[Changes in renal and testicular veins in left-sided varicocele and choice of the surgical method in children and adolescents].

Abstract

Selective phleborenotesticulography, ++tensiometry of the left iliac, right and left renal veins, vena cava inferior, duplex scanning of the left renal vein were performed in 356, 296 and 57 patients, respectively, of a total of 356 examinees aged 8-17 years with left-side varicocele. Among other tests were measurements of hormones in the blood from the left and right testes (n = 24), pO2, pCO2. Stenosis, aortomesenteric compression (AMC) of the left renal vein, left-side venous renotesticular hypertension (RTH) of the left renal vein were diagnosed in 12, 342 and 158 patients, respectively. Secondary genesis of left varicocele has been proved. The diagnosis of left-side phlebohypertensive nephropathy was made preoperatively. Estradiol content in the blood of the left testis was 1.7 times higher than from the right one. 4 groups of patients were formed: group 1 patients (n = 142) had stenosis, AMC, dilatation of the testicular vein (DTV) and RTH; group 2 patients (n = 18) had AMC, DTV, borderline high pressure; group 3 patients (n = 18) had AMC, RTH, multiple thin testicular veins; group 4 patients (n = 174) had moderate AMC without hypertension. 160 patients of group 1 and 2 have undergone two-direction venous testiculo-iliac anastomosis operation. 193 patients of groups 3 and 4 have undergone Ivanissevich's operation. After Ivanissevich's operation 2 patients with secondary varicocele of the third degree retained varicocele of the first degree. After establishment of anastomoses, neither varicocele recurrences nor anastomosis thrombosis were registered.