation of the vessels can lead to higher incidence of the lesion, but that was not corroborated in our analysis. Possible explanations for its occurrence are: a wide peritoneal window opening created with electrocautery near the internal inguinal ring; and additional dissection required to isolate the testicular veins from the artery. Prospective studies are needed to clarify the real incidence of genitofemoral nerve injury and its causes. Conclusions: Laparoscopic varicocelectomy seems to be safe and effective, although complications remain frequent regardless of the technique used. Genitofemoral nerve injury is a complication rarely described that may require rehabilitation, and so awareness for this problem is of paramount importance. Extended summary table Review of previously reported nerve injuries after varicocelectomy procedures. Extended summary table Year No. total cases No. (Incidence, %) of GFNI Ligation method 1993 46 1 (2%) Hot 1994 13 1 (8%) Cold 1994 22 1 (5%) Cold 2002 434 10 (2%) Both 2004 62 3 (5%) Both 2008 27 2 (7%) Hot 2021 a 110 3 (3%) Cold Year, year of publication. No., absolute frequency. GFNI, genitofemoral nerve injuries. Hot - electrocautery, ultrasonic shears; Cold - clips, suture, hem-o-lock. a present series.