Varicocele in children and adolescents. History and current view and state of problem (literature review)

Abstract

A literature review on the subject of varicocele in children which include historical data and question about: etiopathogenesis, epidemiology, diagnostics, treatment and long-term outcomes. The diagnostic method of varicocele unchanged until the XX century and consisted of visual examination and palpation with or without Valsava maneuver. But after entering in diagnostic protocol contrast venography, thermography of testis and ultrasound examination, this protocol have significant changes. For a long time, phlebography has been considered the «gold standard» for the diagnosis of varicocele. But the big disadvantage of this procedure is high invasiveness. Doppler ultrasound mapping has given a new impuls to the diagnosis of varicocele due to minimally invasiveand accessible. G. Liguori, C. Trombetta in their work showed that surgical treatment of varicocele should begin when the testicle size is reduced by more than 20%, or 2 ml of volume in ultrasound examination. Also, the visualization of reflux into the seminal vein is more specific in the ultrasound examination. G. Sigmund et al. introduced the concept of stop-type, shunt-type reflux into the seminal vein. However, in the case of unexplained recurrent varicocele, only antegrade venography can provide sufficient information. The review presents the classic and alternative surgical treatments of varicocele in children. Today it is safe to say that the treatment of varicocele has entered to the era of modern evidence-based medicine. A large number of studies indicate that the expansion of the testicular plexus has a progressive detrimental effect on testicular tissue and leads to a deterioration in sperm count. The methods witch used to correct varicocele earlier was traumatic, but modern surgery has brought many innovative technologies and methods of surgical correction. In addition, there have been impressive developments in bimolecular and functional sperm tests. Nowdays gold standard of surgical treatment varicocele is microsurgical subgingival varicocelectomy but this operation has one big disadvantage. This is possible damage of the testicular artery. The solution of this problem can be obtained by finding new intraoperative way of visualization and defending testicular artery and lymphatic vessels. No conflict of interest was declared by the authors. Key words: varicocele, microsurgical subgingival varicocelectomy, children.