Ipsilateral Testicular Hypotrophy Research Articles

Частота отцовства у мужчин, не оперированных по поводу варикоцеле в детском и подростковом возрасте

Feasibility of prophylactic varicocelectomy in adolescents is under discussion, which determines the importance of studying the frequency of paternity among men who were actively monitored. to evaluate a paternity rate in a group of adult men who have not undergone varicocelectomy in childhood or adolescence. The paternity rate was evaluated using a questionnaire-based survey carried out in 2018 among men who were actively monitored for unilateral varicocele with ipsilateral testicular hypotrophy during adolescence in 1999-2004. A total of 202 questionnaires were sent out checking whether the recipients were willing to have children. Median age at the time of the varicocele diagnosis was 15 years [Q1; Q3] (13-17). At the time of diagnosis, varicocele of grade III was found in 114 (93.4%) boys, and in 8 (6.6%) children, varicocele of grade II was seen. A total of 142 respondents were enrolled. Median age of the participants was 31 (29; 34). 20 men were excluded from the survey, due to prophylactic varicocelectomy (n=8, 5.6%), other reproductive diseases (n=4, 2.8%), previous radiotherapy or chemotherapy (n=2, 1.4%) and reproductive pathologies in the spouses (n=6, 4.2%). 16 (13.1%) participants were not planning to have children. Among the remaining, 9 respondents (6.6%) had no children. Varicocelectomy was carried out in 17 (16.3%) patients due to infertility, and 14 (82.3%) subsequently became fathers. 83 (78.3%) patients had one or more children as a result of spontaneous pregnancy. Paternity frequency in the surveyed group was 91.5%. Our results demonstrate high paternity frequency among men with asymptomatic left-sided varicocele accompanied by ipsilateral testicular hypotrophy during childhood and adolescence who were actively monitored without surgical treatment.

PD20-08 PREDICTORS OF PAIN RESOLUTION AFTER VARICOCELECTOMY FOR PAINFUL VARICOCELE

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia I1 Apr 2016PD20-08 PREDICTORS OF PAIN RESOLUTION AFTER VARICOCELECTOMY FOR PAINFUL VARICOCELE Hyun Jun Park, Du Geon Moon, and Nam Cheol Park Hyun Jun ParkHyun Jun Park More articles by this author , Du Geon MoonDu Geon Moon More articles by this author , and Nam Cheol ParkNam Cheol Park More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1421AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES About 2-10% of men with varicocele complain of pain, mainly in the scrotum or inguinal area. Conservative management may be offered to these patients, including limitation of physical activities, scrotal elevation and treatment with non-steroidal anti-inflammatory analgesics. However, these often do not contribute to pain management. Although varicocelectomy can be a management option in these cases, various success rates and the lack of predictive parameters for surgical outcomes make it difficult for urologists treating patients with painful varicocele. We assessed the effectiveness of varicocelectomy for painful varicocele and examined the factors that might be predictive of outcome. METHODS All patients who underwent a varicocelectomy for pain were included. A review of patient medical records was conducted; patient age, body mass index (BMI), grade, location of the varicocele, testicular volume, duration and quality of the pain (dull, dragging, throbbing, or sharp), and surgical technique (inguinal vs. subinguinal) were documented. All parameters were compared with the resolution of pain (complete, partial, or failure). RESULTS We followed up on 53 of 104 patients (50.9%). Complete postoperative resolution of pain was reported by 28 patients (52.8%), whereas 22 (41.5%) reported partial resolution. Only three patients (5.7%) reported failure. No relationship was observed between postoperative pain resolution and age, BMI, grade of varicocele, location of varicocele, ipsilateral testicular hypotrophy, quality of pain, or surgical technique. The duration of pain before surgery was the only factor that correlated with postoperative pain resolution (univariate, P = 0.004; multivariate, P = 0.002). CONCLUSIONS Our results indicate that varicocelectomy is an effective treatment for painful varicocele in properly selected patients, and that duration of pain before surgery may be predictive of outcome. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e454 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hyun Jun Park More articles by this author Du Geon Moon More articles by this author Nam Cheol Park More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The dilemma of adolescent varicocele.

