Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel

Sılay, Mesrur Selçuk; Hoen, Lisette A. ’t; Quadackaers, Josine; Undre, Shabnam; Bogaert, Guy; Doğan, Hasan Serkan; Kočvara, R; Nijman, Rien J.M.; Radmayr, Christian; Tekgül, Serdar; Stein, Raimund

doi:10.1016/j.eururo.2018.09.042

Cited by 60 publications

(40 citation statements)

References 95 publications

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“…[16,17] Literatürde varikosel tedavisinin operasyon sonrası takip döneminde ipsilateral testisin yakalama büyümesine ulaşması ve semen parametrelerinde iyileşme bazında başarı değerlendirilmesi yapıldığında laparoskopik ve açık Palamo serilerinde %96,8 ve mikroskobik (inguinal ve subinguinal) varikoselektomi sonrası %100 başarı oranları verilmektedir. [18][19][20]…”

Section: Discussionunclassified

Adölesan varikosel tedavisinde uygulanan üç farklı cerrahi yöntem sonuçlarının karşılaştırılması

Uçar¹,

Akgül²,

Caylan³

et al. 2019

Androl Bul

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Varikosel, pampiniform pleksus ve internal spermatik venlerin anormal bir dilatasyonu olup, seminifer tübüllerdeki sıcaklığın artmasına, toksik adrenal ve renal metabolitlerin renal ven yoluyla geri akışına, sperm kalitesinin düşmesine ve testis büyümesinin durmasına neden olur. [1] Erkek infertilitesinin en sık düzeltilebilir nedenidir. Adölesan varikosel insidansı erişkinlere benzer şekilde %15-16'dır. [2] Tedavi endikasyonları arasında varikoselin semptomatik ABSTRACT OBJECTIVES: In the treatment of adolescent varicocele, there isn't any consensus and the ideal technique is not yet defined. Open surgery (microscopy-assisted or not) or laparoscopic techniques are surgical methods used in treatment. We planned to compare the results of microscopic, laparoscopic and open varicocelectomy techniques. MATERIAL and METHODS: Patients who underwent varicocele therapy between 2003-2018 were evaluated retrospectively in 3 groups. Patients who underwent laparoscopic varicocele ligation were included in Group 1, patients who underwent microscopic varicocelectomy were included in Group 2 and patients who underwent subinguinal varicocelectomy were included in Group 3. Three groups were compared in terms for operation and postoperative follow-up data. RESULTS: The study included 113 patients, 30 patients in Group 1, 43 patients in Group 2, 40 patients in Group 3. The mean age was 13.2 years. There was no significant difference between groups in terms of side and varicocele degree. The median operation times for group1.2 and 3 were 55 (35-70), 50 (40-80) and 55 min. (40-70) (p>0.05). The hydrocele development after surgery was detected in 3, 1 and 2 patients, respectively (p>0.05). Varicocele recurrence was not seen in the LVL group, but it was seen in 3 patients in the MV group and in 7 patients in the SV group (p>0.05). Postoperative testicular volume loss was detected in 3 patients in Group 1, 1 patient in Group 2 and in Group 3 no patient was detected. There was no statistical significant different between groups although there were clinical differences between the groups in terms of results or complications. CONCLUSION: In the treatment of adolescent varicoceles, it was found that all 3 techniques can be used successfully but in microscopic or under magnification (via loop) techniques, complication rates seem to be much less and clinical successful rates seem to be much higher.

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Section: Discussionunclassified

Adölesan varikosel tedavisinde uygulanan üç farklı cerrahi yöntem sonuçlarının karşılaştırılması

Uçar¹,

Akgül²,

Caylan³

et al. 2019

Androl Bul

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“…Overall, four meta-analyses have evaluated the effects of varicocele repair in childhood and adolescence so far [11,38,39,40]. Zhou and collaborators [38] reported an improvement in the bilateral testicular volume following varicocelectomy compared with observation, although no benefit on sperm parameters was found.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…The best quality of evidence is offered by the latest systematic review and meta-analysis provided by the EAS/ESPU societies [40], including 12 RCTs (which were meta-analyzed), 47 NCTs (seven prospective and 40 retrospective) and 39 case series (which were qualitatively reviewed), for a total of 16,130 children and adolescents ≤ 21 years of age. The outcomes assessed were a short-term cure or success (evaluated < 9 months), testicular catch-up growth, pain resolution, sperm parameters and paternity (evaluated > 12 months) for benefits, complications such as testicular atrophy, hydrocele, wound infection, and failure rate for harms.…”

Section: Treatment Optionsmentioning

confidence: 99%

Management and Treatment of Varicocele in Children and Adolescents: An Endocrinologic Perspective

