Laparoscopic Lymphatic Sparing Varicocelectomy in Adolescents

Glassberg, Kenneth I.; Poon, Stephen A.; Gjertson, Carl K.; DeCastro, G. Joel; Misseri, Rosalia

doi:10.1016/j.juro.2008.03.064

Cited by 73 publications

(41 citation statements)

References 15 publications

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“…[4][5][6] Initially open surgical approach was the standard, but now there are alternative approaches, such as embolization and laparoscopy. 7,8 The effect of varicocelectomy on semen analysis is controversial. Many articles report favourable outcomes, 9-11 and others do not.…”

Section: Introductionmentioning

confidence: 99%

Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study

Shabana

Teleb

Dawod

et al. 2015

CUAJ

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Introduction: We aim to predict results of varicocelectomy on sperm density and progressive motility using preoperative clinical, laboratory and radiological data and to propose cut-off values for significant parameters. Methods: This prospective study was carried out between July 2011 and June 2014. We included 123 patients in our study. They were diagnosed with primary infertility with varicocele, were scheduled for varicocelectomy, and completed their follow-up. We excluded patients with azoospermia, total necrospermia, recurrent varicocele, and pituitary hormonal abnormalities. Varicocele was diagnosed and graded by physical examination and colour Doppler ultrasound. Semen analyses were completed preoperatively and 6 months postoperatively. Microscopic subinguinal varicocelectomy was done in all cases. Patient demographics, pre-and postoperative clinical data (varicocele grade and semen parameters) were statistically analyzed. Results: The mean ± standard deviation of age, body mass index, and subfertility duration was 28.3 ± 7.4 years, 29.1 ± 2.7 kg/m 2 , and 21.9 ± 7.1 months, respectively. About 53% of our patients (n = 66) had bilateral varicocele, and unilateral disease was found in the other 57 (46.3%) cases. Varicocele grade I was diagnosed in 42 (34.1%) patients, while the other 81 (65.9%) patients had grade II or III. Higher grades of varicocele, preoperative total testosterone level, sperm density, and progressive motility had a statistically significant impact on the outcome of varicocelectomy in univariate testing. Multivariate logistic analysis revealed that grade of preoperative varicocele (95% confidence interval [CI] 5.6-6.3, p = 0.007) and sperm density (95% CI 2.7-1.6, p = 0.0035), and progressive motility (95% CI 1.1-2.3, p = 0.0123) are independent predictors of semen parameters improvement after varicocelectomy. Conclusion:The grade of the varicocele, sperm density, and progressive motility are major predictors of outcome in varicocelectomy. Cut-off values of >8 million/mL and >18% for sperm density and progressive motility, respectively, in men with varicocele grade II or III, indicate a successful outcome. IntroductionVaricocele is an abnormal enlargement and tortuosity of the pampiniform plexus of veins in the spermatic cord. It is the most common identifiable cause of male subfertility, with an estimated prevalence of 15% in the general male population and up to 40% in subfertile men.1 One of the theories of the varicocele influence on spermatogenesis is the resultant venous blood stagnation in the testis that increases oxidative stress and hinders spermatogenesis through a thermal effect. 2Varicocelectomy is by far the most common procedure to treat male subfertility in patients with clinical varicocele. It reduces intratesticular temperature to the normal range. Hence, semen parameters not uncommonly show significant improvement following varicocele ligation. There are many approaches for varicocelectomy. [4][5][6] Initially open surgical approach was the standard, but now...

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Section: Introductionmentioning

confidence: 99%

Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study

Shabana

Teleb

Dawod

et al. 2015

CUAJ

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“…Preservation of lymphatics is strongly advised in varicocelectomy for the superior postoperative outcome. Magnification that allows identification and preservation of the lymphatics can reduce the rate of hydrocele [9,27]. In our study, 23.6 % (29/123) lymphatics were to be ligated for incorrect identification in the ''nonmicroscopic varicocelectomy,'' but in the microsurgical varicocelectomy, an average number of 2.93 (123/42) lymphatics was identified and preserved.…”

Section: Discussionmentioning

confidence: 57%

Macroscopic and microsurgical varicocelectomy: what’s the intraoperative difference?

et al. 2012

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“…1 Recently, studies have shown that varicocele is a bilateral disease, 2 with direct effect on the development of benign prostatic hyperplasia (BPH) and prostate cancer. 3,4 Other recent studies have shown that the prevalence of malfunction of one-way valves in the ISV increases by 10-15% for each decade of life.…”

Section: Editorial Comment To Umbilical Laparoendoscopic Single Site mentioning

confidence: 99%

“…Laparoscopic surgery is especially advantageous for bilateral varicocelectomy. 1,2 However, a comparative study showed no superiority of laparoscopic varicocele ligation over the standard open subinguinal varicocelectomy with respect to operative time, postoperative pain, cost-effectiveness and complications. [5][6][7] Laparoendoscopic single site surgery (LESS) was introduced several years ago.…”

Section: Introductionmentioning

confidence: 99%

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Umbilical laparoendoscopic single site surgery versus inguinal varicocelectomy for bilateral varicocele: A comparative study

et al. 2011

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Abstract:We aimed to determine the efficacy of umbilical laparoendoscopic single site surgery (LESS) bilateral varicocelectomy on the basis of a comparative study versus open inguinal bilateral varicocelectomy. We enrolled 39 patients who underwent bilateral varicocelectomy with predetermined surgical indications at two hospitals with either the LESS (n = 19) or the open inguinal approach (n = 20). Operative time, operation-related pain (10-point visual analog pain scale), catch-up growth of the testes, semen parameters, and complications after surgery between the LESS group and the open group at 3 months after surgery were compared. Operative times were 46.8 and 72.8 min (P < 0.001) in the LESS and open surgery groups, respectively. Patients in the LESS group reported lower surgery-related pain than those in the open surgery group at 3 months (2.5 vs 1.2, P = 0.029). A significant improvement in terms of semen concentration, motility, catch-up growth of the bilateral testes was observed in both groups, although no significant differences were detected between the groups. Postoperative complications were also similar between the two groups. LESS varicocelectomy required a shorter operative time than inguinal varicocelectomy for bilateral cases. In addition, the LESS procedure showed less postoperative pain and cosmetic benefits with similar seminal outcomes. Thus, LESS for patients undergoing bilateral varicocelectomy represents a promising surgical approach.

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Laparoscopic Lymphatic Sparing Varicocelectomy in Adolescents

Cited by 73 publications

References 15 publications

Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study

Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study

Macroscopic and microsurgical varicocelectomy: what’s the intraoperative difference?

Umbilical laparoendoscopic single site surgery versus inguinal varicocelectomy for bilateral varicocele: A comparative study

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