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Zampieri N. Hormonal evaluation in adolescents with varicocele. J Pediatr Urol 2021; 17:49.e1-49.e5. [PMID: 33281047 DOI: 10.1016/j.jpurol.2020.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Varicocele is one of the most frequent disease affecting the fertility potential; OBJECTIVE: the aim of this study is to assess the correlation between clinical and radiological grade of varicocele and hormonal values. STUDY DESIGN The data about adolescents with left unilateral varicocele aged between 13 and 16 years, with Tanner stage V, followed at the Authors' Institution between September 2016 and September 2019 were investigated; inclusion and exclusion criteria were created. Patients underwent standard visit, Ultrasound, Doppler velocimetry and hormonal tests (at T0 and T1). Those patients with testicular hypotrophy underwent surgery. RESULTS During the study period, 75 subjects with left unilateral varicocele were enrolled; 8 patients were excluded.A total of 67 patients were then studied. Among these patients, 37 had testicular hypotrophy, while the others had normal testicular volume. There was no correlation between grade of varicocele and testicular hypotrophy (p = 0.12); among those patients with testicular hypotrophy, there was a statistical correlation with the grade of spermatic vein reflux (grade 4 vs grades 1-2-3) (p = 0.03). Focusing on hormonal values, there was a statistical significant difference between FSH levels, clinical grades of varicocele and grade of spermatic vein reflux: FSH levels were higher in patients with clinical grade 3 varicocele respect to patients with grade 1-2 varicocele and, in particular, patients with grade 3 varicocele, testicular hypotrophy and grade 4 spermatic vein reflux (14 patients) had higher FSH level respect to others (p = 0.02). After surgery there was a significant FSH reduction. CONCLUSIONS Our results demonstrate that higher grade of spermatic vein reflux is associated with testicular hypotrophy and higher FSH levels.
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Affiliation(s)
- Nicola Zampieri
- Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Department of Surgery, Dentistry, Paediatrics and Gynaecology, Paediatric Fertility Lab, University of Verona, Piazzale A.Stefani 1, Verona Italy.
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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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Zhou T, Zhang W, Chen Q, Li L, Cao H, Xu CL, Chen GH, Sun YH. Effect of varicocelectomy on testis volume and semen parameters in adolescents: a meta-analysis. Asian J Androl 2016; 17:1012-6. [PMID: 25677136 PMCID: PMC4814973 DOI: 10.4103/1008-682x.148075] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Varicocele repair in adolescent remains controversial. Our aim is to identify and combine clinical trials results published thus far to ascertain the efficacy of varicocelectomy in improving testis volume and semen parameters compared with nontreatment control. A literature search was performed using Medline, Embase and Web of Science, which included results obtained from meta-analysis, randomized and nonrandomized controlled studies. The study population was adolescents with clinically palpable varicocele with or without the testicular asymmetry or abnormal semen parameters. Cases were allocated to treatment and observation groups, and testis volume or semen parameters were adopted as outcome measures. As a result, seven randomized controlled trials (RCTs) and nonrandomized controlled trials studying bilateral testis volume or semen parameters in both treatment and observation groups were identified. Using a random effect model, mean difference of testis volume between the treatment group and the observation group was 2.9 ml (95% confidence interval [CI]: 0.6, 5.2; P< 0.05) for the varicocele side and 1.5 ml (95% CI: 0.3, 2.7; P< 0.05) for the healthy side. The random effect model analysis demonstrated that the mean difference of semen concentration, total semen motility, and normal morphology between the two groups was 13.7 × 10 6 ml-1 (95% CI: -1.4, 28.8; P = 0.075), 2.5% (95% CI: -3.6, 8.6; P= 0.424), and 2.9% (95% CI: -3.0, 8.7; P= 0.336) respectively. In conclusion, although varicocelectomy significantly improved bilateral testis volume in adolescents with varicocele compared with observation cases, semen parameters did not have any statistically significant difference between two groups. Well-planned, properly conducted RCTs are needed in order to confirm the above-mentioned conclusion further and to explore whether varicocele repair in adolescents could improve subsequently spontaneous pregnancy rates.