Cannarella

Calogero

Condorelli

et al. 2019

JCM

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Pediatric varicocele has an overall prevalence of 15%, being more frequent as puberty begins. It can damage testicular function, interfering with Sertoli cell proliferation and hormone secretion, testicular growth and spermatogenesis. Proper management has a pivotal role for future fertility preservation. The aim of this review was to discuss the diagnosis, management and treatment of childhood and adolescent varicocele from an endocrinologic perspective, illustrating the current evidence of the European Society of Pediatric Urology (ESPU), the European Association of Urology (EAU), the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) scientific societies. According to the ASRM/ESPU/AUA practice committee, the treatment of adolescent varicocele is indicated in the case of decreased testicular volume or sperm abnormalities, while it is contraindicated in subclinical varicocele. The recent EAS/ESPU meta-analysis reports that moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration increase. No specific phenotype in terms of testicular volume cut-off or peak retrograde flow (PRF) is indicated. Based on current evidence, we suggest that conservative management may be suggested in patients with PRF < 30 cm/s, testicular asymmetry < 10% and no evidence of sperm and hormonal abnormalities. In patients with 10–20% testicular volume asymmetry or 30 < PRF ≤ 38 cm/s or sperm abnormalities, careful follow-up may ensue. In the case of absent catch-up growth or sperm recovery, varicocele repair should be suggested. Finally, treatment can be proposed at the initial consultation in painful varicocele, testicular volume asymmetry ≥ 20%, PRF > 38 cm/s, infertility and failure of testicular development.

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“…Dieser Parameter ist nicht nur aufgrund der Messungenauigkeiten unzuverlässig, sondern auch aufgrund der Beobachtung, dass sich eine Volumendiffe-renz von > 15 % in Abhängigkeit vom Tannerstadium bei 39 -64 % der Jugendlichen zeigt [11]. In einer aktuellen systematischen Analyse wurde im Mittel eine Hodenvolumenzunahme von 1,52 ml nach Varikozelentherapie im Vergleich zu keiner Therapie herausgearbeitet [12]. Hier ist zu berücksichtigen, dass ein spontanes Aufholwachstum des Hodens in der Hälfte der Fälle beobachtet werden kann [10].…”

Section: Introductionunclassified

“…Als zweiter relevanter Parameter können die Ejakulatparameter herangezogen werden. Die Daten zur Verbesserung der Spermiogrammparameter beim Jugendlichen mit Varikozele nach einer Therapie sind widersprüchlich: Während eine Metaanalyse aus 2015 [14] keine signifikante Verbesserung zeigte, wurde in 2 aktuellen Analysen [12,15] eine Verbesserung der Samenqualität, insbesondere der Spermienkonzentration herausgearbeitet. Allerdings spielen sich die Veränderungen ganz überwiegend im Normbereich nach WHO ab, und nicht alle Studien haben vollständige Ejakulatanalysen nach WHO dokumentiert [16].…”

Section: Introductionunclassified

Varikozele im Jugendalter, wenn ja, wann und wie? Kontra OP

Kliesch

2019

Aktuel Urol

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ZusammenfassungDie verfügbaren Indikatoren, die eine Therapie der Varikozele beim Adoleszenten rechtfertigen sollen, sind unzureichend: Das Hodenvolumen ist als störanfälliger Messparameter variabel, eine Hodenvolumendifferenz kann physiologisch sein; Hodenvolumen und Samenparameter unterliegen der pubertären Entwicklung. Beide Parameter sollten von daher prospektiv und zu mehreren Zeitpunkten gemessen werden, um eine klare Aussage im Hinblick auf eine mögliche Funktionseinschränkung der Hoden durch eine Varikozele treffen zu können. Nahezu unbeachtet sind endokrine Parameter der Hodenentwicklung, die möglicherweise pathologische Abweichungen anzeigen könnten. Völlig unklar ist der postulierte positive Effekt auf die spätere Fertilität der Betroffenen im Erwachsenenalter: Die wenigen vorliegenden Studien können nicht zeigen, dass eine effektive Prävention einer späteren Fertilitätseinschränkung durch eine frühzeitige Therapie der Varikozele beim Jugendlichen möglich ist. Aus diesen Gründen müssen Risiken und Nutzen der Therapie sorgfältig abgewogen werden. Eine evidenzgesicherte Empfehlung zur Intervention beim Jugendlichen lässt sich aus der aktuellen Datenlage nicht ableiten.

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Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel

Cited by 60 publications

References 95 publications

Adölesan varikosel tedavisinde uygulanan üç farklı cerrahi yöntem sonuçlarının karşılaştırılması

Adölesan varikosel tedavisinde uygulanan üç farklı cerrahi yöntem sonuçlarının karşılaştırılması

Management and Treatment of Varicocele in Children and Adolescents: An Endocrinologic Perspective

Varikozele im Jugendalter, wenn ja, wann und wie? Kontra OP

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