Testicular Growth After Successful Varicocele Correction in Adolescents: Comparison of Artery Sparing Techniques With the Palomo Procedure

Atassi, Omar; Kass, Evan J.; Steinert, Bruce W.

doi:10.1097/00005392-199502000-00065

Cited by 75 publications

(44 citation statements)

References 9 publications

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“…This led those authors to recommend the Palomo mass ligation as the procedure of choice. Atassi et al [28] later reported a 1.3% persistence rate with total ligation in this group. Thus we consider that the term 'recurrence' more correctly describes a varicocele which is not present 3-6 months after surgery and develops sometime thereafter.…”

Section: Discussionmentioning

confidence: 54%

The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long‐term follow‐up

et al. 2001

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Objective To determine, in adolescent boys after varicocelectomy, the incidence of hydroceles, when they develop and whether the development is procedure‐related.Patients and methods The records were retrospectively reviewed of 77 boys who underwent 95 varicocelectomies and had an examination at 6 months after surgery. Fifty‐six patients underwent a standard Palomo procedure (45 left and 11 bilateral) and 21 a modified Ivanissevich repair (14 left and seven bilateral). The mean (range) age of the patients at surgery was 14.1 (10–22) years and the mean follow‐up 25.5 (6–84) months.Results Of the 67 Palomo varicocelectomies 19 (24%) were complicated by hydroceles after surgery, compared with four of 28 (14%) Ivanissevich procedures (P = 0.034). Of the Ivanissevich repairs, none of the 14 unilateral repairs developed hydroceles. Three hydroceles (one bilateral and one left) developed in two of seven patients after bilateral varicocelectomy. Of the Palomo repairs, 12 of 45 unilateral repairs were complicated by hydroceles, and seven developed in five of 11 patients after bilateral varicocelectomy. Although more hydroceles developed after bilateral varicocelectomy, there was no significant difference from the unilateral group. However, patients who developed hydroceles after bilateral varicocelectomy were more likely to require hydrocelectomy (P = 0.013, Fisher's exact test), implying that hydroceles developing after bilateral repair tend to be larger. Of the hydroceles, two were detected in the first 6 months after surgery, nine at 6–12 months, three at 13–18 months, five at 19–24 months and four at > 2 years after surgery. Three patients had late varicocele recurrence, i.e. 15, 37 and 76 months after surgery; these patients had not had varicoceles on palpation after surgery at 3, 14 and 63 months, respectively.Conclusion Hydroceles are detected infrequently within 6 months of varicocelectomy, with most occurring after 6 months and even appearing after 3 years. They occur significantly more often after a Palomo repair. More hydroceles develop after bilateral repair regardless of the technique used, but not significantly so. Because hydroceles often develop, a lymphatic‐sparing procedure should be used, especially for bilateral repair. Recurrent varicoceles may appear as late as 76 months after varicocelectomy in patients where none had been detected at a mean of 27 months after surgery.

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Section: Discussionmentioning

confidence: 54%

The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long‐term follow‐up

et al. 2001

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“…However, several studies have evaluated spermatic artery ligation and found no physiological detriment to the testis. Atassi et al [14] compared testis growth after the Palomo procedure vs the artery-sparing technique, and noted comparable compensatory growth in both groups, with no evidence of atrophy.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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“…Deux arguments majeurs sont en faveur de cette indication de la chirurgie chez l'adolescent, d'une part la r6cup6ration de la croissance testiculaire apr6s cure du varicoc61e [13], d'autre part le fait que les r6sul-tats de la chirurgie sur la fertilit6 semblent meilleurs lorsque le traitement est r6alis6 pr6cocement [14].…”

Section: Traitement Du Varicoceleunclassified

Y a-t-il encore une place pour la chirurgie dans le traitement de l'infertilité masculine?

Navratil

Mottet

Costa

1996

Androl.

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RESUMELes progr~s r6cents de la prise en charge biologique de l'infertilit4 masculine ont surtout port4 sur les m4thodes d'assistance m4dicale ~ la procr4ation. Parall61ement les techniques chirurgicales se sont am41io-r6es, en particulier avec rapport de la microchirurgie. Le traitement du varicoc61e repr6sente la situation oh la place de la chirurgie est la moins claire. Elle ne permet pas en particulier d'obtenir une augmentation du nombre de grossesses, malgr6 une am41ioration fr~quente des param6tres du sperme. Le traitement chirurgical de la cryptorchidie ne se discute plus apr6s 4chec d'un traitement hormonal. Le traitement de l'azoospermie excr4-toire repose sur des anastomoses microchirurgicales n6cessitant une 4quipe entraln6e. Ses meilleurs r~sul-tats sont obtenus dans les obstructions cong4nitales et ne doivent pas ~tre appr4ci4s avant 1 an postop6ratoire. De m~me la reperm6abilisation d~f4-rentielle permet d'obtenir 50% des grossesses en cas de technique microchirurgicale parfaite. La d6gradation des r4sultats avec le temps, impose une raise de sperme en banque de fa~on syst6matique avant la r6alisation d'une vasectomie. Les obstructions des canaux 4jaculateurs peuvent n6cessi-ter le recours ~ des gestes endoscopiques. Enfin les microponctions 6pidi-dymaires ont permis de r6aliser quelques f4condations. Mais les succ~s de I'ICSI ~ partir de pr61~vements chirurgicaux 4pididymaires ou d4f~ren-tiels conduisent ~ 41argir et ~ revoir consid4rablement les indications et les protocoles op6ratoires. Les indications sont ~ pr6ciser, et l'analyse gdn4tique est indispensable. Mais la qualit~ des conceptus obtenus reste la grande interrogation des ann4es ~ venir.

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Testicular Growth After Successful Varicocele Correction in Adolescents: Comparison of Artery Sparing Techniques With the Palomo Procedure

Cited by 75 publications

References 9 publications

The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long‐term follow‐up

The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long‐term follow‐up

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

Y a-t-il encore une place pour la chirurgie dans le traitement de l'infertilité masculine?

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