Treatment Of Adolescent Varicocele Research Articles

The possibilities of osteopathic correction using in adolescents with varicocele: a pilot study

Introduction. Currently, varicocele remains a largely unresolved problem in urology, and this makes it necessary to search for additional, including non-pharmacological, methods of treatment. In recent years, the effectiveness of osteopathic correction of patients with chronic venous insufficiency has been shown. However, at this moment, the use of osteopathic methods in the treatment of varicocele is not widely used, which makes it relevant to conduct research on this topic.The aim is to explore the possibility to use the osteopathic correction in adolescents with varicocele.Materials and methods. The study involved 40 participants aged 13–17 years. Two groups were formed: the main group (20 patients), whose participants received drug treatment and a course of osteopathic correction, and the control group (20 patients, data were collected retrospectively), whose participants received only drug therapy. For both groups, there were collected the parameters (before and after treatment) that characterize the state of the venous network of the spermatic cord (presence/absence of testicular hypotrophy, of cremaster reflex and of a positive Valsalva test; as well as the diameter of the cremaster veins and the value of the resistance index), and information on the presence/absence of pain syndrome.Results. In the control group, whose participants received only drug therapy, there was a significant (p<0,05) increase in the number of detected cases of pain syndrome and a positive Valsalva test, as well as a significant (p<0,05) increase in cremaster vein diameter at the end of treatment. Participants of the main group, who received osteopathic correction in addition to conservative therapy, were characterized by a significant (p<0,05) decrease in the diameter of the cremaster veins and an increase in the resistance index, the results differed significantly (p<0,05) from the corresponding values in the control group. Also, in the main group at the time of completion of treatment, there were recorded a statistically significantly (p<0,05) lower number of cases of pain syndrome, a positive Valsalva test, and the absence of a cremaster reflex in comparison with the control group.Conclusion. The results obtained in the framework of this pilot study allow us to positively assess the prospects for the use of osteopathic correction in the treatment of varicocele in adolescents. It is recommended to continue research in this direction over a longer period of time and on a larger sample size, with the obligatory formation of a parallel control.

Magnified subinguinal varicocelectomy versus conservative methods in treatment of adolescent varicocele

Background Elimination of varicocele in adolescent with lower complication rates is the best treatment modality. Therefore, the ideal technique should aim to ligate all internal and external spermatic veins with preservation of spermatic arteries and lymphatics. Aim We compared the outcome of magnified subinguinal varicocelectomy versus conservative methods in the treatment of adolescent varicocele. Patients and methods A total of 40 adolescent males (aged between 15 and 19 years) with refluxing varicocele and affected semen parameters and testicular volume were included. Overall, 20 patients were treated by magnified subinguinal varicocelectomy and 20 patients treated by conservative methods. All patients were reevaluated and followed for 6 months by several semen parameters and changes in testicular size by Doppler ultrasound. Results A significant improvement was seen in postmagnified subinguinal varicocelectomy group regarding sperm volume, sperm motility, sperm count, progressive movement, vitality, abnormal morphology, testicular volume, and varicocele grade, but in conservative method group, patients showed significant improvement regarding percent of rapid sperm, progressive movement and vitality, and a slight increase in testicular volume. After 6 months, there was a significant difference between both groups regarding sperm volume, progressive movement, vitality, testicular volume, and varicocele grade, so magnified subinguinal varicocelectomy is superior to conservative methods in the management of adolescents with symptomatic varicocele.

Lymphatic sparing laparoscopic varicocelectomy with or without testicular artery preservation: is there a difference?

BackgroundLymphatic sparing laparoscopic Palomo varicocelectomy is a safe and reliable technique for varicocele treatment in adolescents and children. The purpose of this study was to compare the outcomes of lymphatic sparing laparoscopic varicocelectomy with and without testicular artery preservation. The prospective random allocation of selected patients was done at Al-Azhar University Hospital, Pediatric Surgery Department from February 2010 till January 2015. All patients underwent lymphatic sparing laparoscopic varicocelectomy and they were divided into two equal groups, group A underwent laparoscopic Palomo without testicular artery sparing and group B underwent the procedure with testicular artery sparing. The main outcome included operative time, postoperative hydrocele, and persistence of varicocele, together with catch-up testicular growth or testicular atrophy.ResultsOne hundred and sixty male patients presented with left-sided primary varicocele that was diagnosed clinically and affirmed by color Doppler ultrasonography. The mean age was 14.25 ± 1.6 years (ranged 13-16 years). There was one case of persistent varicocele in group A, compared to 8 cases in group B with a statistically significant difference (p = 0.016). A significant difference had been found in the operative time (p = 0.001) between both groups. No hydrocele or testicular atrophy had been detected in both groups. No significant inter-group differences were seen in aspects of age, varicocele grade, and catch-up testicular growth. The mean follow-up period was 42 months (24-60 months).ConclusionLymphatic sparing laparoscopic Palomo varicocelectomy was superior to that with testicular artery preservation as regard varicocele persistence and operative time and hence is preferable for the management of primary pediatric varicocele.

