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Esposito C, Leva E, Castagnetti M, Cerulo M, Cardarelli M, Del Conte F, Esposito G, Chiodi A, Chiarenza M, Di Mento C, Escolino M. Robotic-assisted versus conventional laparoscopic ICG-fluorescence lymphatic-sparing palomo varicocelectomy: a comparative retrospective study of techniques and outcomes. World J Urol 2024; 42:215. [PMID: 38581596 PMCID: PMC10998803 DOI: 10.1007/s00345-024-04909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/26/2024] [Indexed: 04/08/2024] Open
Abstract
PURPOSE This study aimed to compare techniques and outcomes of robotic-assisted varicocelectomy (RAV) and laparoscopic varicocelectomy (LV). METHODS The medical records of 40 patients, who received RAV and LV over a 2-year period, were retrospectively analyzed. Palomo lymphatic-sparing varicocelectomy using ICG fluorescence was adopted in all cases. Three 5-mm trocars were placed in LV, whereas four ports, three 8-mm and one 5-mm, were placed in RAV. The spermatic vessels were ligated using clips in LV and ligatures in RAV. The two groups were compared regarding patient baseline and operative outcomes. RESULTS All patients, with median age of 14 years (range 11-17), had left grade 3 varicocele according to Dubin-Amelar. All were symptomatic and 33/40 (82.5%) presented left testicular hypotrophy. All procedures were completed without conversion. The average operative time was significantly shorter in LV [20 min (range 11-30)] than in RAV [34.5 min (range 30-46)] (p = 0.001). No significant differences regarding analgesic requirement and hospitalization were observed (p = 0.55). At long-term follow-up (30 months), no complications occurred in both groups. The cosmetic outcome was significantly better in LV than RAV at 6-month and 12-month evaluations (p = 0.001). The total cost was significantly lower in LV (1.587,07 €) compared to RAV (5.650,31 €) (p = 0.001). CONCLUSION RAV can be safely and effectively performed in pediatric patients, with the same excellent outcomes as conventional laparoscopic procedure. Laparoscopy has the advantages of faster surgery, smaller instruments, better cosmesis and lower cost than robotics. To date, laparoscopy remains preferable to robotics to treat pediatric varicocele.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Ernesto Leva
- Pediatric Surgery Unit, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Mariapina Cerulo
- Pediatric Surgery Unit, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Mery Cardarelli
- Pediatric Surgery Unit, Ospedale Maggiore Policlinico, Milan, Italy
| | - Fulvia Del Conte
- Pediatric Surgery Unit, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | | | - Annalisa Chiodi
- Pediatric Surgery Unit, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | | | - Claudia Di Mento
- Pediatric Surgery Unit, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
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Syarief AN, Rahman IA, Sangadji ARS, Djojodimedjo T, Rizaldi F. A systematic review and meta-analysis on the efficacy of internal spermatic artery ligation during laparoscopic varicocelectomy in children and adolescents: Is it safe? Arch Ital Urol Androl 2023; 95:11627. [PMID: 37791548 DOI: 10.4081/aiua.2023.11627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Challenges in identifying small testicular arteries and lack of microscopic experience have led to a rising trend in the use of laparoscopic technique for pediatric and adolescent varicocele. The controversy over artery ligation (AL) and artery preservation (AP) during laparoscopic varicocelectomy (LV) is still debatable. This study investigates the effectiveness of AL and AP during LV in pediatric and adolescent varicocele cases. METHODS The systematic searches based on PRISMA guideline were conducted in PubMed, Scopus, ScienceDirect, Web of Science and ProQuest databases with pre-defined keywords. Both quantitative and qualitative analyses were performed to assess catch-up growth, persistence, recurrence, hydrocele, operative time, post-operative testicular volume, and sperm analysis. RESULTS A total of 1512 patients from 9 eligible studies were included. There were no significant differences in catch up growth (OR 0.89; 95%CI 0.53, 1.51; p = 0.68) or hydrocele incidence (OR 0.59; 95%CI 0.28, 1.24; p = 0.16). The recurrence rate and persistence rate in AP group is significantly higher compared to AL group (OR 2.95; 95%CI 1.53, 5.68; p = 0.001 and OR 5.13; 95% CI 2.04, 12.88; p = 0.0005, respectively). The mean operative time during laparoscopic varicocelectomy is significantly longer when arteries are preserved as opposed to when they are ligated (OR 5.33; 95%CI 2.05, 8.60; p = 0.001). AL and AP both improved testicular volume and post-operative sperm analysis. CONCLUSIONS AL showed higher efficacy and comparable safety to AP. We recommend using AL with lymphatic sparing to minimize hydrocele complications.
