Adolescent Varicocelectomy Research Articles

Pattern Of Lymphatic Drainage Of Human Testes With Respect To Hydrocele Formation After Varicocelectomy In Adolescents

PURPOSE During varicocelectomy in adolescents it is complex to preserve at least some of the lymphatic vessels draining the testis, postoperative hydrocele formation consequently represents a complication of this procedure. Basic pattern of the lymphatic drainage of the testes and inguinal canal is described following studies of dissected specimens in male cadavers. MATERIAL AND METHODS Microlymphography was undertaken using a combination of two parts methylen blue and one part India ink. After preservation with intravasal injection of a formol/carbolic mixture histological examination of four inguinal canals were performed. 4 μm sections were cut after fixation in formaldehyde-PBS and stained with mouse monoclonal D2-40 antibody (marker of lymphatic endothelium) and biotinylated secondary antibody. Visualisation of antigen-antibody complex was performed via incubation with streptavidian, alcaline phosphatase, fast red and haematoxylin. Digitalisation was completed with a Zeiss axioplan microscope and AxioVision. RESULTS Lymphographic studies demonstrated lymphatic vessels emerging from the surface of the testis in three groups to escort mainly the testicular artery and vein as well subsequently. Around the vas deferens just delicate lymphatics are evident. At the internal inguinal ring the contrast media outlined two to three main testicular lymphatic trunks which accept the lymph drainage of the three testicular lymphatic groups. CONCLUSIONS The recognition of the three main routes of lymphatic drainage in the inguinal canal arising from the surface of the testes establishes constancy in the morphological pattern and provides the opportunity to preserve at least one main testicular lymphatic trunk irrespective of the surgical procedure.

“REDO ADOLESCENT VARICOCELECTOMY”

You have accessJournal of Urology1 Apr 2009“REDO ADOLESCENT VARICOCELECTOMY” Kenneth I Glassberg, Miguel A Mercado, and Stephen A Poon Kenneth I GlassbergKenneth I Glassberg More articles by this author , Miguel A MercadoMiguel A Mercado More articles by this author , and Stephen A PoonStephen A Poon More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)60496-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "“REDO ADOLESCENT VARICOCELECTOMY”." The Journal of Urology, 181(4S), p. 173 © 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byWoldu S, Van Batavia J, Poon S, Raimondi P and Glassberg K (2010) Is Adolescent Varicocelectomy Safe After Previous Inguinal Surgery?Journal of Urology, VOL. 184, NO. 4S, (1716-1721), Online publication date: 1-Oct-2010. Volume 181Issue 4SApril 2009Page: 173 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Kenneth I Glassberg More articles by this author Miguel A Mercado More articles by this author Stephen A Poon More articles by this author Expand All Advertisement PDF downloadLoading ...

Laparoscopic varicocelectomy in adolescents – two-port approach

Laparoscopic varicocelectomy in adolescents – two-port approach

Adolescent Varicocelectomy—Is the Potential for Catch-Up Growth Related to Age and/or Tanner Stage?

Adolescent varicocelectomy is associated with a 70% incidence of postoperative catch-up growth in boys with ipsilateral testicular hypotrophy. We determined whether preoperative patient age and Tanner stage were related to subsequent catch-up growth. In other words if patients are followed with a period of observation, will a window of opportunity be lost for achieving catch-up growth? We studied a total of 163 boys (mean age 15.1 years, range 10 to 24) with left or bilateral varicoceles who demonstrated 10% asymmetry or greater preoperatively, and had preoperative and postoperative testicular volume measurements available (using either ring orchidometer or ultrasound). Of these patients 59 also had preoperative Tanner stage recorded. Of the patients with preoperative left hypotrophy 69% had achieved catch-up growth at last followup (mean followup 28 months). When treated as a continuous variable, or when divided into general prepubertal vs postpubertal groupings, age at surgery was not significantly associated with catch-up growth. Similarly, there was no significant difference in catch-up growth associated with grade of varicocele, duration of postoperative followup or presence of unilateral left vs bilateral varicocele. No association with Tanner stage was found, although the patient numbers were too small to draw any statistically significant conclusions. The prevalence of testicular catch-up growth after varicocelectomy is high, even for patients in their early 20s. Among males 10 to 24 years old there is no specific age or Tanner stage that offers the best opportunity for catch-up growth.