Paediatric and adolescent varicocele: when, why and how to treat it

Available indicators to justify varicocele treatment in adolescents are insufficient: testis volume is a variable parameter, and testicular asymmetry may be physiological. Testis volume and semen parameters are subject to pubertal development. For evaluation of possible testicular impairment, both parameters should be measured prospectively and at consecutive points in time. Endocrine parameters, which might contribute to a better understanding of possible impairment of testicular function, are neglected in studies. No evidence exists to confirm that varicocele treatment during adolescence leads to the prevention of fertility impairment in adulthood. In summary, risks and benefits of varicocele treatment have to be considered. There is no clear evidence-based recommendation to treat adolescents with varicocele.

Management and Treatment of Varicocele in Children and Adolescents: An Endocrinologic Perspective.

Pediatric varicocele has an overall prevalence of 15%, being more frequent as puberty begins. It can damage testicular function, interfering with Sertoli cell proliferation and hormone secretion, testicular growth and spermatogenesis. Proper management has a pivotal role for future fertility preservation. The aim of this review was to discuss the diagnosis, management and treatment of childhood and adolescent varicocele from an endocrinologic perspective, illustrating the current evidence of the European Society of Pediatric Urology (ESPU), the European Association of Urology (EAU), the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) scientific societies. According to the ASRM/ESPU/AUA practice committee, the treatment of adolescent varicocele is indicated in the case of decreased testicular volume or sperm abnormalities, while it is contraindicated in subclinical varicocele. The recent EAS/ESPU meta-analysis reports that moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration increase. No specific phenotype in terms of testicular volume cut-off or peak retrograde flow (PRF) is indicated. Based on current evidence, we suggest that conservative management may be suggested in patients with PRF < 30 cm/s, testicular asymmetry < 10% and no evidence of sperm and hormonal abnormalities. In patients with 10–20% testicular volume asymmetry or 30 < PRF ≤ 38 cm/s or sperm abnormalities, careful follow-up may ensue. In the case of absent catch-up growth or sperm recovery, varicocele repair should be suggested. Finally, treatment can be proposed at the initial consultation in painful varicocele, testicular volume asymmetry ≥ 20%, PRF > 38 cm/s, infertility and failure of testicular development.

Laparoscopic treatment of varicocele within adolescents in two African countries.

Varicocele is often ignored by adolescents and their parents, in our context. The aim of the study is to present the indications and results of laparoscopic treatment in a population of adolescent students.Subjects and Methods:It is a descriptive and analytical prospective study over a period of 9 months (January to September 2013), focussed on cases of varicocele Grade 3 found in adolescents during a screening, and who underwent surgical treatment by laparoscopy. The laparoscopic treatment was done as part of a training mission to paediatrics surgeons, through a European Non-governmental organisation in two university hospitals in Africa. Of 2724 adolescent students examined, 149 (5.47%) had a varicocele. The average age was 16.39 ± 2.05 years (12 and 19). The side was unilateral (79.19%) with 76.51% left or bilateral (20.81%) (P = 0.00). According to the classification of Dubin and Amelar, there were 58 (38.92%) cases of Grade 1, 66 (44.30%) were Grade 2 and 25 (16.78%) were Grade 3.Results:The laparoscopic treatment was performed in 23 patients with varicocele Grade 3, by modified Palomo's technique, sectioning a segment of vessels between clips (15) between nodes (2) or after coagulation without clips and ligation (6). The hospital stay was 36 h. It has been observed one case of post-operative moderate vaginal hydrocele and 11 cases testicular hypertrophy.Conclusion:The laparoscopic treatment of varicocele in adolescents reduces post-operative morbidity related to conventional open surgery. This technique has been available in two poor African countries through partnership north-south.

