Management of adolescent varicocele

Zundel, Sabine; Szavay, Philipp; Stanasel, Irina

doi:10.1016/j.sempedsurg.2021.151084

Cited by 11 publications

(12 citation statements)

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“…Varicocele is common in adolescent males, especially after puberty; varicocele is the most common urinary system disease in boys (Zundel et al, 2021). This study suggests that in the past 20 years, researchers have paid more attention to adult varicocele, probably because the main harm of varicocele lies in its effect on fertility, and there is no unified standard for fertility assessment of adolescent varicocele patients.…”

Section: Discussionmentioning

confidence: 99%

Bibliometrics and visualisation analysis of literature on varicocele: From 2002 to 2021

Bao

Guo

et al. 2022

Andrologia

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Varicocele is a common disease in men, with a global incidence of approximately 25%. A comprehensive and systematic analysis of the knowledge map on it will help in assessing frontier research and identify knowledge gaps. In total, 4103 articles published from 2002 to 2021 in 1066 journals were included. They represent the current research status worldwide, potential hotspots and future research directions. In the past decades, the number of publications and citations of varicocele‐related studies have increased steadily. Academic institutions in the United States played a leading role in varicocele research. The country, institution, journal and author with the most publications were the United States (779), Cleveland Clinic Foundation (132), Andrologia (246) and Agarwal A (106), respectively. The most frequently used keywords were Varicocele (1620), Male Infertility (944), Varicocelectomy (288), Testis (245), Sperm (166), Oxidative Stress (144), Azoospermia (119), Semen Analysis (118), Laparoscopy (116) and Adolescent (97). Currently, the main focus of current varicocele research is its surgical treatment method and effect on sperm quality. The frontier research hotspot is the specific mechanism of varicocele‐induced decrease in sperm quality.

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Section: Discussionmentioning

confidence: 99%

Bibliometrics and visualisation analysis of literature on varicocele: From 2002 to 2021

Bao

Guo

et al. 2022

Andrologia

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“…The incidence of varicocele in adolescent males is 15%, which is similar to adult series. 1 It is characterized by dilatation of the testicular vein and the pampiniform venous plexus within the spermatic cord caused by venous reflux. The countercurrent heat exchange system within the spermatic vessels is impaired.…”

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confidence: 99%

Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery vs Scrotal Antegrade Sclerotherapy in Adolescent Varicocele

et al. 2023

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Purpose:Varicocele is a common condition in adolescence and the most common correctable cause of infertility. This study aimed to analyze and compare the outcomes of scrotal antegrade sclerotherapy and laparoscopic Palomo surgery in a tertiary referral center.Materials and Methods:Patients with left grade 3 varicocele indicated for surgery were prospectively enrolled and randomly allocated to the scrotal antegrade sclerotherapy and laparoscopic Palomo surgery groups, with their respective contralateral normal testes taken as controls. The primary outcome measures were clinical varicocele recurrence, testicular catch-up growth, and postoperative hydrocele. All patients were evaluated clinically and using Doppler ultrasound by radiologists.Results:From 2015 to 2020, 113 patients completed the study and were statistically analyzed (scrotal antegrade sclerotherapy, n = 57; laparoscopic Palomo surgery, n = 56). All patients had significantly smaller testes preoperatively; the testicular volume differences with control testes were −23% in scrotal antegrade sclerotherapy and −19% in laparoscopic Palomo surgery. At 12-month follow-up, there were no statistically significant differences in clinical recurrences between the 2 groups (scrotal antegrade sclerotherapy = 5.3% vs laparoscopic Palomo surgery = 5.4%, P > .05, noninferiority test). Testicular catch-up growths were observed in both groups; the mean testicular volume difference between the treatment and control testes decreased from −23% to −8.1% in scrotal antegrade sclerotherapy (P < .001) and from −19% to −9.3% in laparoscopic Palomo surgery (P < .001) at 12-month follow-up. There was no postoperative hydrocele in the scrotal antegrade sclerotherapy group compared to 7 cases in the laparoscopic Palomo surgery group (0% vs 13%, P = .006).Conclusions:Both scrotal antegrade sclerotherapy and laparoscopic Palomo surgery are safe and effective procedures for treatment of adolescent varicocele with significant positive effect on testicular catch-up growth. Scrotal antegrade sclerotherapy is not inferior to laparoscopic Palomo surgery in terms of clinical recurrence rate and has significantly less postoperative hydrocele.