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Affiliation(s)
- Ahmad Nurfakhri Syarief
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Ilham Akbar Rahman
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Agung Ravi Saputra Sangadji
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Tarmono Djojodimedjo
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Fikri Rizaldi
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
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Tandon S, Bennett D, Mark Nataraja R, Pacilli M. Outcome following the surgical management of varicocele in children and adolescents: a systematic review and meta-analysis. Ther Adv Urol 2023; 15:17562872231206239. [PMID: 37868369 PMCID: PMC10590051 DOI: 10.1177/17562872231206239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background The ideal surgical approach for the management of varicocele in children and adolescents remains controversial. Several techniques are available including artery- or lymphatic-sparing with optical magnification (via open inguinal or sub-inguinal approach), laparoscopic, antegrade and retrograde embolization/sclerotherapy. Objectives We aimed to appraise the clinical outcomes of these techniques in children and adolescents. Data Sources and Methods A systematic review was conducted (1997-2023). Meta-analysis or proportional meta-analysis for non-comparative studies (Freeman-Tukey transformation) using the random effects model was conducted. Results are expressed as overall proportion % and 95% confidence interval (CI). Results We identified 1910 studies; 632 duplicates were removed, 1278 were screened, 203 were reviewed and 56 were included, with 12 reporting on 2 different techniques (total of 68 data sets). Optical magnification via inguinal approach (498 cases): recurrence 2.5% (0.6-5.6), hydrocele 1.6% (0.47-3.4), testicular atrophy 1% (0.3-2.0), complications 1.1% (0.2-2.6); optical magnification via sub-inguinal approach (592 cases): recurrence 2.1% (0.7-4.4), hydrocele 1.26% (0.5-2.3), testicular atrophy 0.5% (0.1-1.3), complications 4% (1.0-8.8). Laparoscopic with mass-ligation/division (1943 cases): recurrence 2.9% (1.5-4.6), hydrocele 11.4% (8.3-14.9); complications 1.5% (0.6-2.9); laparoscopic with lymphatic-sparing (974 cases): recurrence 2.4% (1.5-3.5), hydrocele 1.2% (0.45-3.36), complications 1.2% (0.05-3.9); laparoscopic with artery-sparing (228 cases): recurrence 6.6% (2.3-12.9), hydrocele 6.5% (2.6-12.0). Antegrade embolization/sclerotherapy (403 cases): recurrence 7.6% (5.2-10.4), hydrocele 0.8% (0.17-1.9), technical failure 0.6% (0.1-1.6), complications 4.0% (2.3-6.1); retrograde embolization/sclerotherapy (509 cases): recurrence 6.9% (4.6-9.5), hydrocele 0.8% (0.05-2.5), technical failure 10.2% (4.6-17.6), and complications 4.8% (1.0-11.2). Conclusion The recurrence rate varies between 2.1% and 7.6% and is higher with the embolization/sclerotherapy techniques. Post-operative hydrocele rate varies between 0.8% and 11.4% and is higher with the laparoscopic mass-ligation/division technique. Testicular atrophy has not been reported with the laparoscopic and embolization/sclerotherapy techniques. The retrograde embolization technique is associated with 10% technical failure (inability to complete the procedure). The laparoscopic lymphatic-sparing technique is characterized by the lowest recurrence rate, incidence of hydrocele and other complications, and no reports of testicular atrophy.