Efficacy of microsurgical versus laparoscopic techniques on adolescent varicocele: a meta-analysis

Objective To analyze the efficacy of microsurgical versus laparoscopic varicocelectomy in treatment of adolescent varicocele. Methods All literature about treatment of adolescent varicocele, which met the inclusion criteria, were retrieved by two reviewers and data were extracted to perform a meta-analysis in the use of RevMan 5.3 downloaded from Cochrane library. Results A total of four controlled trials consist of 310 patients were included in the analysis, which displayed that: there was no significant difference in patients with postoperative testicular volume increase or in postoperative recurrence rate between the microsurgical group and the laparoscopic group(P=0.66 and P=0.19). Operative time of the microscopic group was longer than the laparoscopic group(P<0.01) and incidence of postoperative complications of microsurgery was lower(P=0.003). Conclusions Compared with adolescent varicocele, microsurgical varicocelectomy is relatively safer. More high-quality randomized controlled trials in this study are needed for further verification. Key words: Varicocele; Laparoscopes; Microscopy; Meta-Analysis

Our results of laparoscopic Palomo procedure in the treatment of adolescent varicocele

Amac: Bu calismanin amaci adolesan yas grubunda varikosel nedeniyle cerrahi tedavi yapilan hastalarin sonuclarini sunmaktir. Gerec ve Yontem: Subat 2012- Subat 2016 tarihleri arasinda varikosel nedeniyle ameliyat edilen hastalarin dosyalari geriye donuk olarak incelendi. Hastalar, demografik verileri, klinik sikâyetleri, fizik muayene bulgulari ve radyolojik olarak skrotal renkli doppler ultrasonografi (US) sonuclari ile degerlendirildi. Varikosel, Hoekstra ve ark. yaptigi dilate ven capinin degerlendirildigi siniflamaya gore evrelendirildi. Semptomatik evre 2 - 3 varikosel ve testis boyutlarinda kuculme olan hastalara cerrahi yapildi. Tedavi sonuclari ve komplikasyonlari kaydedildi. Bulgular: Yas ortalamasi 13±2 (10-16) olan 14 hasta degerlendirildi. Hastalarin tamami skrotumda agri ve sislik sikayetleri ile basvurmuslardi. Hastalarin tumunde varikosel sol tarafta idi. Hastalarin 7’si (%50) evre 2, 7’si (%50) evre 3 idi. Cerrahi yontem olarak laparoskopik Palomo yontemi uygulandi. Ortalama ameliyat suresi 28 ±4 (20-45) dakika. Ameliyat sirasinda hicbir hastada komplikasyon yasanmadi. Ortalama hastanede kalis suresi 2 gun (1-3) idi. Ortala­ma ameliyat sonrasi izlem 12 ± 9 (3-48) ay idi. Kontrolde hastalarin 11’inde varikosel duzeldi, 3 hastada ise evre 3’ten evre 1’e geriledi. Nuks gorulmedi. Sadece bir hastada (%7) hidrosel gelisti. Sonuc: Laparoskopik Palomo yontemini yuksek basari, dusuk komplikasyon orani, daha az agri, kisa surede sosyal yasama donus, iyi kozmetik sonuc gibi faydalari sebebiyle avantajli bir yontemdir. Ayrica single port laparoskopide ise eldiven yardimi ile hazirlanan torakoport dusuk maliyet ve kolay ulasilabilir olmasi sebebiyle tercih edilebilir.

The progress of diagnosis and treatment of adolescent varicocele

It is well known that adolescent varicocele is one reason to induce the testicular hypotrophy and potential infertility.Its indication and methods of treatment are controversial.This review provides the recent progress in diagnosis and treatment of adolescent varicocele including the indications and methods of surgical treatment, as well as new information of future researcher in the areas. Key words: Adolescent; Varicocele; Indication; Treatment

Adolescent varicocele: A large multicenter analysis of complications and recurrence in academic programs