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Affiliation(s)
| | | | | | | | | | | | - Guang-Hua Chen
- Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Ying-Hao Sun
- Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
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Camoglio FS, Zampieri N. Varicocele treatment in paediatric age: relationship between type of vein reflux, surgical technique used and outcomes. Andrologia 2015; 48:389-92. [DOI: 10.1111/and.12458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- F. S. Camoglio
- Department of Surgical Sciences; Pediatric Surgical Unit; Policlinico ‘G.B.Rossi’; University of Verona; Verona Italy
| | - N. Zampieri
- Department of Surgical Sciences; Pediatric Surgical Unit; Policlinico ‘G.B.Rossi’; University of Verona; Verona Italy
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Nork JJ, Berger JH, Crain DS, Christman MS. Youth varicocele and varicocele treatment: a meta-analysis of semen outcomes. Fertil Steril 2014; 102:381-387.e6. [DOI: 10.1016/j.fertnstert.2014.04.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/15/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
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Akdemir S, Gurocak S, Konac E, Ure I, Onen HI, Gonul II, Sozen S, Menevse A. Different surgical techniques and L-carnitine supplementation in an experimental varicocele model. Andrologia 2013; 46:910-6. [DOI: 10.1111/and.12172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- S. Akdemir
- Faculty of Medicine; Department of Urology; Gazi University; Ankara Turkey
| | - S. Gurocak
- Faculty of Medicine; Department of Urology; Gazi University; Ankara Turkey
- Faculty of Medicine; Department of Medical Biology and Genetics; Gazi University; Ankara Turkey
| | - E. Konac
- Faculty of Medicine; Department of Medical Biology and Genetics; Gazi University; Ankara Turkey
| | - I. Ure
- Faculty of Medicine; Department of Urology; Gazi University; Ankara Turkey
| | - H. I. Onen
- Faculty of Medicine; Department of Medical Biology and Genetics; Gazi University; Ankara Turkey
| | - I. I. Gonul
- Faculty of Medicine; Department of Pathology; Gazi University; Ankara Turkey
| | - S. Sozen
- Faculty of Medicine; Department of Urology; Gazi University; Ankara Turkey
| | - A. Menevse
- Faculty of Medicine; Department of Medical Biology and Genetics; Gazi University; Ankara Turkey
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Serefoglu EC, Saitz TR, La Nasa JA, Hellstrom WJ. Adolescent varicocoele management controversies. Andrology 2013; 1:109-15. [PMID: 23258638 DOI: 10.1111/j.2047-2927.2012.00004.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/18/2012] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
Abstract
Varicocoele is defined as excessive dilatation of the pampiniform venous plexus of the spermatic cord. Varicocoele frequently appears during early puberty and is recognized to be the most common surgically correctable cause of male infertility. However, the actual incidence in adolescents, pathophysiology and the association with male factor infertility all remain somewhat controversial. The most accurate diagnostic technique for identifying young men who will benefit from surgical treatment has yet to be established. Observations of testicular asymmetry and deteriorating semen quality helped establish current guidelines and recommendations for surgical treatment. Further studies, comparing observation with surgical intervention, are needed to refine the current indications for varicocoele repair in the adolescent male.