Adolescent varicocele is associated with ipsilateral testicular hypotrophy and the concern for future infertility. A testicular size discrepancy greater than 15-20% between left and right testicle is an indication for treatment to allow catch-up growth in the hope of preventing a future decline in fertility. Some authors advocate for a period of watchful waiting, as normal testicular growth may occur asymmetrically. We review the current literature to highlight some controversies and challenges in management.

Active Surveillance of the Adolescent with Varicocele: Predicting Semen Outcomes from Ultrasound

We hypothesized that active surveillance of the adolescent varicocele is not associated with a high prevalence of suboptimal semen analysis and that patients with abnormal semen analysis have smaller testicular volumes and larger volume differentials. We conducted an institutional review board approved retrospective cohort study of adolescents with a clinically detected varicocele. Patients were initially observed by serial scrotal ultrasound evaluating testicular size and differential. Semen analysis was routinely collected in Tanner V cases, around age 18 years. Prevalence of normal semen analysis parameters was calculated, and logistic regression was used to model the ability of age at presentation and testicular volume parameters to predict a normal semen analysis. A cohort of 73 patients underwent surveillance with a mean ± SD age at presentation of 15.5 ± 2.3 years. Median followup was 2.7 years, during which time subjects underwent a median of 3 scrotal ultrasounds. A low total motile count was found in 48 patients (66%). Neither age at presentation nor testicular volume differential could predict normal semen volume, density, sperm motility or total motile count. Total testicular volume from the final ultrasound predicted total motile count (p = 0.008). However, the collective observations of volume during the entire period of surveillance could not predict total motile count (p = 0.847). There is a high prevalence of suboptimal semen analysis in adolescents with a varicocele who are followed with active surveillance. Total testicular volume can predict total motile count at the end of adolescence but not throughout.

Predictors of pain resolution after varicocelectomy for painful varicocele

Varicocelectomy is a management option for patients with painful varicocele. In this study, we assessed the effectiveness of varicocelectomy for painful varicocele and examined the factors that might be predictive of outcome. All patients who underwent a varicocelectomy for pain between February 2007 and July 2009 were included. A review of patient medical records was conducted; patient age, body mass index (BMI), grade, location of the varicocele, testicular volume, duration and quality of the pain (dull, dragging, throbbing or sharp) and surgical technique (inguinal versus subinguinal) were documented. All parameters were compared with the resolution of pain (complete, partial or failure). We followed up on 53 of 104 patients (51.0%). Complete postoperative resolution of pain was reported by 28 patients (52.8%), whereas 22 (41.5%) reported partial resolution. Only three patients (5.7%) reported failure. No relationship was observed between postoperative pain resolution and age, BMI, grade of varicocele, location of varicocele, ipsilateral testicular hypotrophy, quality of pain or surgical technique. The duration of pain before surgery was the only factor that correlated with postoperative pain resolution (univariate, P=0.004; multivariate, P=0.002). Our results indicate that varicocelectomy is an effective treatment for painful varicocele in properly selected patients, and that duration of pain before surgery may be predictive of outcome.

Does G Force Increase the Incidence of Varicocele in Air Force Pilot Cadets?

Objective: Air Force pilots are subjected to acceleration (G) forces with a known effect upon the vascular system. Specific training and anti-G maneuvers are used to counteract this effect, and allow pilots to operate at the limits of human endurance. The objective of the present study is to determine whether acceleration affects the incidence of varicocele. Subjects and Methods: The incidence of varicocele during training in 234 Air Force pilots was assessed. Height, weight, BMI and testicular volume were recorded for every participant. A group of 35 pilots with an absence of varicocele, randomly selected, acted as the control group. Results: Left-sided varicocele was confirmed in 23 (9.8%) pilots. Affected pilots tended to be taller (p = 0.073) and had a smaller mean left testicular volume (p < 0.001) than the control group. Eight cases (35%) were grade I, 10 (43%) were grade II, and 5 (22%) were grade III. For grades I and II, there was a trend for the testicular volume to decrease (p = 0.349 and 0.067, respectively). In grade III varicocele, this difference was statistically significant (p < 0.05). Conclusions: The incidence of varicocele in fighter pilots during training is not higher than in other groups of the same age. Affected individuals tend to be taller, with ipsilateral testicular hypotrophy.

