Varicocele: A Multidisciplinary Approach in Children and Adolescents

Mazzoni, G; Fiocca, G; Minucci, Sergio; Pieri, Stefano; Paolicelli, Domenico; M, Morucci; Bibbolino, Corrado; Medici, Lorenzo; Calisti, Alessandro

doi:10.1016/s0022-5347(05)68232-8

Cited by 37 publications

(19 citation statements)

References 18 publications

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“…The ideal choice should be effective for any type of varicocele, have minimal morbidity, preserve optimal testicular function and be cost effective [19]. Comparison of costs is very difficult, as costs seem to vary widely among countries, and depend on the caseload of the centre and on whether the equipment is dedicated only to the treatment of varicocele or used also for other conditions [20,21]. Final testicular function is a questionable end-point in children as well, as it is difficult to differentiate postoperative from spontaneous improvement.…”

Section: Discussionmentioning

confidence: 99%

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Evolving management of adolescent varicocele

Castagnetti

Cimador

Catalano

et al. 2008

Journal of Pediatric Urology

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Objective: To review the evolution in indications for treatment and treatment modalities for adolescent varicocele at our centre, and evaluate the impact of varicocelectomy on final outcome. Patients and methods: Between 1995 and 2006, we treated 242 left varicoceles. Preoperative assessment included clinical evaluation, measurement of testicular volumes, and colourDoppler ultrasound (CDUS). A subinguinal varicocelectomy was performed in 124 patients (group A), and a laparoscopic non-artery-sparing Palomo procedure in the remaining 118 (group B). In group B patients, CDUS was also used to investigate the functional anatomy of varicocele, and all the veins found to be refluxing were divided during surgery. The two groups were compared with regard to indications for surgery and outcome. Results: Over time the proportion of patients operated on because of testicular growth retardation increased. Persistence/recurrence rate was comparable between the two groups. In 13% of group B patients, the deferential vein was found to be refluxing on preoperative CDUS and was divided at surgery. Hydrocele rate was higher in group A, unless the vaginalis was excised and everted during varicocelectomy. About 75% of patients with preoperative left testicular growth failure experienced postoperative catch-up growth, irrespective of treatment. Conclusion: Indications for treatment are still evolving. Varicocele can successfully be treated in the majority of cases by either a laparoscopic or subinguinal approach. Both techniques require care, and CDUS can aid in the decision making. Most patients with preoperative testicular growth failure experience postoperative catch-up growth.

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Section: Discussionmentioning

confidence: 99%

“…Being an entirely endovascular procedure, it does not carry any risk of hydrocele formation. Recurrence/persistence rate varies between 7% and 20% [20,23], a possible reason for recurrence being that this approach only addresses a possible reflux in the ISV.…”

Section: Discussionmentioning

confidence: 99%

Evolving management of adolescent varicocele

Castagnetti

Cimador

Catalano

et al. 2008

Journal of Pediatric Urology

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“…The high retroperitoneal (Palomo), radiologic and laparoscopic approaches can be performed for internal spermatic vein ligation. [14,[20][21][22] The inguinal (Ivanissevich) and subinguinal approaches can be also used to ligate the external spermatic veins. Conventional varicocelectomy performed without optical magnification may miss smaller internal spermatic veins that may dilate in the future and cause recurrence.…”

Section: Diagnosis Of Adolescent Varicocelementioning

confidence: 99%

Update on the novel management and future paternity situation in adolescents with varicocele

Çayan

Bozlu

Akbay

2017

Turkish Journal of Urology

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Varicocele is a progressive disease, and the incidence of varicocele and varicocele related testicular hypotrophy increases with puberty. This review updates novel management and future paternity potential in adolescents with varicocele. Main goal of treatment of the adolescent varicoceles is preservation of fertility. Current recommendations for adolescent varicocele repair are testicular hypotrophy (>2 mL or >20%) on the affected side and/or impaired spermatogenesis in the post-pubertal period. The best treatment modality for adolescent varicocele should include elimination of the varicocele with lower complication rates. Microsurgical varicocelectomy techniques have been shown to result in fewer recurrences and postoperative complications than conventional varicocelectomy in adolescents. We conducted a meta-analysis, including 2 studies with the control groups, and reporting paternity situation after varicocele treatment. In this metaanalysis, varicocele repair increases paternity rate 2.42 times with a p value of 0.000. Adolescents with varicocele and their families should be counselled in the light of these findings.

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“…Persistence rates range from 7% to 20%, pos sibly because this surgical approach only addresses reflux in the ISV. [79][80][81][82] Laparoscopic and retroperitoneoscopic varico celectomy have also gained popularity in the last decade. Irrespective of the approach, a Palomo high ligature of the ISV is performed, which means that refluxes in associated districts are not addressed.…”

Section: Surgical Treatment Optionsmentioning

confidence: 99%

The hemodynamic approach to evaluating adolescent varicocele

et al. 2012

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| During adolescence, the risk of developing a varicocele increases. Prevalence is less than 1% in boys aged younger than 10 years, but approaches that of the general adult population (about 15%) during puberty. For adolescent males with varicoceles, surgical risk factors have not yet been clearly delineated and clinical severity correlates poorly with prognosis. Fortunately, the widespread use of Doppler ultrasonography is transforming the diagnostic work-up for this demographic. A continuous reflux detected by color Doppler ultrasound (CDUS) is thought to have a negative prognostic value and evidence suggests that a peak retrograde flow above 38 cm per second is a powerful predictor of lack of spontaneous improvement in adolescent patients with ≥20% asymmetry between testes. CDUS also enables the detection of varicocele resulting from reflux in the deferential vein adjunctive to a refluxing internal spermatic vein; a causality that accounts for approximately 15% of cases. In addition to a diagnostic role, hemodynamic parameters can be used to predict the risk of persistence or worsening asymmetry. Although further studies are necessary to validate single parameters, it seems that the more severe the reflux, the greater the likelihood that the patient will develop testicular asymmetry.

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Varicocele: A Multidisciplinary Approach in Children and Adolescents

Cited by 37 publications

References 18 publications

Evolving management of adolescent varicocele

Evolving management of adolescent varicocele

Update on the novel management and future paternity situation in adolescents with varicocele

The hemodynamic approach to evaluating adolescent varicocele

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