Adolescent varicocelectomy: Postoperative catch-up growth is not secondary to lymphatic ligation

Purpose The major indication for adolescent varicocelectomy is testicular asymmetry with the left testicle smaller than the right. Catch-up growth following surgery is one of the parameters used to assess efficacy of surgery. However, it is not clear whether this represents true tissue growth or increased interstitial fluid secondary to lymphatic obstruction. The purpose of this study was to compare catch-up growth in patients who underwent varicocelectomy with and without lymphatic preservation. Materials and methods We retrospectively analyzed the outcomes of 136 boys (mean age 15.1 years) who had 10% or greater preoperative testicular asymmetry and underwent varicocelectomy between 1997 and 2006. Surgery was either a laparoscopic nonlymphatic sparing or laparoscopic lymphatic sparing varicocelectomy. All patients had pre- and postoperative ultrasound volume measurements at least 6 months following surgery. The groups were compared for incidence of postoperative catch-up growth, achieving less than 10% testicular asymmetry. Results After a mean follow up of 24.7 months, catch-up growth was achieved in 62.8% of patients. There was no significant difference between the groups in regard to catch-up growth (51.7% vs 66.3%, P = 0.193). Conclusions Since no significant difference was found between the laparoscopic nonlymphatic sparing and laparoscopic lymphatic sparing varicocelectomies, we conclude that lymphatic obstruction is not the cause of catch-up growth.

369: Adolescent Varicocelectomy: Is the Potential for Catch-up Growth Related to age or Tanner stage?

You have accessJournal of UrologyModerated Poster 11, Sunday, May 20, 2007 1:00 - 3:00 pm1 Apr 2007369: Adolescent Varicocelectomy: Is the Potential for Catch-up Growth Related to age or Tanner stage? G. Joel DeCastro, Kenneth I. Glassberg, Stephen A. Poon, Carl K. Gjertson, Ahmad Shabsigh, and Laurant Laor G. Joel DeCastroG. Joel DeCastro More articles by this author , Kenneth I. GlassbergKenneth I. Glassberg More articles by this author , Stephen A. PoonStephen A. Poon More articles by this author , Carl K. GjertsonCarl K. Gjertson More articles by this author , Ahmad ShabsighAhmad Shabsigh More articles by this author , and Laurant LaorLaurant Laor More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30622-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "369: Adolescent Varicocelectomy: Is the Potential for Catch-up Growth Related to age or Tanner stage?." The Journal of Urology, 177(4S), pp. 122–123 © 2016 by American Urological AssociationFiguresReferencesRelatedDetailsCited ByDiamond D (2018) Adolescent Versus Adult Varicoceles—How Do Evaluation and Management Differ?Journal of Urology, VOL. 181, NO. 6, (2418-2419), Online publication date: 1-Jun-2009.Glassberg K (2018) Editorial CommentJournal of Urology, VOL. 180, NO. 3, (1114-1115), Online publication date: 1-Sep-2008. Volume 177Issue 4SApril 2007Page: 122-123 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information G. Joel DeCastro More articles by this author Kenneth I. Glassberg More articles by this author Stephen A. Poon More articles by this author Carl K. Gjertson More articles by this author Ahmad Shabsigh More articles by this author Laurant Laor More articles by this author Expand All Advertisement PDF DownloadLoading ...

Ipsilateral Testicular Catch-up Growth after Varicocelectomy in Adolescents

Purpose: After adolescent varicocelectomy, there is a lack of standards for the follow-up and evaluation of the catch-up growth. We investigated the time to achieve catch-up growthaccording to the difference in testicular volume as compared to the contralateral testis. Materials and Methods: From 1997 to 2004, 51 patients with at least a 1cc difference in testicular volume, as compared to the contralateral testis, and for whom the follow up was longer than 6 months were the subjects of this study. Testicular volume was measured using a Prader orchidometer and catch-up growth was defined as the equalization of testicular volume to the contralateral testis. The time to catch-up growth was investigated. Results: 47 of 51 patients had a GIII varicocele and 4 had a GII varicocele. The mean difference in testicular volume was 2.9±1.8cc. Catch-up growth was noted in 33 (64.7%) and the mean time to catch-up growth was 14.7 months. Catch-up growth occurred in 52.2%, 67.8 and 74.3% of the patients at 1, 2 and 3 years, respectively (the Kaplan-Meier). The time to catch-up growth was significantly shorter in those with a testicular volume difference of less than 3cc prior to operation (p=0.02, the log-rank test). There was no significant difference according to the age when surgery was performed ( 0.05, the log-rank test). Conclusions: Catch-up growth following varicocelectomy in adolescents can be expected in about 65% of patients and this occurs within 2 years for most patients. The preoperative testicular volume difference is associated with the speed of the catch-up growth. However, whether recovery of testicular volume means recovery of testicular function needs further study. (Korean J Urol 2007;48:731-734) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Results of microsurgical subinguinal varicocelectomy in children and adolescents