After varicocelectomy a wide range of recurrence rates have been reported from 0 to 18%, and rates of post-operative hydrocele formation between 0 and 29%. Controversy exists as to the appropriate approach for varicocele treatment, whether open, laparoscopic, or percutaneous embolization (PE) is best for young men. The literature on treatment of adolescent varicocele is limited to high-volume single surgeon, single institution, or small multi-institution series. Our goal was to evaluate the retreatment and complication rates from numerous institutions to determine more generalizable results. The Faculty Practice Solutions Center database was queried to identify males under age 19 years with a diagnosis and/or treatment of varicocele between January 2009 and December 2012. Patients were followed until December 2013 (1-5 years follow-up) to determine if they had occurrence of outcome variables: retreatment, diagnosis, or treatment of hydrocele. Associations of the variables age, race, insurance type, geographical region, surgeon-volume, and surgical approach, with outcome variables were analyzed using a mixed-effects Cox proportional hazard model. Of 6,729 patients with a diagnosis of varicocele, 1,036 underwent open (405), laparoscopic (530), or percutaneous embolization (PE) (101) treatment by 213 physicians. Retreatment rates after open, laparoscopic, and PE treatments were 1.5%, 3.4% and 9.9%, respectively. Race, region, insurance type, and age were not independently associated with outcomes. The incidence of hydrocele after open, laparoscopic, and PE treatments was 4.9%, 8.1%, and 5%, respectively. No approach was independently associated with diagnosis or treatment of hydrocele. Young age was associated with a significantly higher rate of hydrocele formation. For each year of age, there was a 14% decreased rate of hydrocele formation. Although this series contains the largest cohort of patients, physicians, and institutions, we were limited by the inability to determine actual recurrence rates. Only patients receiving retreatment at the same institution within the 1-5 year follow-up period were captured. As such, the true rate of varicocele recurrence may be higher. The retreatment rate is influenced by the physician's threshold to retreat and the patient's desire to undergo another procedure. Despite its limitations, this is the first study to compare open, laparoscopic, and percutaneous approaches to varicocele treatment. Percutaneous embolization has a significantly higher retreatment rate compared with either open or laparoscopic varicocelectomy. Retreatment and hydrocele formation after open and laparoscopic approaches were not significantly different. This supports a surgeon and family choosing an approach based on patient characteristics and surgeon preference.

Lymphatic and testicular artery-sparing laparoscopic varicocelectomy in children and adolescents

Background/aim The ideal operation for the treatment of adolescent varicocele has been debated for many years. The division of lymphatic vessels during varicocelectomy is complicated by hydrocele formation and decline in testicular function. The aim of this study is to report on our series of children who underwent lymphatic and testicular artery-sparing laparoscopic varicocelectomy (LTASLV). Patients and methods Thirty boys with primary left-sided varicocele were subjected to LTASLV. The indications for intervention were scrotal pain and discomfort in 18 cases (60%), hypotrophy in nine cases (30%), and family preference in three cases (10%). An intraparenchymal injection of 2 ml methylene blue was administered after induction of anesthesia. LTASLV was performed for all patients. The main outcome measurements included operative time, hospital stay, development of hydrocele, varicocele recurrence, and testicular atrophy. Results The study included 30 patients with primary left-sided varicocele. Their mean age was 12.25 ± 1.6 years (range 9-16 years). Grade 3 varicocele was present in 21 cases (70%) and grade 2 varicocele was present in nine cases (30%). Stained lymphatics could easily be observed alongside the testicular artery and veins in 28 cases, whereas in two cases, a second injection of methylene blue with lowering of CO 2 pressure was required for visualization. All procedures were completed laparoscopically without conversions or complications. The mean operative time was 40 ± 2.6 min (range 30-50 min). All patients achieved full recovery and were discharged within 24 h. The mean follow-up period was 18 ± 4.3 months (range 10-36 months). Residual varicocele was noted in one case (3.3%) with no hydrocele formation or testicular atrophy. Conclusion This study shows good results with respect to postoperative hydrocele rates. LTASLV resulted in 0% of hydrocele and decreased the risk of varicocele recurrence. However, larger series are necessary.

The experience of conservative treatment of left-side varicocele in adolescents

The experience of conservative treatment of left-side varicocele in adolescents

Proteomic analysis of seminal plasma and its correlation to surgical intervention in the treatment of adolescent varicocele

OBJECTIVE: The most common clinical condition associated to male infertility is varicocele. However, little is known regarding protein pathways through which varicocele leads to alterations or if correction of varicocele may reestablish normal protein profiles. Thus, we set out to determine protein profiles in seminal plasma before and after varicocelectomy in adolescents.

Proteomic Analysis of Seminal Plasma and Its Correlation to Surgical Intervention in the Treatment of Adolescent Varicocele.

Proteomic Analysis of Seminal Plasma and Its Correlation to Surgical Intervention in the Treatment of Adolescent Varicocele.