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“…2 Alternatively, the subinguinal microscopic varicocelectomy (with both arterial- and lymphatic-sparing techniques, as well as ligation of gubernacular vessels to prevent recurrence) or endovascular therapy via interventional radiology is available. 2 At our institution, all 3 treatment options are offered to patients and their families.…”

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confidence: 99%

“…The SAS recurrence rate is lower than the 10%-16% reported relapse rate in studies from radiologic literature. 2…”

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confidence: 99%

“…The initial technique of high retroperitoneal en bloc ligation of spermatic vessels, described over 70 years ago by Alejandro Palomo, 1 has evolved to now include modifications such as testicular artery-sparing and/or lymphatic-sparing technique. 2 Alternatively, the subinguinal microscopic varicocelectomy (with both arterial-and lymphatic-sparing techniques, as well as ligation of gubernacular vessels to prevent recurrence) or endovascular therapy via interventional radiology is available. 2 At our institution, all 3 treatment options are offered to patients and their families.In this issue of The Journal, Chung et al (page 600) report their outcomes in a much-needed randomized controlled trial assessing surgical techniques for adolescent varicoceles.…”

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Laparoscopic vs Sclerotherapy for Varicoceles: Who Prevails?

Thaker

2023

Journal of Urology

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Surgical management of adolescent varicoceles has seen great enthusiasm for innovation over the past few decades. For those patients who meet clear criteria for intervention, several treatment options exist. The initial technique of high retroperitoneal en bloc ligation of spermatic vessels, described over 70 years ago by Alejandro Palomo, 1 has evolved to now include modifications such as testicular artery-sparing and/or lymphatic-sparing technique. 2 Alternatively, the subinguinal microscopic varicocelectomy (with both arterial-and lymphatic-sparing techniques, as well as ligation of gubernacular vessels to prevent recurrence) or endovascular therapy via interventional radiology is available. 2 At our institution, all 3 treatment options are offered to patients and their families.In this issue of The Journal, Chung et al (page 600) report their outcomes in a much-needed randomized controlled trial assessing surgical techniques for adolescent varicoceles. 3 The authors present us with an appropriately powered, unbiased, and well-executed study. While the scrotal antegrade sclerotherapy (SAS) approach has been previously discussed by Tauber and Johnsen, 4 and Mazzoni et al, 5 this is the first report supporting the technique against laparoscopic Palomo surgery. As of the latest survey of pediatric urologists, the laparoscopic approach is the most well known and widely performed. 6 The authors discuss several important findings: 1. Sclerotherapy via a scrotal, antegrade approach has a recurrence rate of 5.3%, which is equivalent to the laparoscopic Palomo surgery recurrence rate of 5.3%. The SAS recurrence rate is lower than the 10%-16% reported relapse rate in studies from radiologic literature. 2 2. The liquid agent of air-foamed sodium tetradecyl sulphate plus Lipiodol (ethiodized oil) is a safe sclerotherapy agent, without any report of allergic reaction, venous rupture, extravasation, or epididymo-orchitis in the treated cohort. 3. Catch-up growth of the ipsilateral testicle was shown in both surgical approaches at an equivalent rate at 12 months postoperatively.

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Management of adolescent varicocele

Cited by 11 publications

References 60 publications

Bibliometrics and visualisation analysis of literature on varicocele: From 2002 to 2021

Bibliometrics and visualisation analysis of literature on varicocele: From 2002 to 2021

Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery vs Scrotal Antegrade Sclerotherapy in Adolescent Varicocele

Laparoscopic vs Sclerotherapy for Varicoceles: Who Prevails?

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