Objectives To report our experience with microsurgical subinguinal varicocelectomy in boys younger than 18 years old. Methods A total of 92 boys with a mean age of 15.8 years (range 11 to 18) underwent microsurgical subinguinal varicocelectomy because of ipsilateral testicular hypotrophy (n = 63), pain, or parental preference. The varicoceles were grade III in 82 (89.1%) and grade II in 10 (10.9%) boys. Microsurgery was assisted by an operating microscope (10× to 25×) and Doppler probe. All boys were discharged home on the same day of surgery. Results Of the 92 patients, 78 attended the initial postoperative visit at 1 month and 61 attended the 1-year follow-up visit. At 1 year, 40 (65.6%) of 61 testes demonstrated catch-up growth, with no evidence of testicular loss or persistent hypotrophy in the other 21. The only complication was persistent scrotal pain in 1 patient. At 1 year of follow-up, 1 patient (1.6%) had a recurrence and no patients had hydrocele formation or evidence of testicular loss or persistent hypotrophy. Conclusions Microsurgical subinguinal varicocelectomy is a safe, effective, and minimally invasive treatment modality in children and adolescents.

Retroperitoneoscopic varicocelectomy in children and adolescents

Background/Purpose In the pediatric population the failure rate of sclerotherapy for the treatment of varicocele has been reported to be up to 35%. Therefore, the aim of our study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in children and adolescents. Methods A total of 97 patients were operated on for left-sided varicocele using the retroperitoneoscopic approach between January 1999 and July 2003. Median age was 12.3 years (range, 6-16 years). A 10-mm subcostal retroperitoneoscopic port was used. The operation was performed through an operative laparoscope according to Palomo's technique, with the mass division of spermatic vessels after bipolar coagulation below the renal vein. Elective conversion to laparoscopic transperitoneal varicocelectomy was performed in cases of difficulties in identifying the vessels. The postoperative follow-up included clinical and ultrasound assessment (range, 6-48 months). Results A total of 17 (17.6%) patients needed elective conversion to laparoscopic transperitoneal varicocelectomy. In RV, the mean operative time was 28 minutes (range, 15-55 minutes), the mean hospital stay was 2 days, persistence rate was 11.2%, and hydrocele occurrence was 6.2%. Conclusions Our results indicate that the RV is an acceptable technique to achieve the high division of the spermatic vessels. The advantage of this anatomic approach is its very low invasiveness.

Paternity After Adolescent Varicocele Repair

Varicocelectomy has long been a therapeutic modality used in the treatment of male infertility. In the past decade, adolescent varicocelectomy has become a frequent procedure to preserve testicular growth and to help prevent future infertility. Because our clinical population includes a large portion of orthodox Jews who traditionally marry early and are forbidden to use birth control by religious law, we thought that by studying our patients, we might be able to accelerate our follow-up regarding paternity. In addition, we wanted to learn whether adolescent varicocelectomy might have any negative impact. Questionnaires inquiring as to the marital and paternity status, postoperative course, and complications were sent to 50 patients who had undergone a unilateral or bilateral varicocele repair during adolescence and who were at least 21 years old at the time of this review. In addition, a careful chart review was performed to examine the perioperative and postoperative parameters of each respondent. Of the 43 responses (86% response rate), 18 of 18 patients who had attempted to father a child were successful. The remaining 25 were not married or had never attempted to father a child. In the paternity group, 10 of the fathers had undergone an Ivanissevich repair; the remaining 8 had a Palomo repair. Sixteen of the 18 had unilateral varicocelectomies, and 2 underwent bilateral repairs. Of those with a unilateral varicocele, the indication for surgery in 10 was a grade 2 to 3 varicocele associated with a >20% volume difference when compared with the right testicle. Three had 10% to 20% volume loss, whereas the remaining three had unusually large grade 3 varicoceles without concurrent volume difference. Varicocelectomy in the adolescent population has been proposed as a therapeutic intervention to preserve both fertility and testicular growth. Although not showing a cause-and-effect relationship, it is our contention that varicocelectomy in adolescence at worst does no harm and at best preserves fertility.