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.

Report on varicocele and infertility

Controversies regarding diagnosis and treatment of varicoceles in male partners in infertile couples are considered in detail.

Varicocele in Adolescents: A 6-Year Longitudinal and Followup Observational Study

Through a school screening program for varicocele we studied the prognostic value of hemodynamic vs clinical grading for predicting the risk of progression, time to worsening and the final outcome in adolescents with varicocele. A school screening program was set up for boys between ages 10 and 16 years to assess pubertal development, varicocele, testicular vein reflux and testicular volume. Those who eventually had ipsilateral testicular hypotrophy underwent surgery. All patients underwent semen analysis after age 18 years. Varicocele grade was correlated with pubertal development, testicular vein reflux and semen quality in all groups, whether treated or untreated. A total of 2,107 boys were screened, of whom 609 had a varicocele. By the end of the study 92 patients (15.1%) had undergone surgery. Hypotrophy correlated with spontaneous testicular vein reflux (high grade) in all cases. Semen analysis showed abnormal results in 36% treated and 20% untreated patients. Children with varicocele should be regularly monitored to identify varicocele grade, testicular volume and vein reflux grade, and management should be determined accordingly. Spontaneous venous reflux toward the testis independent of varicocele grade closely correlates with the onset of testicular hypotrophy and abnormal semen analysis.

Relationship Between Testicular Volume and Varicocele in Patients With Infertility

We evaluated the relationship between varicocele and testicular volume determined by ultrasonography in infertile men. This study included 432 age-matched infertile men, 17 fertile men without scrotal abnormalities, and 20 fertile men with left clinical varicocele. The percentage testicular volume difference (%) between the right and left testicles was calculated as (right testicular volume - left testicular volume) x 100/right testicular volume. Of 432 infertile men, 91 had a left clinical varicocele, 32 had left clinical and right subclinical varicoceles, 9 had bilateral clinical varicoceles, 51 had a left subclinical varicocele, 22 had bilateral subclinical varicoceles, 8 had a right subclinical varicocele, and 219 had no varicocele. The relative decrement in left testicular volume compared with right testicular volume was not restricted to patients with varicocele. The presence of right subclinical varicocele did not influence absolute or percentage testicular volume differences in patients with left clinical or subclinical varicocele. Fertile patients with left clinical varicocele had larger absolute and percentage testicular volume differences than patients with infertility and fertile patients without scrotal abnormalities. However, infertile patients with left clinical varicocele, irrespective of the presence of right subclinical varicocele, had larger absolute and percentage testicular volume differences than infertile patients without varicocele, and more frequently had 15% to 30% testicular volume differences than those without varicocele. Left clinical testicular varicocele is associated with relative ipsilateral testicular hypotrophy in infertile patients. However, a subclinical varicocele was not important in determining differences between right and left testicular volumes.

LigaSure Vessel Sealing System in Laparoscopic Palomo Varicocele Ligation in Children and Adolescents

We review our experience with laparoscopic Palomo varicocele ligation using the LigaSure device in children and adolescents. Between June 2003 and December 2004, 25 varicoceles were treated by laparoscopic Palomo varicocele ligation using LigaSure vascular sealing. Patient ages ranged from 10 to 19 years (mean, 14.5 years). Indications for surgery included grade II-III varicocele or ipsilateral testicular hypotrophy. One patient was affected by recurrent contralateral inguinal hernia and 2 presented with an ipsilateral patent processus vaginalis. We placed a 5-mm umbilical port for access, and kept pneumoperitoneum below 15 mm Hg. Under laparoscopic guidance, two additional ports of 3 and 5 mm were inserted in the lower right and left quadrants, respectively. Once the vessels were isolated, the vascular sealant was applied 3-4 times to ensure coagulation of the spermatic vessels; the vessels were then divided with laparoscopic 5-mm scissors. Inguinal hernia and patent processus vaginalis were treated according to Schier's technique. All procedures were performed in our day surgery facility. Mean operative time was 18 minutes, which is significantly less than the time required in a similar group of 12 patients who underwent laparoscopic clip ligation. There were no perioperative complications. Eleven of 16 patients recovered testicular size. Two patients had postoperative hydrocele: the first was treated successfully with scrotal aspiration, while the other patient required scrotal hydrocelectomy. Laparoscopic Palomo varicocele sealing can be performed safely and rapidly and is highly successful in correcting varicoceles in young males. We also found it to be the ideal technique to correct the associated inguinal hernia or patent processus vaginalis.