Diagnosis, Evaluation and Treatment of Adolescent Varicocele

A varicocele can be defined as an abnormal tortuosity and dilation of the veins of the pampiniform plexus. Idiopathic varicocele is usually asymptomatic. It is noticed as an asymmetry in scrotal size, and presents as heaviness in the scrotum, or rarely with testicular pain. In most cases the adolescent is unaware of the varicocele and it is discovered during a regular physical examination or during examination for military service. The incidence of high-grade varicocele is approximately 5 % throughout the world. Varicocele is associated with a time dependant growth arrest in adolescents and adult males. There is a clear association between varicocele, infertility and testicular growth arrest. It is also known that varicocelectomy can reverse testicular growth arrest in adolescents. These facts have raised the question of how to best manage the adolescents with a varicocele. Adolescents do not present with infertility and thus should prophylactic repair be performed to prevent infertility in the future? Who would benefit the most by varicocelectomy: the adolescents with testicular growth arrest or any adolescent with a varicocele? Is it better to wait for a semen analysis or offer earlier treatment based on testicular growth arrests? These questions can be only answered when we have better understanding of the pathophysiology of varicocele. The purpose of this review is to present the current literature on adolescent varicocele and provide guidelines to the clinician how to manage the adolescents with a varicocele.

Experience with Varicoceles in Children and Young Adults

Experience with Varicoceles in Children and Young Adults

Microsurgical treatment of varicocele in adolescents: R.L. Mialdea, J. Sanabia, R.M. Crespo, et al. Eur J Pediatr Surg 5:101–103, (April), 1995

Microsurgical treatment of varicocele in adolescents: R.L. Mialdea, J. Sanabia, R.M. Crespo, et al. Eur J Pediatr Surg 5:101–103, (April), 1995

Microsurgical treatment of varicocele in adolescents.

Between March 1990 and November 1992, 22 adolescents with varicocele, 13 unilateral left and 4 bilateral, are presented. They were all treated with microsurgical techniques by shunting the venous drainage by means of a spermatic inferior epigastric end-to-side anastomosis. The results achieved have been optimum with the clinical disappearance of varicose veins in 100% of the cases and the elimination of the spontaneous reflux of the interna spermatic vein in 100% of the patients shown by echodoppler. This technique enables the establishment of an immediate and physiological testicular venous drainage fundamental for testicular growth and development.

Effects of varicocele treatment in adolescents: A randomized study

Effects of varicocele treatment in adolescents: A randomized study

Effects of varicocele treatment in adolescents: a randomized study

To study the effects of varicocele treatment on testicular function in adolescents. A prospective controlled study in 88 randomly selected adolescents. All participants were referred to the fertility outpatient clinic of our university hospital. All participants with a varicocele were randomly assigned into two groups. Group 1 (n = 33) was not treated, whereas group 2 (n = 34) was treated. A similar group of healthy volunteers without a varicocele served as a control group (group 3, n = 21). Testes volumes were measured at intake and during follow-up using an orchiometer. Semen analysis was performed according to standard procedures both at intake and after 1 year of follow-up. Serum hormone levels were determined at intake using a radioimmunoassay. Treatment was performed by means of transcatheter embolization of the left testicular vein. Testes volumes and semen quality at intake and after 1 year of follow-up were compared within and between the three groups. Hormonal parameters were determined at intake only. Before treatment, the mean left testis volume in groups 1 (n = 26) and 2 (n = 27) (20.0 mL; 95% confidence interval [CI]: 18.2 to 21.8 and 21.6 mL; 95% CI: 19.4 to 23.8, respectively) were significantly smaller than those in the control group (n = 19) (24.5 mL; 95% CI: 22.7 to 26.4). During follow-up, left testis volumes of the treated group were comparable with those in the control group (24.2 mL; 95% CI: 22.2 to 26.1 and 24.8 mL; 95% CI: 23.0 to 26.7 respectively) and significantly (P < 0.001) different from the untreated group (20.3 mL; 95% CI: 18.8 to 21.8). A significant increase in left (P < 0.01) as well as right (P < 0.05) testis volume was observed after treatment. Semen parameters before treatment were not significantly different between the three groups. Sperm concentration increased significantly (P < 0.01) from 47.4 x 10(6)/mL (95% CI: 42.5 to 53.3) to 68.9 x 10(6)/mL (95% CI: 50.6 to 87.2) in the treated group, whereas semen quality in the untreated and control groups did not change. Although both testes volumes and sperm concentration improved in the treated group, these phenomena were not consistently correlated to each other. Although not apparent in all adolescents, varicocele correction resulted in an increase in left testis volume and sperm concentration. At this moment, it is not clear if early preventive treatment of varicocele in adolescents, in time, will have a positive effect on testicular function.