Optimizing the Operative Treatment of Boys with Varicocele: Sequential Comparison of 4 Techniques

Optimizing the Operative Treatment of Boys with Varicocele: Sequential Comparison of 4 Techniques

Experience with Varicoceles in Children and Young Adults

Experience with Varicoceles in Children and Young Adults

COMPARATIVE ASSESSMENT OF PEDIATRIC TESTICULAR VOLUME: ORCHIDOMETER VERSUS ULTRASOUND

COMPARATIVE ASSESSMENT OF PEDIATRIC TESTICULAR VOLUME: ORCHIDOMETER VERSUS ULTRASOUND

THE ADOLESCENT VARICOCELE I: LEFT TESTICULAR HYPERTROPHY FOLLOWING VARICOCELECTOMY

Ipsilateral testicular catch-up growth has been reported to occur in approximately 80% of adolescents with varicoceles following unilateral varicocelectomy. We have been observing not only catch-up growth, but hypertrophy (left at least 10% larger than right testicular volume) in some adolescents postoperatively. To our knowledge this phenomenon has not been previously described. We assess the incidence of left testicular hypertrophy following ipsilateral varicocele ligation and whether it is related to age at operation and/or procedure performed. We reviewed the records of 42 patients who underwent unilateral left varicocelectomy for asymptomatic varicoceles. Testicular volume was determined before and after surgery, and all patients were followed for a minimum of 6 months. Indication for surgery was ipsilateral left testicular hypotrophy in 23 cases, grade 2 to 3 varicocele with palpably softer ipsilateral left testicle in 5, grade 3+ varicoceles in 12, an exaggerated response to gonadotropin-releasing hormone stimulation test in 1 and persistent pain in 1. Average patient age at operation was 14.7 years (range 9 to 22) and average followup was 22 months (range 6 to 84). Patients were stratified according to Palomo versus modified Ivanissevich technique and age at operation. Testes were measured using the Takihara ring orchidometer with relative volume of the left testis expressed as a percentage of the right testis. Results were compared in different age groups as well as by procedure performed to correct the varicocele using chi-square analysis. Left testicular hypertrophy developed in 13 of 32 patients (43.8%) who underwent a Palomo repair and in 3 of the 10 (30%) who underwent a modified Ivanissevich repair. When compared by age at operation, 8 of 20 patients (40%) 14.7 years old or younger had left testicular hypertrophy compared to 8 of 22 (36.4%) older than 14.7 years. Differences between these groups were not statistically significant. Ipsilateral testicular hypertrophy occurs in a substantial number of adolescents following varicocele ligation. This phenomenon does not seem to be dependent on age at surgery or type of varicocele repair.

The influence of surgical approach and intraoperative venography on successful varicocelectomy in adolescents: L.S. Palmer, M. Maizels, W.E. Kaplan, et al. J Urol 158:1201–1204, (September), 1997

The influence of surgical approach and intraoperative venography on successful varicocelectomy in adolescents: L.S. Palmer, M. Maizels, W.E. Kaplan, et al. J Urol 158:1201–1204, (September), 1997

The Influence of Surgical Approach and Intraoperative Venography on Successful Varicocelectomy in Adolescents

We evaluated the importance of intraoperative venography and surgical approach on varicocele recurrence after surgical varicocelectomy in male adolescents. The analysis was done using local data and composite data from the literature. We reviewed the records of patients undergoing varicocele ligation between 1986 and 1995 at our institution. Data were stratified by surgical approach and performance of venography, and compared by cross table analysis. Data were then compiled from the literature from series that included cases stratified according to surgical approach and/or performance of venography. The impact of these parameters on recurrence rates was assessed by computing success rates and cross table analysis. At our institution 33 boys underwent ligation via a suprainguinal (27) or inguinal (8) approach. Intraoperative post-ligation venography was performed in 16 cases and omitted in 19. Neither surgical approach nor performance of venography influenced the recurrence rate in these patients (not statistically significant). Similarly, venography did not affect the recurrence rate after stratification by surgical approach (not significant). The overall success rate was 97% (34 of 35 cases). These data were added to those of 3 published studies, totaling 252 varicoceles with comparable groupings. Mean success rate after a suprainguinal and inguinal approach was 95.6 (93.2 to 97.4) and 88.3% (82.7 to 100%), respectively. Recurrence tended to be less common after a suprainguinal than an inguinal approach (p = 0.06). Post-ligation venography did not statistically affect the success rate after stratification according to surgical approach but it was associated with a higher success rate when performed with the inguinal approach. Irrespective of the performance of venography, the suprainguinal surgical approach yields higher success rates than the inguinal approach to varicoceles in adolescents. Post-ligation intraoperative venography fails to affect significantly the success of varicocele ligation but it may be useful during an inguinal approach.