The adolescent varicocele: Current issues

Introduction The incidence of varicoceles in adult men is approximately the same as that for adolescent boys, whether they are from Belgium, Denmark, or are of African American decent (ie, approximately 15%) [1–3]. Thirty to 41% of men evaluated for infertility are diagnosed with a left varicocele [4–6]. Although two thirds of these men will demonstrate improved semen parameters postoperatively, only 40% will achieve paternity, which is a result that is less than ideal [6]. Therefore, it would be worthwhile to select out those who might benefit from earlier surgery, perhaps even in adolescence. After all, it has been documented that abnormal semen parameters can occur even before the age 20 years [6,7]. A number of issues have been brought to light regarding the adolescent varicocele. In this commentary we address the most important issues including 1) the progressive nature of the adolescent varicocele; 2) the degree of asymmetry that beckons surgery; 3) the wide variability in percentage of repairs performed bilaterally in published adolescent series; 4) the choice of surgical procedure to be performed; and 5) postvaricocelectomy hydroceles. Ipsilateral testicular hypotrophy is a frequent finding in boys, with a varicocele existing in 60% of those with a grade 2 or 3 left varicocele [8]. When boys with preoperative hypotrophy were operated on, Kass and Bellman [9] found that 80% will achieve postoperative catch-up growth. Although this observation made in 1987 served as a landmark report and changed the approach to the adolescent varicocele, Barwell [10] had already identified ipsilateral testicular volume loss in teenagers 100 years earlier. He also found that when following ligation of the testicular veins “the testicle became harder and regained some of its dimension.”

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.

Increased seminal reactive oxygen species levels in patients with varicoceles correlate with varicocele grade but not with testis size

Increased levels of reactive oxygen species (ROS) are associated with clinical varicoceles; however, its correlation with varicocele grade and testis size is unknown. In our study, seminal ROS levels showed significant correlation with left varicocele grade and significantly elevated seminal ROS levels were seen in men with left varicocele grade 2 and 3 compared to grade 1.

LAPAROSCOPIC PALOMO VARICOCELE LIGATION IN CHILDREN AND ADOLESCENTS: RESULTS OF 103 CASES

We evaluate our experience using the laparoscopic Palomo varicocele ligation (LPV) technique in male children and adolescents with varicoceles. Between September 1994 and September 2002, 122 varicoceles were treated using LPV with either mass cord vascular clip application (68) or LigaSure (Valleylab, Boulder, Colorado) vascular sealing (54). All procedures were performed as day surgery cases and patients were allowed to return to normal activities as soon as they could tolerate them. Followup was scheduled for 6 to 12 weeks and 1 year postoperatively. Testicular size was evaluated using a Prader orchidometer. Of the 122 patients 103 were evaluable at the initial postoperative visit and 96 at 1-year followup. Patient ages ranged from 9 to 19 years (mean 14.6). Operating time was 9 to 52 minutes (mean 28), although in the last 2 years (28 cases) mean operative time has decreased to 14.6 minutes. Indications for surgery included ipsilateral testicular hypotrophy in 84 cases, symptoms in 3 and parental choice in 16. At followup only 1 recurrent varicocele (vascular sealant group) was identified which was subsequently re-treated successfully using vascular sealant LPV. At 1 year 64 of 78 testes (82%) demonstrated catch-up growth and there was no evidence of testicular loss or persistent hypotrophy in the others. Reactive hydroceles were identified in 6 patients equally distributed between the 2 LPV techniques. Surgery was required on 2 of these hydroceles due to size, and the other 4 are small and are being observed. Temporary scrotal emphysema occurred in the vast majority of patients and 1 patient required laparoscopic closure of a small sigmoid serosal tear. No patients required narcotic medications for greater than 48 hours. LPV is a highly successful method to correct varicoceles in young males with catch-up growth similar to series using other accepted standard techniques. LPV can be performed safely and rapidly as an outpatient and allows early return to activity. As with the open Palomo technique, hydrocele is a bothersome complication that may require a second surgical procedure if correction is warranted.