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Affiliation(s)
- E C Serefoglu
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Abadía-Forcén T, Ayuso-González L, Pisón-Chacón J, Barberena-Iriberri J, González-Temprano N, Pérez-Martínez A. Lymphatic preservation in varicocele in the adolescent: does prior embolization limit spermatic dissection? J Pediatr Urol 2012; 8:431-3. [PMID: 22056732 DOI: 10.1016/j.jpurol.2011.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 09/04/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE One of the complications after complete section of the spermatic pedicle in the treatment of adolescent idiopathic varicocele is the formation of a scrotal lymphocele. This can be avoided by preserving lymphatic vessels using dye, but there is a risk that dissection may be complicated in patients who have previously undergone embolization. The aim of this study was to determine whether prior embolization limits spermatic dissection. MATERIAL AND METHOD We used lymphography with dye (Patent Blue) prior to surgery in order to mark and preserve the lymph vessels during spermatic section. This was done by laparoscopy with a single umbilical port. RESULTS We treated six patients aged 12.5-15 years (mean 13.12 years), two of whom had grade 2 varicoceles and four grade 3. Prior percutaneous embolization with metallic coils had been undertaken in all cases but had not been curative. Post-surgery controls were undertaken for a mean duration of 5 months without any lymphoceles appearing. No testicles were lost, nor did any other complication arise. CONCLUSION The presence of embolization material in the spermatic veins and perivascular fibrosis does not complicate surgery, enabling the single port laparoscopic technique to be undertaken.
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Affiliation(s)
- Teresa Abadía-Forcén
- General Surgery, Complejo Hospitalario de Navarra, C/Irunlarrea 4, 31008 Pamplona Navarra, Spain.
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Tomaszewski JJ, Casella DP, Turner RM, Casale P, Ost MC. Pediatric laparoscopic and robot-assisted laparoscopic surgery: technical considerations. J Endourol 2011; 26:602-13. [PMID: 22050504 DOI: 10.1089/end.2011.0252] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Laparoscopy has become an effective modality for the treatment of many pediatric urologic conditions that need both extirpative and reconstructive techniques. Laparoscopic procedures for urologic diseases in children, such as pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation, have proven to be safe and effective with outcomes comparable to those of open techniques. Given the steep learning curve and technical difficulty of laparoscopic surgery, robot-assisted laparoscopic surgery (RAS) is increasingly being adopted in pediatric patients worldwide. Anything that can be performed laparoscopically in adults can be extended into pediatric practice with minor technical refinements. We review the role of laparoscopic and RAS in pediatric urology and provide technical considerations necessary to perform minimally invasive surgery successfully.
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Affiliation(s)
- Jeffrey J Tomaszewski
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Abstract
A varicocele is a dilatation of the testicular vein and the pampiniform venous plexus within the spermatic cord. Although rare in pediatric populations, the prevalence of varicoceles markedly increases with pubertal development. Varicoceles are progressive lesions that may hinder testicular growth and function over time and are the most common and correctable cause of male infertility. Approximately 40% of men with primary infertility have a varicocele, and more than half of them experience improvements in semen parameters after varicocelectomy. The decision to treat adolescents with varicocele is a controversial one. The task for pediatricians and urologists is to identify those adolescents who are at greatest risk for infertility in adulthood, in an effort to offer early surgical intervention to those most likely to benefit.
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Affiliation(s)
- Samuel P Robinson
- Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0118, USA
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Zampieri N, Pellegrino M, Ottolenghi A, Camoglio FS. Effects of bioflavonoids in the management of subclinical varicocele. Pediatr Surg Int 2010; 26:505-8. [PMID: 20162420 DOI: 10.1007/s00383-010-2574-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Subclinical varicocele is a relative rare condition. The aim of this study is to identify the role of bioflavonoids in the management of subclinical varicocele. MATERIALS AND METHODS We analyzed the medical charts of patients treated for subclinical varicocele with bioflavonoids between 1999 and 2004; inclusion criteria were created before treatment. Short and long-term results after treatment were studied and compared with untreated patients. RESULTS One hundred and sixty-eight patients with left subclinical varicocele were included in the study. Long-term results showed a possible correlation between use of bioflavonoids and lesser rate of clinical progression to palpable varicocele (11 vs. 31%), higher rate of stable vein reflux (47 vs. 38%) and higher resolution rate (41 vs. 31%) (p > 0.05). Bioflavonoids did not show any protective factor against testicular growth arrest. CONCLUSIONS Subclinical varicocele should be considered as the starting point of varicocele, and although the use of bioflavonoids in patients with subclinical varicocele could reduce the development of palpable varicocele, it cannot prevent the onset of testicular growth arrest.