The Influence of Surgical Approach and Intraoperative Venography on Successful Varicocelectomy in Adolescents

Purpose We evaluated the importance of intraoperative venography and surgical approach on varicocele recurrence after surgical varicocelectomy in male adolescents. Materials and Methods The analysis was done using local data and composite data from the literature. We reviewed the records of patients undergoing varicocele ligation between 1986 and 1995 at our institution. Data were stratified by surgical approach and performance of venography, and compared by cross table analysis. Data were then compiled from the literature from series that included cases stratified according to surgical approach and/or performance of venography. The impact of these parameters on recurrence rates was assessed by computing success rates and cross table analysis. Results At our institution 33 boys underwent ligation via a suprainguinal (27) or inguinal (8) approach. Intraoperative post-ligation venography was performed in 16 cases and omitted in 19. Neither surgical approach nor performance of venography influenced the recurrence rate in these patients (not statistically significant). Similarly, venography did not affect the recurrence rate after stratification by surgical approach (not significant). The overall success rate was 97% (34 of 35 cases). These data were added to those of 3 published studies, totaling 252 varicoceles with comparable groupings. Mean success rate after a suprainguinal and inguinal approach was 95.6 (93.2 to 97.4) and 88.3% (82.7 to 100%), respectively. Recurrence tended to be less common after a suprainguinal than an inguinal approach (p = 0.06). Post-ligation venography did not statistically affect the success rate after stratification according to surgical approach but it was associated with a higher success rate when performed with the inguinal approach. Conclusions Irrespective of the performance of venography, the suprainguinal surgical approach yields higher success rates than the inguinal approach to varicoceles in adolescents. Post-ligation intraoperative venography fails to affect significantly the success rate of varicocele ligation but it may be useful during an inguinal approach.

Blue venography in adolescent varicocelectomy: A modified surgical approach

Background/Purpose: Conventional varicocelectomy is often complicated by postoperative recurrences. When failure occurs, it is likely to be caused by incomplete interruption of the testicular vein, which is divided into multiple branches, or by the parallel collaterals, and to incompetence of the cremasteric vein(s). Occasionally it is caused by reversed flow in the deferential vein(s). Methods: The author reports his experience with 172 consecutive corrections of varicocele in adolescents (mean age, 13.4 years) by means of a personally modified technique. This technique is characterized by ileoinguinal access to all venous areas such as the retroperitoneum and the inguinal canal; ligature and transection of the internal and external spermatic veins, the parallel collaterals, and the deferential vein(s), if dilated and tortuous, with spermatic artery preservation; control of the interruption of flow in these veins by injection of methylene-blue solution in a vein of the pampiniform plexus (blue venography). Optical magnification (4x) and papaverine solution were also used. The rationale for this surgical approach is twofold: interruption of all testicular veins incompetent and potentially incompetent; easy and effective intraoperative control of venous interruption. Results: No varicocele recurrences or postoperative controlateral varicoceles were detected (follow-up, 6 to 24 months). The complications include a postoperative testicular atrophy by intraoperative methylene-blue extravasation with large hematoma of the cord and three postoperative hydroceles. Conclusion: The surgical approach reported here is a simple, safe, artery-sparing technique.

Varicocele Related Testicular Atrophy and its Predictive Effect Upon Fertility

Varicoceles are the most common reversible cause of male factor infertility, yet approximately 80% of men with varicoceles are fertile. Therefore, it is unclear whether all adolescents should undergo prophylactic varicocelectomy to prevent future infertility or whether a subgroup of patients who are at increased risk for future infertility can be identified and treated. Testicular size discrepancy or hypotrophy of the testis associated with a unilateral varicocele has been suggested as an indication for prophylactic varicocelectomy in adolescents. We examined 946 men attending a urological clinic for complaints other than infertility to determine whether testis size discrepancy was predictive of infertility in men with left varicoceles. A left varicocele was detected on physical examination in 211 men, of whom 173 (82%) had been able to father children and 38 (18%) had never fathered children. A group of 630 men without palpable varicoceles served as controls, including 528 (84%) with a history of fertility. Testicular size was measured using an orchidometer and the average testicular volume difference was obtained by subtracting left from right testicular volume. The mean testicular volume difference for the fertile men without varicoceles (1.6 ± 0.3ml.) was significantly lower than the fertile men with varicoceles (3.1 ± 0.4ml.) (p <0.05) and infertile men with varicoceles (2.5 ± 0.6ml.) (p <0.05). There was no significant difference between fertile and infertile men with varicoceles. This study confirms prior reports that the majority of men with left varicoceles are able to father children and that varicoceles cause significant ipsilateral testicular atrophy/hypotrophy. However, we were unable to demonstrate a correlation between loss of testicular volume and fertility status in men with left varicoceles. Further study is needed to identify the clinical parameters predictive of future infertility in adolescents with varicoceles.