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Sack BS, Schäfer M, Kurtz MP. The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired? Curr Urol Rep 2017; 18:38. [PMID: 28315171 DOI: 10.1007/s11934-017-0686-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The primary indication for varicocele repair in adults, that of failed paternity, must be substituted in the adolescent population with surrogate parameters of testicular size differential and semen analysis. Making recommendations based on these two parameters is incredibly difficult because studies often have contradictory findings, different patient populations, and lack of long-term follow up of the key endpoint, paternity. Therefore, it is not a surprise that recommendations for adolescent varicocele repair are general (with some exceptions) and necessarily so because of limitations in quality of evidence. Apart from pain, all indications for varicocele repair in adolescence remain controversial. This highlights the most important task for future studies: to prevent pediatric urologists from allowing a potentially damaging process to go untreated, while at the same time avoiding unnecessary intervention on a highly prevalent condition.
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Affiliation(s)
- Bryan S Sack
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Mattias Schäfer
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatric Surgery and Pediatric Urology, Cnopf'sche Kinderklinik, St. Johannis-Muehlgasse 19, 90419, Nuremberg, Germany
| | - Michael P Kurtz
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
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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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Fast AM, Deibert CM, Van Batavia JP, Nees SN, Glassberg KI. Adolescent varicocelectomy: does artery sparing influence recurrence rate and/or catch-up growth? Andrology 2013; 2:159-64. [DOI: 10.1111/j.2047-2927.2013.00142.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 09/02/2013] [Accepted: 09/13/2013] [Indexed: 11/28/2022]
Affiliation(s)
- A. M. Fast
- Division of Pediatric Urology; Morgan Stanley Children's Hospital of New York - Presbyterian; Columbia University College of Physicians and Surgeons; New York NY USA
| | - C. M. Deibert
- Division of Pediatric Urology; Morgan Stanley Children's Hospital of New York - Presbyterian; Columbia University College of Physicians and Surgeons; New York NY USA
| | - J. P. Van Batavia
- Division of Pediatric Urology; Morgan Stanley Children's Hospital of New York - Presbyterian; Columbia University College of Physicians and Surgeons; New York NY USA
| | - S. N. Nees
- Division of Pediatric Urology; Morgan Stanley Children's Hospital of New York - Presbyterian; Columbia University College of Physicians and Surgeons; New York NY USA
| | - K. I. Glassberg
- Division of Pediatric Urology; Morgan Stanley Children's Hospital of New York - Presbyterian; Columbia University College of Physicians and Surgeons; New York NY USA
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Abstract
Testicular varicocele is present in 15 % of adolescent boys. The very impact of this pathology and who will be at risk of developing into infertility remains unclear. Research on the pathophysiology, results of surgical or radiological interventions and potential predictors for long-term impairment of spermatogenesis and thus fertility is still ongoing. Indications for treatment are mainly based on differences in testicular volumes as semen parameters are most often not available; however, whether testicular volume is a valuable prognostic parameter for later fertility remains questionable. Approximately 50 % of adolescent patients with varicocele experience spontaneous increase of testicular volume without any intervention.
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Affiliation(s)
- K Czeloth
- Abteilung für Klinische Andrologie, Centrum für Reproduktionsmedizin und Andrologie
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