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Affiliation(s)
- Sarthak Tandon
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia
| | - Daniel Bennett
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia
| | - Ramesh Mark Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Level 5, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Teng J, Jia Z, Ai X, Luo X, Guan Y, Hao X, Fei W. Robotic-assisted laparoscopic artery-sparing varicocelectomy using indocyanine green fluorescence angiography: Initial experience. Andrologia 2020; 52:e13774. [PMID: 32786090 DOI: 10.1111/and.13774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022] Open
Abstract
We reported our initial experience of robotic-assisted laparoscopic artery-sparing varicocelectomy using indocyanine green (ICG) fluorescence angiography in treatment of varicocele. A total of 45 varicocelectomies in 27 patients were performed. The mean operation time was 49.1 ± 8.5 min for unilateral and 65.6 ± 8.3 min for bilateral repair. 47.2 s after ICG injection, testicular artery (TA) was visualised. After an interval of 31.3 s, fluorescent veins were identified. Of all the 45 spermatic cords, 68.9% had a solitary artery, while 31.1% had 2 arteries. The mean hospital stay was 1.6 ± 0.9 days. Semen concentration and motility were significantly improved 6 months after surgery, no recurrence, hydrocele or testicular atrophy was observed. Our study demonstrated that robotic-assisted laparoscopic artery-sparing varicocelectomy using ICG fluorescence angiography is a safe, effective and promising technique in treatment of varicocele.
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Affiliation(s)
- Jingfei Teng
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhuomin Jia
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xing Ai
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao Luo
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yawei Guan
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xuemei Hao
- Department of Anesthesiology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Weiwei Fei
- Department of Anesthesiology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
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Ulusoy O, Karakus OZ, Ateş O, Hakgüder FG, Olguner M, Akgür FM. Successful outcomes in adolescent varicocele treatment with high-level laparoscopic varicocelectomy. J Pediatr Surg 2020; 55:1610-1612. [PMID: 31378366 DOI: 10.1016/j.jpedsurg.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE In this study, we aimed to compare the effects of testicular vein ligation level on complications encountered; i.e. high-level ligation cranial to the linea terminalis vs ligation caudal to the linea terminalis. METHODS A total of 47 unilateral adolescent patients, treated with laparoscopic varicocelectomy between January 2004 and December 2017, were reviewed retrospectively. Patients were divided into two groups in terms of ligation level: caudal to the linea terminalis as group 1 and cranial to the linea terminalis as group 2. Symptoms, varicocele grades, preoperative testicular growth arrest, operative method, hydrocele formation, postoperative recurrence and testicular catch-up growth were recorded. RESULTS The mean operation time was 38.6 ± 10.2 min (34-53 min) in group 1 and was 33.6 ± 6.4 min (29-42 min) in group 2. Single hydrocele occurred in the laparoscopic nonselective varicocelectomy in group 1 (4.5%) and was successfully treated with open hydrocelectomy. Single varicocele recurrence was observed in the laparoscopic selective varicocelectomy in group 1 (4.5%) and treated with laparoscopic nonselective varicocelectomy cranial to the linea terminalis. CONCLUSIONS The high-level ligation of the spermatic veins cranial to the linea terminalis during laparoscopic varicocelectomy, independent of the technique applied, may contribute to reasonable low hydrocele and recurrence rates. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
| | - Osman Zeki Karakus
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Faika Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Silay MS, Hoen L, Quadackaers J, Undre S, Bogaert G, Dogan HS, Kocvara R, Nijman RJM, Radmayr C, Tekgul S, Stein R. Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. Eur Urol 2018; 75:448-461. [PMID: 30316583 DOI: 10.1016/j.eururo.2018.09.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022]
Abstract
