Adolescent Varicocelectomy: Success at What Cost? Clinical Outcome and Cost Comparison of Surgical Ligation and Percutaneous Embolization

Wickham, Azadeh; Vu, Dan; El-Arabi, Ahmad M.; Gatti, John M.

doi:10.1089/lap.2020.0836

Cited by 7 publications

(7 citation statements)

References 8 publications

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“…There were two main factors in our analysis. First, the high cost of surgery may be the main factor affecting the selection of patients ( Balasubramanian et al, 2019 ; Wickham et al, 2021 ). After surgery, some patients’ sperm still cannot return to the normal state or become pregnant naturally, so they still need to seek other alternatives.…”

Section: Discussionmentioning

confidence: 99%

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Liu

Huang

Zheng³

et al. 2022

Front. Pharmacol.

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Objective: The aim of the study was to explore the evidence of JWRJD in the treatment of cryptozoospermia.Methods: A total of 162 cryptozoospermia patients with varicocele who refused to undergo surgery were included from January 2021 to December 2021. They were divided into the Jiawei Runjing Decoction group (group A), tamoxifen group (group B), and no treatment group (group C), and after the follow-up for 3 months, therapeutic effectiveness was compared. Network pharmacology was used to analyze and validate the effects and mechanisms of JWRJD.Results: Fifty-eight patients were treated with JWRJD, 55 with tamoxifen, and 49 without any treatment. After treatment, five patients were lost: one in group A, one in group B, and three in group C. The sperm count and the decrease of FSH in group A were significantly higher, but the degree of decline in the testicular volume and the degree of vein expansion have decreased significantly, which were closely related to the testicular volume (TV) [especially changes in the left testicular volume (ΔL-TV)], citric acid (CC) and its changes (ΔCC), and the vein width (VW) [especially left spermatic vein width (L-VW) and mean vein width (M-VW) and their changes (ΔL-VW and ΔM-VW)], as well as the sperm count before the treatment (bSC), which were the significant indexes to predict the therapeutic effect, especially for patients >35 years old and with grade III varicoceles. Network pharmacological analysis verifies that it can be regulated by fluid shear stress and the atherosclerosis pathway to improve the testicular microenvironment for spermatogenesis.Conclusion: JWRJD may promote spermatogenesis in cryptozoospermia patients with varicocele, which may be closely related to improving the testicular microenvironment, especially for >35 year olds and grade III varicocele patients.

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Section: Discussionmentioning

confidence: 99%

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Liu

Huang

Zheng³

et al. 2022

Front. Pharmacol.

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“…Complications associated with coil insertion such as migration to the heart or pulmonary arteries and infection are rare but potentially serious. Moreover, the use of X-rays can be considered a disadvantage [34,35].…”

Section: Treatmentmentioning

confidence: 99%

Controversies in the Laparoscopic Treatment of Varicocele in the Pediatric Population

Marte¹

2024

Current Concepts and Controversies in Laparoscopic Surgery

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At present, treatment of varicocele is still controversial in adolescents for at least three reasons. Firstly, the long-term outcome of treatment is not known in the absence of spermiogram support and in terms of long-term follow-up. Secondly, it is still uncertain which is the best type of operation for children/adolescents. Thirdly, the principle that if a technique is designed for adults, it can also be safely performed in adolescents cannot be applied. A recent systematic literature review and meta-analysis demonstrated that open and laparoscopic techniques appear to yield better results with a microsurgical approach compared with laparoscopy. However, laparoscopic techniques that preserve the lymphatic vessels appear to have a clear advantage by preventing postoperative hydrocele. At present, the evaluation and choice of treatment for adolescent varicocele patients are based not on objective fertility criteria (paternity) but on indirect evidence that testicular function or spermatogenesis and thus ultimately also fertility may be compromised. In the absence of sufficient data regarding the treatment of varicocele at a pediatric age, the choice of the technique appears to depend largely on the experience and preferences of the surgeon rather than on a shared option.

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“…Twenty studies compared surgical ligation and sclero‐embolization in patients with varicocele. There were three prospective non‐randomized studies (Nasr et al, 2017; Nasser et al, 2020; Sepúlveda et al, 2018), five randomized clinical trials (Bolla, 2014; Nieschlag et al, 1993; Sayfan et al, 1992; Yavetz et al, 1992; Zucchi et al, 2005), and 12 retrospective studies (Bechara et al, 2009; Beutner et al, 2007; Dewire et al, 1994; Feneley et al, 1997; Jing et al, 2020; Mazzoni et al, 1999, 2001; Mongioì et al, 2019; Motta et al, 2019; Parsch et al, 1990; Shlansky‐Goldberg et al, 1997; Wickham et al, 2021).…”

Section: Evidence Synthesismentioning

confidence: 99%

Do sclero‐embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Results from a systematic review and meta‐analysis

Fabiani

Pavia²,

Stramucci

et al. 2022

Andrologia

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We aimed to systematically review complications, and recurrence rate of varicocele treatment by comparing the surgical ligature versus sclero-embolization techniques in children, adolescents and adults. The secondary outcomes were the evaluation of semen parameters and spontaneous pregnancy rate in adults. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05. Twenty studies were included. Incidence of postoperative hydrocele was significantly higher in the surgical ligation group (OR 3.06 95% CI 1.06-8.88, p = 0.04). Incidence of postoperative orchiepidydimitys was significantly higher in sclero-embolization group (OR 0.26 95% CI 0.08-0.85, p = 0.02). Presence of normal spermatozoa was significantly higher sclero-embolization group compared with the surgical ligature group (MD 2.54% 95% CI 0.43-4.65, p = 0.02). No difference was found in overall complications, wound infection, testis pain, surgical site hematoma, total sperm count, sperm motility, pregnancy and recurrence rate. This review confirms that current data does still not support the superiority of one type of treatment over other ones.

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Adolescent Varicocelectomy: Success at What Cost? Clinical Outcome and Cost Comparison of Surgical Ligation and Percutaneous Embolization

Cited by 7 publications

References 8 publications

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Controversies in the Laparoscopic Treatment of Varicocele in the Pediatric Population

Do sclero‐embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Results from a systematic review and meta‐analysis

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