Adolescent varicocele: emerging understanding

Diamond, David A.

doi:10.1046/j.1464-410x.92.s1.9.x

Cited by 26 publications

(11 citation statements)

References 33 publications

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“…This kind of varicocele can be addressed successfully by several techniques including open surgical ligation via a subinguinal, inguinal, or retroperitoneal approach; minimally invasive procedures; or radiologic embolization [2,3]. The only possible cause for recurrence in this scenario is the presence of collaterals bypassing the site of ISV interruption [1,4,9].…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly refluxing vein is the internal spermatic vein (ISV) [1]. The ISV can be interrupted using several techniques including classic surgical repair via a subinguinal, inguinal, or high retroperitoneal approach; minimally invasive surgery; or percutaneous scleroembolization [2,3]. Any technique relying on interruption of the ISV alone, however, may involve varicocele recurrence or persistence whenever veins draining the testicle other than the ISV are refluxing as well [1,4,5].…”

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confidence: 99%

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Comprehensive laparoscopic approach to pediatric varicocele based on preoperative color Doppler ultrasound assessment

et al. 2007

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Background This study aimed to assess whether laparoscopic treatment for any kind of varicocele is possible after preoperative identification of refluxing veins by color Doppler ultrasound (CDUS). Methods At the authors' institution, 98 patients with a median age of 11.3 years (range, 7.1-16 years) were evaluated for a left varicocele. Preoperatively, all the patients underwent ultrasound scan assessment of testicular volume and CDUS to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. In all the patients, laparoscopic division of the spermatic artery and veins was performed as close as possible to the internal inguinal ring. The other vessels were coagulated and divided if shown to be refluxing on CDUS. Results Color Doppler ultrasound showed reflux only in the ISV in 87 cases (88.7%), but in both the ISV and the deferential in the remaining 11 cases (11.2%). During a median follow-up period of 18 months (range, 6-49 months), none of the authors' patients experienced varicocele recurrence either clinically or according to CDUS scanning. The median left testicular volume increased significantly postoperatively. Conclusion The proposed technique based on laparoscopic interruption of the ISV and testicular artery very close to the internal inguinal ring, meticulous CDUS assessment to rule out reflux in the deferential vein, and coagulation of refluxing deferential veins allows successful laparoscopic treatment of most varicoceles.Successful surgical treatment of a varicocele requires the interruption of every refluxing vein draining the testicle. The most commonly refluxing vein is the internal spermatic vein (ISV) [1]. The ISV can be interrupted using several techniques including classic surgical repair via a subinguinal, inguinal, or high retroperitoneal approach; minimally invasive surgery; or percutaneous scleroembolization [2,3]. Any technique relying on interruption of the ISV alone, however, may involve varicocele recurrence or persistence whenever veins draining the testicle other than the ISV are refluxing as well [1,4,5].In our early experience, to interrupt all the possible refluxing systems, we performed varicocelectomy via a microsurgical subinguinal ligation of all the dilated veins detected at surgery [6]. Subsequently, the development of accurate techniques for color Doppler ultrasound (CDUS) allowed us to perform preoperatively an accurate and comprehensive assessment of all the major venous systems draining the testicles [7]. We therefore started to restrict the subinguinal approach to varicoceles with reflux detected in multiple veins and to treat those due to reflux only into the ISV by laparoscopic high ligation according to Palomo.The current study aimed to test the hypothesis that successful laparoscopic treatment for any kind of varicocele can be achieved by selective laparoscopic interruption of all the veins detected by preoperative CDUS to be refluxing.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Comprehensive laparoscopic approach to pediatric varicocele based on preoperative color Doppler ultrasound assessment

et al. 2007

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“…The median (range) age at surgery was 15 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) years. Patients were stratified based on the surgical technique…”

Section: Methodsmentioning

confidence: 99%

“…In all, 92 patients undergoing surgical spermatic vein ligation at Children's Hospital Boston between 1996 and 2006, and with > 1 year of followup, were evaluated. The median (range) age at surgery was 15 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) years. Before and after surgery, the varicocele grade (according to Dubin and Amelar [3]), testicular volume and testicular consistency were determined by the attending urologist.…”

