Adolescent varicocele

Evaluation of testicular catch-up growth in adolescent microsurgical varicocelectomy

OBJECTIVE

The incidence of varicocele is approximately 15% in adolecent men. Early treatment with varicocele is aimed to resolve testicular hypotrophy and ensure catch-up growth. The aim of this study was to evaluate ipsilateral catch-up growth rates relative to contralateral testicular growth in adolescents with varicocele undergoing microsurgical subinguinal varicocelectomy.

MATERIAL AND METHODS

Fifty adolescents with unilateral grade 2-3 varicoceles were included in the study. All patients underwent microsurgical subinguinal left varicocelectomies performed by the same experienced surgeon. All patients were evaluated clinically and using orchidometric measurements to define the grade of varicocele and testicular volume at presentation and follow-up. The number of internal and external spermatic veins, testicular arteries and lymphatic vessels preserved during the subinguinal microsurgical varicocelectomy were recorded. The mean follow-up period was 26 months (range 6-48 months).

RESULTS

At presentation, mean patient age was 12.9±2.1 years. Mean testicular preoperative volumes were 7.1±4.3 mL for the right and 5.4±3.4 mL for the left testis. There were significant differences between mean volumes of the right and left testis (p=0.002). At the final postoperative follow-up visit, mean testicular volumes were 10.8±5.1 mL (range 3-25) for the right and 9.9±4.3 mL (range 2-20) for the left, and the difference between the right and left testicular volumes was insignificant (p=0.47). In our series, catch-up growth was observed in 70% (35/50) of our patients.

CONCLUSION

Adolescent varicocelectomy is associated with a higher percentage of patients showing testicular catch-up growth. In our study, similarly to the available literature the catch-up growth rate was found as 70% and observed to have positive effects of adolescent varicocelectomy on testicular growth.

Laparoscopic varicocele ligation: are there advantages compared with the microscopic subinguinal approach?

OBJECTIVES

To compare the operative time, outcome, complications, and patient costs between laparoscopic varicocele ligation (LVL) and subinguinal microscopic varicocelectomy (SMV) in two patient cohorts. Varicocele therapy is a controversial issue, with no single approach adopted as the best therapeutic option. LVL has been considered more expensive and of no proven benefit compared with SMV.

METHODS

We compared two groups of patients who underwent surgical correction of varicocele at our institutions during a 6-year period. Group 1 included postpubertal adolescents who underwent LVL and group 2 included adults seen at an infertility practice who underwent SMV. The outcome measures selected included operative time, direct hospital costs to the patient, and negative outcomes.

RESULTS

We identified a total of 72 patients, 36 (mean age 13.8 years) in group 1 and 36 (mean age 34.1 years) in group 2. Group 1 had no persistent or recurrent varicoceles compared with 4 patients in group 2. Three men in group 2 required emergency room evaluation and no patient did so in group 1. No hydroceles developed in group 2, but three developed in group 1.

CONCLUSIONS

LVL resulted in shorter operative times and fewer negative outcomes compared with SMV. This translated into lower direct patient costs for LVL. For those who have mastered laparoscopic techniques, LVL should be considered a safe, cost-effective option in the correction of varicoceles.

The Adolescent Varicocele: Diagnostic and Treatment Patterns of Pediatricians. A Public Health Concern?

PURPOSE

We determine whether practice patterns of pediatricians contribute to delays in diagnosing and treating adolescents with varicoceles.

MATERIALS AND METHODS

A survey consisting of 11 multiple-choice questions was mailed to 5,000 pediatricians selected by zip code in New York State. Zip codes were chosen to reflect urban, suburban and rural counties.

RESULTS

A total of 544 of the 5000 (10.9%) surveys were returned, and 92 (16.9%) pediatricians acknowledged that they did not routinely perform physical examinations of the genitalia of adolescent males patients. Of 497 pediatricians who routinely or occasionally examine the genitalia 54 (10.9%) did not examine for the presence of varicoceles. When pediatricians were asked how they assess for the presence of varicoceles, 13 of 521 (2.5%) only used visual inspection, 50 (9.6%) only examined patients in the supine position and 379 (72.7%) of these pediatricians never used Valsalva maneuvers. Of 517 respondents 442 (85.5%) referred patients with varicoceles to a urologist for followup and 72 (13.9%) did no further evaluation. When asked to indicate what they thought was the greatest concern regarding the pediatric varicocele, 327 of 497 (65.0%) pediatricians indicated deterioration of future infertility, 120 (30.0%) indicated testicular growth retardation, 105 (24.2%) indicated pain and 18 (4.3%) indicated cosmesis.

CONCLUSIONS

A significant percentage of pediatricians do not routinely perform physical examinations for varicoceles or appropriately examine for varicoceles, despite the majority being aware of the potential significance of varicoceles. This study demonstrates the need for increased educational efforts among pediatricians regarding the need for physical examination of the genitalia, the techniques for appropriate physical examination, and the need for appropriate referral and followup of adolescents with varicoceles.