Surgical approaches for varicocele in pediatric patient

Parrilli, Alejandra; Roberti, Agnese; Escolino, Maria; Esposito, Ciro

doi:10.21037/tp.2016.09.11

Cited by 20 publications

(5 citation statements)

References 37 publications

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“…The problem with the varicocele is not in the diagnosis, which is quite easy, but with further management. The controversy relates to when to include surgical treatment, especially in the case of varicoceles in adolescent boys, where there is no data on sperm alterations or infertility [10,11]. Surgical treatment is usually implemented in patients with grade III of varicocele, with scrotal pain or with volume difference of more than 20% [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Informed consent was obtained from each participant parents. The patients with varicoceles were graded according to the clinical classification system by WHO (grade I: inducible during a Valsalva manoeuvre (n = 10); grade II: palpable (n = 11); grade III: visible (n = 9) [10,11]. Patients who had previous varicocele surgery, right varicoceles, and other testicular anomalies were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

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Testicular Sonographic Color Doppler Dynamic Tissue Perfusion Measurements in Adolescents with Varicocele

et al. 2019

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Aim: The aim of the study was an assessment of the effects of varicocele on testis parenchyma and microcirculation with the use of the dynamic tissue perfusion measurements. Methods: Color Doppler sonographic dynamic testis parenchyma perfusion measurements were performed with PixelFlux software in 30 children with left testis varicocele. The right testes without varicocele comprised the control group. Results: Testicular parenchymal perfusion in testes with varicocele was reduced when compared to the control testes. The differences were found in all measured perfusion parameters. Statistical significance was found in the case of mean velocity and resistance index parameters. According to the grade of varicocele, the perfusion was the most reduced in patients with grade III of varicocele. Conclusion: Testicular parenchymal perfusion decreases in patients with varicocele, mostly in higher grades of varicocele. In case of validation, the method can be used in determining the damage of the testis with varicocele and the need for surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Testicular Sonographic Color Doppler Dynamic Tissue Perfusion Measurements in Adolescents with Varicocele

et al. 2019

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“…Subinguinal mikrocerrahi yaklaşım, erişkin infertil erkeklerde varikosel ligasyonu için altın standart haline gelmişken, çocukların ve ergen hastaların sadece %2'sinde bir mikrocerrahi yaklaşım yapıldığı raporlanmaktadır. [8] Daha önce tek merkez ve daha az sayıda hasta ile laparoskopik ve mikroskobik varikoselektomi tekniklerinin sonuçlarını karşılaştırdığımız çalışmada teknikler arasında istatistiksel anlamlı bir fark saptamamış ve her iki tekniğin de etkili ve güvenli bir şekilde tercih edilebileceği sonucunu paylaşmıştık. [9] 2014 yılında Pastuszak ve ark.…”

Section: Discussionunclassified

Adölesan varikosel tedavisinde uygulanan üç farklı cerrahi yöntem sonuçlarının karşılaştırılması