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Affiliation(s)
- Nicola Zampieri
- Pediatric Surgical Unit, Department of Anesthetic and Surgical Sciences, University of Verona, Policlinico G.B.Rossi, piazzale L.A.Scuro n.1, 37134, Verona, Italy.
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Abstract
Whether or not varicocele causes infertility is a contentiously debated issue. This study aimed to compare semen parameters and pregnancy rate in infertile males who underwent varicocelectomy with preserved or accidentally ligated testicular artery. Ninety-five infertile oligoasthenozoospermic patients with left-sided varicocele were subjected to subinguinal varicocelectomy with trial of preserving testicular artery. According to absence or presence of testicular artery in the histological excised pedicle the cases were divided into two groups; group 1 (n = 60) with preserved testicular artery and group 2 (n = 35) where the artery was accidentally ligated being not defined or injured. Semen analysis was carried out after 4, 8 and 12 months and post-operative pregnancy rate was assessed after 1 year. Serum follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone (T) were estimated pre- and post-operatively. Semen parameters (total sperm count, sperm concentration and sperm motility) showed significant increase post-operatively compared with pre-operative parameters but were comparable in both groups with no significant difference. Serum FSH, LH, T hormones and pregnancy rate (23.3% versus 22.9%) 1 year post-operatively showed no significant difference. It is concluded that accidental ligation of testicular artery has no deleterious effect on semen parameters during primary varicocele repair if the testicular arterial supply was not compromised.
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Affiliation(s)
- H K Salem
- Urology Departments, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
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Zampieri N, Mantovani A, Ottolenghi A, Camoglio FS. Testicular catch-up growth after varicocelectomy: does surgical technique make a difference? Urology 2008; 73:289-92. [PMID: 18817958 DOI: 10.1016/j.urology.2008.07.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 07/08/2008] [Accepted: 07/15/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Catch-up growth of the affected testis in adolescents after varicocele repair has been well documented. Many investigators have found evidence that testicular hypotrophy related to varicocele can be reversed by early intervention. The aim of this study was to analyze the testicular catch-up growth rate in pediatric patients, correlating it with patient age at surgery, varicocele size, procedures used, and semen quality. METHODS Between March 1990 and September 2006, a total of 465 varicocelectomies were performed at our department. We evaluated the mean testicular volume before and after varicocelectomy in patients aged 9-14 years. Two procedures were used: laparoscopic artery-preserving varicocelectomy (group 1) and open inguinal microscopic artery-preserving varicocelectomy with a venous-venous bypass (group 2). The testicular volume was measured before and after surgery using ultrasonography, and the mean testicular catch-up growth was recorded. RESULTS Although the overall catch-up growth rate for both groups was 80%, after 18 months, only 45% of patients in group 1 and 34% of patients in group 2 had equal bilateral testicular volume. None of these procedures showed a statistically significant correlation with age at surgery, varicocele size, or catch-up rate. The semen analysis results did not show statistically significant differences between the 2 groups. CONCLUSIONS Although 80% of patients demonstrated testicular catch-up, with a different distribution depending on the procedure type used but without statistically significant differences, only 32% of patients had complete and real testicular volume catch-up.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Policlinico GB, Verona, Italy
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Zampieri N, Cervellione RM. Varicocele in adolescents: a 6-year longitudinal and followup observational study. J Urol 2008; 180:1653-6; discussion 1656. [PMID: 18715592 DOI: 10.1016/j.juro.2008.03.114] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Indexed: 10/21/2022]
Abstract
PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Nicola Zampieri
- Unit of Paediatric Surgery, University of Verona, Verona, Italy
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