CONTEXT The benefits and harms of intervention (surgical or radiological) versus observation in children and adolescents with varicocele are controversial. OBJECTIVE To systematically evaluate the evidence regarding the short- and long-term outcomes of varicocele treatment in children and adolescents. EVIDENCE ACQUISITION A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A priori protocol was registered to PROSPERO (CRD42018084871), and a literature search was performed for all relevant publications published from January 1980 until June 2017. Randomized controlled trials (RCTs), nonrandomized comparative studies (NRSs), and single-arm case series including a minimum of 50 participants were eligible for inclusion. EVIDENCE SYNTHESIS Of 1550 articles identified, 98 articles including 16 130 patients (7-21 yr old) were eligible for inclusion (12 RCTs, 47 NRSs, and 39 case series). Varicocele treatment improved testicular volume (mean difference 1.52ml, 95% confidence interval [CI] 0.73-2.31) and increased total sperm concentration (mean difference 25.54, 95% CI 12.84-38.25) when compared with observation. Open surgery and laparoscopy may have similar treatment success. A significant decrease in hydrocele formation was observed in lymphatic sparing versus non-lymphatic sparing surgery (p=0.02). Our findings are limited by the heterogeneity of the published data, and a lack of long-term outcomes demonstrating sperm parameters and paternity rates. CONCLUSIONS Moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration. Current evidence does not demonstrate superiority of any of the surgical/interventional techniques regarding treatment success. Long-term outcomes including paternity and fertility still remain unknown. PATIENT SUMMARY In this paper, we review benefits and harms of varicocele treatment in children and adolescents. We found moderate evidence that varicocele treatment results in improvement of testicular volume and sperm concentration. Lymphatic sparing surgery decreases hydrocele formation. Paternity and fertility outcomes are not clear.
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Affiliation(s)
- Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Lisette Hoen
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Josine Quadackaers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Shabnam Undre
- Department of Pediatric and Adult Urology, East and North Herts NHS Trust, Stevenage, UK
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Radim Kocvara
- Department of Urology, General Teaching Hospital and Charles University 1st Faculty of Medicine in Praha, Prague, Czech Republic
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, University of Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Guo LQ, Zhang XL, Liu YQ, Sun WD, Zhao ST, Yuan MZ. The application of laparoscopic Doppler ultrasound during laparoscopic varicocelectomy in infertile men. Asian J Androl 2017; 19:214-218. [PMID: 27678469 PMCID: PMC5312221 DOI: 10.4103/1008-682x.189622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this study is to evaluate the benefits of laparoscopic Doppler ultrasound (LDU) application during laparoscopic varicocelectomy (LV), and to compare the surgical outcomes and complications between LDU-assisted LV (LDU-LV) and conventional LV for infertile patients with varicoceles; 147 infertile patients were randomly divided into two groups. Operative and postoperative parameters, semen parameters, and the pregnancy rate were compared. There were no differences in baseline demographics. The operative time was significantly longer in LDU-LV group than LV group. The incidence of postoperative hydrocele was 1.4% (1/72) in LDU-LV group versus 10.7% (8/75) in LV group, which showed a significant difference (P < 0.05). However, other surgical outcomes, such as postoperative hospital stay, postoperative recurrence, and testicular atrophy, were similar between the two groups. Sperm concentration and sperm motility were significantly increased in both groups at 3, 6, and 12 months after surgery (P < 0.01), and they were higher in LDU-LV than LV group in 12 months after surgery (34.21 ± 6.36 vs 29.99 ± 6.04 for concentration, P < 0.05; 40.72 ± 8.12 vs 37.31 ± 6.12 for motility, P < 0.05). Sperm morphology was comparable between the two groups. The pregnancy rate showed no significant difference (44.4% of the LDU-LV vs 37.3% of the LV, P > 0.05). In conclusion, compared with LV, LDU-LV could safely and effectively ligate all spermatic veins and preserve spermatic arteries without leading to high varicocele recurrence and postoperative hydrocele. Given the benefits that sperm counts as well as sperm motility favoring LDU-LV, we recommend that LDU should be routinely used as an effective tool to improve outcomes and safety of laparoscopic varicocelectomy.