Microsurgical spermatico-epigastric venous anastomosis in the treatment of varicocele in children: assessment of long-term patency.

To demonstrate the long-term patency of microsurgical anastomoses between the internal spermatic vein and the inferior epigastric vein, constructed in the treatment of essential varicocele in paediatric patients to supplement ligation of the spermatic veins. We submitted 66 patients to inguinopelvic colour-flow Doppler ultrasonography. The patients had been treated 18 - 36 months earlier for essential varicocele by microsurgical inguinal ligation of the testicular venous pedicle and anastomosis between the internal spermatic vein and the inferior epigastric vein. Preoperatively, the 66 patients operated on at ages ranging from 10 to 16 years (13 +/- 1.4) presented with Dubin and Amelar grade II (14 patients) or grade III (52 patients) left varicocele with ipsilateral testicular hypotrophy. The postoperative follow-up showed 2 cases of persistence of disease and 3 cases of persistence of "medium" spermatic vein reflux without clinical evidence of varicocele. Seven patients developed left hydrocele which resolved spontaneously in 5 cases, whereas in 2 cases it proved necessary to perform an eversion of the tunica vaginalis of the testis. The results obtained in patients treated for Coolsaet type I varicocele (64 patients) were as follows: long-term patency of the anastomosis was observed in 58/64 patients (90.6 %); in 4 patients (6.2 %) the left inferior epigastric vein presented a position in relation to the homologous artery that prevented adequate sampling and thus made it impossible to assess the patency of the anastomosis; in 2 patients (3.1 %) the anastomosis was closed. In the two patients who had submitted to anastomosis for Coolsaet type III varicocele, colour-flow Doppler failed to identify the shunt. The results of this study demonstrate that microsurgical anastomosis between the internal spermatic vein, and the inferior epigastric vein remains competent in the long term, thus confirming the validity of this technique for the treatment of essential varicocele in children.

COMPARATIVE ASSESSMENT OF PEDIATRIC TESTICULAR VOLUME: ORCHIDOMETER VERSUS ULTRASOUND

COMPARATIVE ASSESSMENT OF PEDIATRIC TESTICULAR VOLUME: ORCHIDOMETER VERSUS ULTRASOUND

Ipsilateral Testicular Hypotrophy is Associated With Decreased Sperm Counts in Infertile Men With Varicoceles

Purpose The presence of ipsilateral testicular growth retardation (hypotrophy) is the most common indication for prophylactic varicocele repair in adolescents in an effort to prevent future infertility. We examined the relationship between semen parameters and ipsilateral versus contralateral testicular size in men with unilateral varicoceles to determine whether testicular size is an appropriate parameter for predicting future fertility. Materials and Methods We studied the records of consecutive patients with palpable unilateral left varicoceles for whom a history, physical examination and semen analysis were available. Total motile sperm counts of men with and without ipsilateral testicular hypotrophy were compared. Results We identified 611 patients with unilateral clinical left varicoceles, including 305 (50%) with ipsilateral testicular hypotrophy. Mean total motile sperm counts plus or minus standard error of mean were significantly less in the patients with than without testicular hypotrophy (80 +/− 5.2 versus 126 +/− 7.8 × 10 6 sperm, p = 0.0018). Hypotrophy was more common in patients with large varicoceles (73%) than in those with medium (53%) or small (43%) varicoceles. Conclusions Infertile patients with testicular hypotrophy associated with unilateral varicoceles have worse semen parameters than those without hypotrophy. These data support the practice of varicocele repair in adolescents with varicocele associated testicular growth retardation.

Ipsilateral Testicular Hypotrophy is Associated With Decreased Sperm Counts in Infertile Men With Varicoceles

Ipsilateral Testicular Hypotrophy is Associated With Decreased Sperm Counts in Infertile Men With Varicoceles