Section: Methodsmentioning

confidence: 99%

Varicocele surgery: a decade’s experience at a children’s hospital

et al. 2009

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used by eight different urology faculty members. Microsurgery and attempted artery-sparing were applied to some Palomo, Ivannisevich, and subinguinal cases but not to laparoscopic procedures. RESULTSThe laparoscopic (100%) and Palomo (93%) techniques had significantly higher success rates than the Ivanissevich approach (69%). The success rate with the subinguinal technique (88%) was intermediate between the more successful supra-inguinal and less successful inguinal approaches. There was a higher hydrocele rate (32%) in the laparoscopic approach. Artery sparing significantly lowered hydrocele rates but had no effect on success rates. Incorporating microsurgery also had no effect on success rates but resulted in no hydrocele formation. One case of testicular atrophy occurred in a patient undergoing microsurgical arterysparing subinguinal spermatic vein ligation. There was compensatory growth in 68% of patients operated on for testicular hypotrophy. CONCLUSIONSDuring our 10-year experience the laparoscopic and Palomo approaches were the most successful. The subinguinal approach (usually incorporating microsurgery and artery sparing) had an intermediate success rate. The Ivanissevich approach was least successful. Hydroceles did not occur when microsurgery was used, and were significantly less common with artery sparing. The only case of testicular atrophy was with a microsurgical arterysparing subinguinal approach. When the spermatic vein was ligated for testicular hypotrophy there was compensatory growth in two-thirds of testes. OBJECTIVESTo review our experience at a children's hospital over a 10-year period with the Palomo, Ivanissevich, subinguinal and laparoscopic techniques for varicocele, assessing the success and complication rates according to specific procedure, and the added effect that the modifications of microsurgery and artery-sparing has had on these rates. A second objective was to assess the rate of testicular compensatory growth after surgery for testicular hypotrophy. PATIENTS AND METHODSNinety-two patients with > 1 year of followup between 1996 and 2006 were assessed retrospectively. The median (range) age at surgery was 15 (8-21) years. Patients were stratified based on the surgical technique

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“…2). In a prospective study, Diamond et al [29] observed that abnormal outcome of semen analysis occurred already when volume disparity was [10 %, and abnormal outcome became significant when the volume disparity was more than 20 %. In contrast, there was no statistical correlation between the degree of varicocele and impaired semen analysis.…”

Section: Varicocele In Prepubescent Boys or Adolescentsmentioning

confidence: 99%

Children and adults varicocele: diagnostic issues and therapeutical strategies

et al. 2014

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Varicocele is defined as abnormally dilated scrotal veins. It is present in 15 % of normal males and in 40 % of males with infertility. This disorder is a challenge for the physicians involved in the diagnosis and treatment, as the pathophysiology of varicocele is not yet completely understood. For this reason, accurate diagnostic criteria and clear indications for treatment in asymptomatic adolescents or adults with clinical or subclinical varicocele are still not defined. Ultrasonography (US) is considered the best method for calculating the volume of the testicles, measuring vein diameter and monitoring the growth of the testis in adolescent patients. Color-Doppler US is the method of choice for detecting spermatic vein reflux and for classifying the grade of varicocele. Various classification systems have been published with recommendations on how to perform US imaging of the scrotum. Currently, color-Doppler US and spectral analysis are the most effective, non-invasive diagnostic procedures as they allow detection of subclinical varicocele associated with infertility. Various techniques are used in the treatment of varicocele including open surgery, laparoscopic procedures and interventional radiology. However, there is no consensus among physicians on which technique is the most effective in terms of outcome and complication rates. This review shows that color-Doppler US is currently the most widely employed diagnostic method for detection and classification of varicocele caused by venous reflux, as it is reliable and easily performed. The review also highlights the role of varicocelectomy in the management of adult male infertility.Riassunto Il varicocele è una dilatazione abnorme delle vene scrotali. Esso si riscontra nel 15 % degli uomini normali e nel 40 % dei soggetti che presentano infertilità. Rappresenta ancora oggi un problema clinico per gli specialisti che sono coinvolti nella diagnosi e nel trattamento di questa affezione, in quanto i meccanismi fisiopatologici che stanno alla base di questa patologia non sono stati ancora chiariti in maniera completa. Per questi motivi non esistono ancora indicazioni condivise tra i medici sulle possibilità diagnostiche e sulle scelte terapeutiche da applicare negli adolescenti asintomatici o negli adulti con varicocele clinico o subclinico. L'esame ultrasonografico dello scroto viene considerato attualmente come la metodica migliore per calcolare il volume dei testicoli, per misurare il diametro dei vasi venosi e per seguire l'accrescimento testicolare negli adolescenti. Il Color-Doppler è il metodo più semplice e preciso per studiare e documentare l'inversione del flusso nelle vene spermatiche e serve per una precisa classificazione del varicocele. Sono state proposte numerose classificazioni cliniche ed ecografiche del varicocele e sono state pubblicare raccomandazioni su come condurre l'esame ecografico dello scroto per l'identificazione del varicocele. Attualmente il color-Doppler associato all'analisi spettrale è la procedura diagnostica più 18...

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Adolescent varicocele: emerging understanding

Cited by 26 publications

References 33 publications

Comprehensive laparoscopic approach to pediatric varicocele based on preoperative color Doppler ultrasound assessment

Comprehensive laparoscopic approach to pediatric varicocele based on preoperative color Doppler ultrasound assessment

Varicocele surgery: a decade’s experience at a children’s hospital

Children and adults varicocele: diagnostic issues and therapeutical strategies

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