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Affiliation(s)
- Li-Qiang Guo
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Xiu-Lin Zhang
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Yu-Qiang Liu
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China.,Institute of Urology, Shandong University, Jinan, Shandong 250033, China
| | - Wen-Dong Sun
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Sheng-Tian Zhao
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China.,Institute of Urology, Shandong University, Jinan, Shandong 250033, China
| | - Ming-Zhen Yuan
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
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Comparison of Treatment Outcomes of Different Spermatic Vein Ligation Procedures in Varicocele Treatment. Am J Ther 2016; 23:e1329-e1334. [DOI: 10.1097/mjt.0000000000000232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
In recent years, there has been increasing interest in transitional urology, or how to best prepare patients with major congenital urologic diseases, such as bladder exstrophy and neuropathic bladder, to manage their own health care with adult urologists. However, common pediatric urologic conditions may be encountered by the adult urologist with more regularity. This review focuses on three relatively common conditions which may be identified in childhood, the consequences from which a patient may seek help from an adult urologist: cryptorchidism, varicocele, and Klinefelter syndrome.
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Affiliation(s)
- Kristina D Suson
- Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI, 48201, USA.
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10
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Qi X, Wang K, Zhou G, Xu Z, Yu J, Zhang W. The role of testicular artery in laparoscopic varicocelectomy: a systematic review and meta-analysis. Int Urol Nephrol 2016; 48:955-65. [PMID: 26971102 DOI: 10.1007/s11255-016-1254-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/23/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE We performed this meta-analysis to evaluate the efficacy and safety of artery preserving versus artery non-preserving in laparoscopic varicocelectomy. METHODS All publications up until October 2015 were searched in PubMed, EMBASE, Ovid, Web of Science, and Cochrane library. Randomized controlled trials (RCTs) and cohort studies (CSs) that compared the difference in two operative approaches in laparoscopic varicocelectomy were included. Statistical analysis was performed using Stata version 12.0. RESULTS A total of four RCTs and ten CSs involving 503 cases with artery preserving and 911 cases with artery non-preserving met our inclusion criteria. Meta-analysis showed that artery preserving had higher recurrence rate [risk ratio (RR) = 2.91, 95 % confidence interval (CI) 1.83-4.61; P = 0.000], lower incidence of hydrocele formation (RR = 0.18; 95 % CI 0.08-0.42; P = 0.000), and prolonged operating time [standard mean difference (SMD) = 1.27; 95 % CI 0.17-2.37; P = 0.023], compared with artery non-preserving in laparoscopic varicocelectomy. The results were similar in postoperative catch-up growth (RR = 1.00; 95 % CI 0.86-1.17; P = 0.985) and testicular atrophy (RR = 0.36; 95 % CI 0.09-1.54; P = 0.169). Besides, no significant difference was found in sperm concentration, motility, and normal morphology between two groups, as well as on postoperative pregnancy rate (RR = 0.95; 95 % CI 0.65-1.40; P = 0.809). CONCLUSION With the advantages of less recurrence, easier operating and less time spending, and comparable results in other respects, artery non-preserving is preferable to artery preserving in laparoscopic varicocelectomy, although there is a relatively high incidence of hydrocele formation. Considering the limitation of included studies, more large-scaled RCTs are required to confirm the present findings.
