The Adolescent Varicocele: What's New With an Old Problem in Young Patients?

Skoog, Steven J.; Roberts, Kenneth P.; Goldstein, Marc; Pryor, Jon L.

doi:10.1542/peds.100.1.112

Cited by 167 publications

(113 citation statements)

References 93 publications

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“…Actually, varicocele repair may be accomplished by open surgery, laparoscopy, or interventional radiology. [1][2] Besides, treatment may be performed at different levels, including retroperitoneal, inguinal, and subinguinal. All these methods, however, have been reported to be associated with some risk of varicocele persistence/recurrence due to collateral refluxing veins not interrupted at surgery.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Surgery of Deferential Reflux in Pediatric and Adolescent Varicocele

Cimador

Pace

Sergio

et al. 2009

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: This study aimed to assess whether deferential reflux in pediatric and adolescent varicocele can be successfully treated laparoscopically. Materials and Methods: Since 2001 at our institution, 148 boys were evaluated for a left varicocele. Preoperatively, all the patients underwent ultrasound scan assessment of testicular volume and color-Doppler US (CDUS) to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. Boys with ISV reflux were treated by laparoscopic transperitoneal Palomo; boys with isolated deferential reflux or associated to ISV reflux were laparoscopically managed adding to the former procedure, coagulation or clipping of refluxing deferential veins. Results: Reflux in both the ISV and the deferential vein was observed in 21 (14.1%) out 148 boys with varicocele. Only one case (0.6%) of varicocele was caused by an isolated deferential reflux. No reflux in the cremasteric vein was observed. After a median follow up period of 2 years (range, 6 months-5 years), none of our patients with deferential reflux experienced varicocele recurrence either clinically or according to CDUS scanning. No testicular atrophy was observed. Conclusion: Our diagnostic approach is a rigorous standard for identifying all the venous systems concurring with the varicocele. Our proposed technique with laparoscopic interruption or coagulation of deferential veins when proved by CDUS to be refluxing may allow successful treatment for most varicoceles. This method allows reduction in recurrence of varicocele due to a missed deferential reflux.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic Surgery of Deferential Reflux in Pediatric and Adolescent Varicocele

Cimador

Pace

Sergio

et al. 2009

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Therefore, the results of the GnRH test in adolescents with varicocele should be analyzed individually to assign them an appropriate value. The grade III varicocele patients from this series with significative volume reduction in the ipsilateral testicle, independently of the GnRH test results, have been considered at high risk to develop testicular dysfunction, and they will require early surgical correction, since testicular growth arrest is one of the indications to perform prophylactic varicocelectomy at this age [21].…”

Section: Discussionmentioning

confidence: 99%

Pituitary and Testicular Function in Adolescents With Varicocele

Osuna

Cruz

et al. 1999

Archives of Andrology

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“…Despite an incidence of 15% among healthy boys, 1 the management of adolescent varicocele remains one of the most controversial issues in pediatric urology. The incidences of varicocele and varicocele-related testicular atrophy increase during puberty.…”

Section: Introductionmentioning

confidence: 99%

Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele

2016

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Objective: To compare the surgical outcomes of subinguinal and high inguinal approaches for microsurgical varicocelectomy. Methods: A total of 81 patients with left varicocele were randomly assigned to undergo microsurgical left varicocelectomy by the subinguinal (n = 41) or high inguinal (n = 40) approach. These two techniques were compared with regard to the operative parameters, complications and testicular growth. Anatomical parameters, including the numbers and diameters of internal spermatic arteries, veins and lymphatic vessels, were recorded. Results: The microsurgical step was significantly shorter for the high inguinal approach compared with the subinguinal approach (25.5 vs 33.3 min, respectively, P < 0.01). The numbers of preserved arteries and ligated veins were significantly greater and the artery size was significantly smaller for the subinguinal (1.6 arteries, 11.5 veins and 1.1 mm, respectively) compared with the high inguinal approach (1.2 arteries, 7.3 veins and 1.3 mm; P < 0.001, <0.0001 and <0.01, respectively). There was one patient with postoperative hydrocele, and three with persistent scrotal pain after treatment with the subinguinal approach. The postoperative catch-up growth rates at 24 months were 70% and 78% for the subinguinal and high inguinal approaches, respectively. Conclusions: The microsurgical subinguinal and high inguinal approaches seem to yield similar success rates in terms of testicular growth. However, the high inguinal approach is easier to carry out, as it requires fewer divisions of veins and is associated with a larger diameter of the spermatic artery.

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The Adolescent Varicocele: What's New With an Old Problem in Young Patients?

Cited by 167 publications

References 93 publications

Laparoscopic Surgery of Deferential Reflux in Pediatric and Adolescent Varicocele

Laparoscopic Surgery of Deferential Reflux in Pediatric and Adolescent Varicocele

Pituitary and Testicular Function in Adolescents With Varicocele

Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele

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