Varicocele recidivado

Regardless of the surgical approach, all patients were
noted to have large veins within the internal spermatic
cord, just proximal to its joining with the vas deferens;
these veins were found to be in continuity with the
dilated veins in the external spermatic cord. Recurrences
were presumably a result of these dilated veins, because
varicoceles were no longer apparent once these veins
were surgically ligated. On the contrary, distal collaterals,
often thought of as the etiology of recurrences, were
likely not the cause of the recurrences, because these
veins were routinely left intact in all but one case. It is
conceptually hard to understand why patients who have
undergone a Palomo or laparoscopic repair, and presumably
had their internal spermatic veins ligated proximally,
would be found to have dilated veins in the distal
internal spermatic cord. One explanation for these recurrences
involves the possible presence of undetected small
collateral veins that join the internal spermatic cord just
proximal to the joining of the vas deferens; these veins
may then dilate after the repair.
CONCLUSIONS:Redo varicocelectomy can be accomplished successfully and has a similar chance of achieving catch-up growth as does an initial repair. Postoperatively, there exists a small risk of testicular volume compromise and a significant risk of hydrocele development. Distal collateral veins may have a smaller role in varicocele formation and recurrence than previously thought.
Evaluation and Management of
the Persistent/Recurrent Varicocele
Kenneth I. Glassberg, Gina M. Badalato, Stephen A. Poon, M. A. Mercado,
Peter M. Raimondi, and Anthony Gasalberti
UROLOGY 77: 1194–1198, 2011.