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Affiliation(s)
- Xiaokang Qi
- Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.,Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Kunpeng Wang
- Department of Urology, The First People's Hospital of Lianyungang City, No. 182 North Tongguan Road, Xinpu District, Lianyungang, 222002, Jiangsu, China
| | - Guangchen Zhou
- Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Zhen Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Junjie Yu
- Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Wei Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Yu W, Rao T, Ruan Y, Yuan R, Cheng F. Laparoscopic Varicocelectomy in Adolescents: Artery Ligation and Artery Preservation. Urology 2016; 89:150-4. [DOI: 10.1016/j.urology.2015.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/06/2015] [Accepted: 11/27/2015] [Indexed: 11/17/2022]
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12
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Zhang Y, Yang X, Wu X, Zhang H, Chen S, Gao X. Microsurgical varicocelectomy with transfixing of the difficult-to-isolate periarterial vein using microsutures. Urology 2015; 85:948-52. [PMID: 25709049 DOI: 10.1016/j.urology.2014.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/14/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To address difficulty in isolating the adhered periarterial vein in microsurgical subinguinal varicocelectomy, we introduced the transfixing microsuture method as well as to evaluate the impact of this technical modification on the surgical success of varicocele repair. MATERIALS AND METHODS We retrospectively evaluated 4 patients with a mean age of 31.5 years who underwent subinguinal varicocelectomy with transfixion of the difficult-to-isolate periarterial vein (a 9-0 transfixing microsuture was placed transversely through the periarterial vein as near to the adjacent border between the testicular artery and adherent vein as possible; then, it was knotted to nick or completely ligate the lumen.) The incidence of recurrence or persistence, postoperative hydrocele formation, sperm improvement, and symptom release was analyzed. RESULTS In 4 cases, the periarterial vein transfixing procedures were performed with a mean follow-up of 6 months. No postoperative recurrence or hydrocele was identified postoperatively. One patient reported no symptom improvement, but there was significant improvement in the symptoms and/or semen parameters in the other 3 patients. Postoperative ultrasonography evaluation revealed that there was no postoperative varicocele recurrence or persistence, no hydrocele formation, and no testicular atrophy. CONCLUSION When the adhered periarterial vein is difficult to isolate and ligate, transfixing the vein with a microsuture in microsurgical subinguinal varicocelectomy is a viable compromise that reduces the incidence of postoperative recurrence or persistence without serious complications.
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Affiliation(s)
- Yan Zhang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Xiaojian Yang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Wu
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Zhang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shitao Chen
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Gao
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Abstract
The role of laparoscopy in the case of nonpalpable cryptorchidism is both diagnostic and therapeutic. Laparoscopic orchiopexy for nonpalpable testes in the pediatric population has become the preferred surgical approach among pediatric urologists over the last 20 years. In contrast, laparoscopic varicocelectomy is considered one of several possible approaches to the treatment of a varicocele in an adolescent; however, it has many challengers and it has not gained universal acceptance as the gold standard. This article reviews the published evidence regarding these surgical techniques.
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14
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Cho SJ, Kim SC, Kim KS, Park S. Magnification-assisted subinguinal varicocelectomy with testicular delivery in children: a preliminary report. World J Mens Health 2014; 32:93-8. [PMID: 25237659 PMCID: PMC4166376 DOI: 10.5534/wjmh.2014.32.2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/06/2014] [Accepted: 05/27/2014] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of magnification-assisted subinguinal varicocelectomy (MASV) with testicular delivery in children with severe varicocele. MATERIALS AND METHODS We retrospectively analyzed the clinical data of 23 children 15 years or younger (mean age, 12.3±1.8 years) who underwent MASV with testicular delivery and ligation of all collateral veins except arteries and deferential veins between January 2010 and January 2014. All patients had grade 3 varicocele on the left side. Varicocelectomy was decided upon due to scrotal hypotrophy (n=14, 60.9%), the existence of mass (n=6, 26.1%, including 1 recurrent case), and discomfort (n=3, 13.0%). The preservation of internal spermatic artery (ISA) was successful in 8 patients (34.8%). The mean follow-up time was 10.8±6.6 months. RESULTS The surgical success rate of varicocelectomy was 100%. The overall symptom resolution rate was 91.3%. The scrotal mass and discomfort disappeared, but testicular catch-up growth did not occur in 2 among 14 patients with scrotal hypotrophy. The left testis volume increased from 6.5±4.3 mL to 10.6±7.5 mL (p=0.003). There were no significant inter-group differences in terms of the surgical success rate, symptom resolution, and catch-up growth between the ISA preservation group and the ligation group. None of the subjects demonstrated testicular atrophy or hydrocele after surgery. CONCLUSIONS MASV with testicular delivery is an effective and safe method for children with severe varicocele.
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Affiliation(s)
- Suk Ju Cho
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Seong Cheol Kim
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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