Dilemma of adolescent varicocele: Long-term outcome in patients managed surgically and in patients managed expectantly

Moursy, Essam; ElDahshoury, Mohammed Z.; Hussein, Mohammed M.; Mourad, M.; Badawy, Abdelbasset A.

doi:10.1016/j.jpurol.2013.01.017

Cited by 34 publications

(36 citation statements)

References 18 publications

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“…[28] In various current series 73-90% catch-up growth rates have been detected. [20][21][22] In our study 70% catch-up growth rate was detected. However, Cayan et al [29] observed improvement in previously low sperm counts of 15-19-year-old men after varicocelectomy, while testicular catch-up growth was not observed in these patients.…”

Section: Discussionsupporting

confidence: 53%

“…In various novel series catch-up growth rates have varied between 73, and 90 percent. [20][21][22] In studies performed on the impact of surgical method on catch-up growth rate, any effect of surgical method on testicular catch-up rate could not be detected. [13,23] Recently, Shiraishi et al [23] , performed subinguinal, and high-ligation microsurgical varicocelectomy, and indicated 70, and 78% catch-up growth rates during 24 months of the follow-up period, respectively.…”

Section: Discussionmentioning

confidence: 96%

“…[9] Some investigators have reported recovery of testicular development, and sperm dysfunction after varicocelectomy. [10,20,21] Sinanoğlu et al [10] followed up 39 adolescents with varicocele at 3 month-intervals after varicocelectomy just by calculating testicular volumes. As a result of an average followup of 39 months, they reported catch-up growth in 90% of the cases with ipsilateral testicular atrophy.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of testicular catch-up growth in adolescent microsurgical varicocelectomy

Bedir¹,

Keskin²,

Karabakan³

et al. 2017

Turkish Journal of Urology

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Objective: The incidence of varicocele is approximately 15% in adolecent men. Early treatment with varicocele is aimed to resolve testicular hypotrophy and ensure catch-up growth. The aim of this study was to evaluate ipsilateral catch-up growth rates relative to contralateral testicular growth in adolescents with varicocele undergoing microsurgical subinguinal varicocelectomy. Material and methods:Fifty adolescents with unilateral grade 2-3 varicoceles were included in the study. All patients underwent microsurgical subinguinal left varicocelectomies performed by the same experienced surgeon. All patients were evaluated clinically and using orchidometric measurements to define the grade of varicocele and testicular volume at presentation and follow-up. The number of internal and external spermatic veins, testicular arteries and lymphatic vessels preserved during the subinguinal microsurgical varicocelectomy were recorded. The mean follow-up period was 26 months (range 6-48 months).Results: At presentation, mean patient age was 12.9±2.1 years. Mean testicular preoperative volumes were 7.1±4.3 mL for the right and 5.4±3.4 mL for the left testis. There were significant differences between mean volumes of the right and left testis (p= 0.002). At the final postoperative follow-up visit, mean testicular volumes were 10.8±5.1 mL (range 3-25) for the right and 9.9±4.3 mL (range 2-20) for the left, and the difference between the right and left testicular volumes was insignificant (p= 0.47). In our series, catch-up growth was observed in 70% (35/50) of our patients. Conclusion:Adolescent varicocelectomy is associated with a higher percentage of patients showing testicular catch-up growth. In our study, similarly to the available literature the catch-up growth rate was found as 70% and observed to have positive effects of adolescent varicocelectomy on testicular growth.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of testicular catch-up growth in adolescent microsurgical varicocelectomy

Bedir¹,

Keskin²,

Karabakan³

et al. 2017

Turkish Journal of Urology

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“…23 In a study by Moursy et al, 59 of 60 patients with a varicocele and less than 20% asymmetry managed conservatively were found to have normal semen analysis at age 18 (mean followup 79 months). 32 Others have also described normalization of total motile sperm count in two-thirds of Tanner V boys with uncorrected varicocele. 33 On the other hand, randomized trials have shown improvement in semen parameters following varicocelectomy (see Treatment and outcomes).…”

Section: Semen Analysismentioning

confidence: 98%

Varicoceles in the pediatric population: Diagnosis, treatment, and outcomes

Reyes¹,

Locke²,

Afshar³

2017

CUAJ

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Varicocele is commonly encountered in adolescents. There are still many controversies regarding pathophysiology, health effects, clinical significance, and optimum treatment of this condition. This article reviews the current evidence pertaining to children and adolescents with varicocele. This group present a unique and somehow challenging situation, since they are still going through pubertal changes that may confound the effects of the disease and its treatment on the developing testes.

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“…In Souhag, Egypt, Moursy et al [52] examined 173 adolescent varicocele patients. Clinical and sonographic evaluation was carried out to define varicocele grade and testicular volume.…”

Section: Views Against Early Interventionmentioning

confidence: 99%

A challenging ‘bag of worms’

Younis¹,

Hamed²

2015

Human Andrology

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About 4.6-16.2% of male adolescents may be affected by varicocele. The most important damaging effect of varicocele in adolescents is testicular growth arrest (hypotrophy). Ultrasound is more accurate compared with orchidometry in detecting hypotrophy. Histopathologically, the testis of adolescent boys affected by varicocele shows Leydig cell hyperplasia, decreased number of spermatogonia per tubule, spermatogenesis arrest, and sloughing of the germinal epithelium. Varicocele in adolescents negatively affects sperm density and motility, and this seems to be related to testicular volume. To treat or not to treat adolescent varicocele is a controversial question. This is due to conflicting reports about the effectiveness of varicocelectomy. On one hand, some studies demonstrated a significant catch-up growth of the testis but found that prophylactic varicocele repair might expose many individuals to the unnecessary risks of surgery. Furthermore, this catch up of testicular volume could be due to edema secondary to severing of lymphatics during the procedure. On the other hand, other studies found that varicocele correction in adolescents not only improved testicular hypotrophy but also improved semen quality. Complications of varicocelectomy, such as recurrence or hydrocele incidence, are less common in open varicocelectomy than in laparoscopic or percutaneous embolization when treating varicocele in adolescents.

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Dilemma of adolescent varicocele: Long-term outcome in patients managed surgically and in patients managed expectantly

Cited by 34 publications

References 18 publications

Evaluation of testicular catch-up growth in adolescent microsurgical varicocelectomy

Evaluation of testicular catch-up growth in adolescent microsurgical varicocelectomy

Varicoceles in the pediatric population: Diagnosis, treatment, and outcomes

A challenging ‘bag of worms’

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