Uçar¹,

Akgül²,

Caylan³

et al. 2019

Androl Bul

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Varikosel, pampiniform pleksus ve internal spermatik venlerin anormal bir dilatasyonu olup, seminifer tübüllerdeki sıcaklığın artmasına, toksik adrenal ve renal metabolitlerin renal ven yoluyla geri akışına, sperm kalitesinin düşmesine ve testis büyümesinin durmasına neden olur. [1] Erkek infertilitesinin en sık düzeltilebilir nedenidir. Adölesan varikosel insidansı erişkinlere benzer şekilde %15-16'dır. [2] Tedavi endikasyonları arasında varikoselin semptomatik ABSTRACT OBJECTIVES: In the treatment of adolescent varicocele, there isn't any consensus and the ideal technique is not yet defined. Open surgery (microscopy-assisted or not) or laparoscopic techniques are surgical methods used in treatment. We planned to compare the results of microscopic, laparoscopic and open varicocelectomy techniques. MATERIAL and METHODS: Patients who underwent varicocele therapy between 2003-2018 were evaluated retrospectively in 3 groups. Patients who underwent laparoscopic varicocele ligation were included in Group 1, patients who underwent microscopic varicocelectomy were included in Group 2 and patients who underwent subinguinal varicocelectomy were included in Group 3. Three groups were compared in terms for operation and postoperative follow-up data. RESULTS: The study included 113 patients, 30 patients in Group 1, 43 patients in Group 2, 40 patients in Group 3. The mean age was 13.2 years. There was no significant difference between groups in terms of side and varicocele degree. The median operation times for group1.2 and 3 were 55 (35-70), 50 (40-80) and 55 min. (40-70) (p>0.05). The hydrocele development after surgery was detected in 3, 1 and 2 patients, respectively (p>0.05). Varicocele recurrence was not seen in the LVL group, but it was seen in 3 patients in the MV group and in 7 patients in the SV group (p>0.05). Postoperative testicular volume loss was detected in 3 patients in Group 1, 1 patient in Group 2 and in Group 3 no patient was detected. There was no statistical significant different between groups although there were clinical differences between the groups in terms of results or complications. CONCLUSION: In the treatment of adolescent varicoceles, it was found that all 3 techniques can be used successfully but in microscopic or under magnification (via loop) techniques, complication rates seem to be much less and clinical successful rates seem to be much higher.

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“…Several surgical techniques are available to treat varicocele, using open surgery via inguinal or sub-inguinal approach or using minimally invasive surgery via retro-peritoneoscopic high ligation or laparoscopic ligation [ 7 – 11 ]. The main issue of laparoscopic approach is the high incidence of postoperative hydrocele due to lymphatics injury, reported in up to 20% of operated patients [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Robotic-assisted versus conventional laparoscopic ICG-fluorescence lymphatic-sparing palomo varicocelectomy: a comparative retrospective study of techniques and outcomes

Esposito,

Leva,

Castagnetti

et al. 2024

World J Urol

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Purpose This study aimed to compare techniques and outcomes of robotic-assisted varicocelectomy (RAV) and laparoscopic varicocelectomy (LV). Methods The medical records of 40 patients, who received RAV and LV over a 2-year period, were retrospectively analyzed. Palomo lymphatic-sparing varicocelectomy using ICG fluorescence was adopted in all cases. Three 5-mm trocars were placed in LV, whereas four ports, three 8-mm and one 5-mm, were placed in RAV. The spermatic vessels were ligated using clips in LV and ligatures in RAV. The two groups were compared regarding patient baseline and operative outcomes. Results All patients, with median age of 14 years (range 11–17), had left grade 3 varicocele according to Dubin–Amelar. All were symptomatic and 33/40 (82.5%) presented left testicular hypotrophy. All procedures were completed without conversion. The average operative time was significantly shorter in LV [20 min (range 11–30)] than in RAV [34.5 min (range 30–46)] (p = 0.001). No significant differences regarding analgesic requirement and hospitalization were observed (p = 0.55). At long-term follow-up (30 months), no complications occurred in both groups. The cosmetic outcome was significantly better in LV than RAV at 6-month and 12-month evaluations (p = 0.001). The total cost was significantly lower in LV (1.587,07 €) compared to RAV (5.650,31 €) (p = 0.001). Conclusion RAV can be safely and effectively performed in pediatric patients, with the same excellent outcomes as conventional laparoscopic procedure. Laparoscopy has the advantages of faster surgery, smaller instruments, better cosmesis and lower cost than robotics. To date, laparoscopy remains preferable to robotics to treat pediatric varicocele.

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Surgical approaches for varicocele in pediatric patient

Cited by 20 publications

References 37 publications

Testicular Sonographic Color Doppler Dynamic Tissue Perfusion Measurements in Adolescents with Varicocele

Testicular Sonographic Color Doppler Dynamic Tissue Perfusion Measurements in Adolescents with Varicocele

Adölesan varikosel tedavisinde uygulanan üç farklı cerrahi yöntem sonuçlarının karşılaştırılması

Robotic-assisted versus conventional laparoscopic ICG-fluorescence lymphatic-sparing palomo varicocelectomy: a comparative retrospective study of techniques and outcomes

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