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Allameh F, Hasanzadeh Haddad A, Abedi A, Ranjbar A, Qashqai H, Fadavi B, Yousefi M. Varicocelectomy with primary gubernaculum veins closure: A randomised clinical trial. Andrologia 2018; 50:e12991. [PMID: 29460294 DOI: 10.1111/and.12991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 11/30/2022] Open
Abstract
To evaluate the effect of microsurgical inguinal varicocelectomy with testicular delivery on semen parameters. A total of 416 patients, diagnosed with grade III varicocele, were randomised into two groups. One group underwent microsurgical inguinal varicocelectomy without testicular delivery. For the other group, testicular delivery and ligation of gubernacular and all collateral veins were performed. A semen analysis was performed before and 6 months after the procedure. Mean age of the patients in the case and control groups was 27.3 ± 6.1 years and 25.9 ± 4.6 years respectively (p = .1). The total number of recurrence after 6 months in the conventional and testicular delivery groups was 13 (6.5%) and 3 (1.5%) (p < .05). No case of hydrocele formation was observed in any of the groups. All sperm parameters were improved 6 months after the surgery in both groups. But comparing the mean improved difference between the two groups revealed a significant difference in improvement in sperm motility for patients who had undergone varicocelectomy with testicular delivery (p = .05). Microsurgical inguinal varicocelectomy is a safe and efficient technique with a minimum chance of post-operative complications and recurrence and also may have role in improvement of sperm motility compared with conventional techniques.
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Affiliation(s)
- F Allameh
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Hasanzadeh Haddad
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Abedi
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Ranjbar
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Qashqai
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - B Fadavi
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Yousefi
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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Blevrakis E, Chatzidarellis E, Anyfantakis D, Sakellaris G, Raissaki M, Zoras O, Mamoulakis C, Sofras F, Chrysos E. Impact of varicocele on biological markers of gonadal function. Hernia 2015; 20:435-9. [PMID: 25731948 DOI: 10.1007/s10029-015-1361-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/20/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study is to evaluate the potential effect of varicocele in the hormonal and clinical profile of adolescents. METHODS Twenty adolescents at Tanner stage 4-5 with left varicocele were studied and compared with a control group of 20 healthy adolescents. All patients underwent ultrasonographic testicular volumetry as well as hormonal evaluation of inhibin B, testosterone, baseline and gonadotropin-releasing hormone stimulated, follicle-stimulating hormone as well as luteinizing hormone. Statistical analysis was performed using the student's t test with p value <0.05 taken as statistical significant. RESULTS Patients with varicocele showed reduced levels of inhibin B compared to controls and a significant reduction in the testicular volume on the affected side. The response of luteinizing hormone to gonadotropin-releasing hormone stimulation was significantly higher in the varicocele group compared to the control group. Furthermore a significant inverse relationship of inhibin B compared to follicle-stimulating hormone was noted. CONCLUSION Serum inhibin B levels could represent a useful marker of Sertoli cell damage caused by varicocele.
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Affiliation(s)
- E Blevrakis
- Department of Pediatric Surgery, University Hospital of Heraklion, Crete, Greece.
| | | | - D Anyfantakis
- Primary Health Care Centre of Kissamos, Chania, Crete, Greece
| | - G Sakellaris
- Department of Pediatric Surgery, University Hospital of Heraklion, Crete, Greece
| | - M Raissaki
- Department of Radiology, University Hospital of Heraklion, Crete, Greece
| | - O Zoras
- Department of Surgical Oncology, University Hospital of Heraklion, Crete, Greece
| | - C Mamoulakis
- Department of Urology, University Hospital of Heraklion, Crete, Greece
| | - F Sofras
- Department of Urology, University Hospital of Heraklion, Crete, Greece
| | - E Chrysos
- Department of General Surgery, University Hospital of Heraklion, Crete, Greece
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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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Kim KS, Lee C, Song SH, Cho SJ, Park S, Moon KH, Ryu DS, Park S. Impact of internal spermatic artery preservation during laparoscopic varicocelectomy on recurrence and the catch-up growth rate in adolescents. J Pediatr Urol 2014; 10:435-40. [PMID: 24314819 DOI: 10.1016/j.jpurol.2013.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 11/04/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effectiveness of laparoscopic varicocelectomy (LV) in adolescents with varicocele and analyze the impact of internal spermatic artery (ISA) preservation on surgical outcomes. MATERIALS AND METHODS Data on 92 adolescents with left varicocele who underwent LV between December 1998 and January 2011 were retrospectively analyzed. The mean age of the patients was 13.2 ± 2.1 years. Age, grade of disease, number of ligation veins, recurrence rates, and catch-up growth were analyzed in patients who underwent ISA preservation and ligation. The median duration of the follow-up was 21 months. RESULTS ISA preservation was performed on 50 patients (54%). There were no significant inter-group differences in terms of age, varicocele grade, number of ligation veins, and catch-up growth (93% vs. 90%). The patients who received artery preservation demonstrated a higher recurrence rate (22%) than those who received artery ligation (5%; p = 0.032). Among 13 patients who had persistent or recurrent varicocele, nine were treated with embolization and one was treated with magnification-assisted subinguinal varicocelectomy. None of these 10 patients demonstrated recurrence or testicular atrophy. CONCLUSIONS LV with ISA ligation can reduce the recurrence rate and results in the same catch-up growth rate in comparison with LV with ISA preservation.
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Affiliation(s)
- K S Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, 138-736 Seoul, South Korea
| | - C Lee
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, 138-736 Seoul, South Korea
| | - S H Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, 138-736 Seoul, South Korea
| | - S J Cho
- Department of Anesthesiology and Pain Medicine, Cheju National University College of Medicine, Cheju National University Hospital, 690-716, #154, 3-Do 2-Dong, Jeju City, South Korea
| | - S Park
- School of Mechanical Engineering, Pusan National University, 30 Jangjeon-dong, Gumjeong-gu, 609-735 Busan, South Korea
| | - K H Moon
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, 138-736 Seoul, South Korea
| | - D S Ryu
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 50, Hapsung-dong, Masan hoewon-gu, 630-723 Changwon, South Korea
| | - S Park
- Department of Urology, University of Ulsan College of Medicine, Ulsan University Hospital, 290-3 Jeonha-dong Dong-gu, 682-714 Ulsan, South Korea.
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Lee HJ, Cheon SH, Ji YH, Moon KH, Kim KS, Park S, Park S. Clinical characteristics and surgical outcomes in adolescents and adults with varicocele. Korean J Urol 2011; 52:489-93. [PMID: 21860771 PMCID: PMC3151638 DOI: 10.4111/kju.2011.52.7.489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/20/2011] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare clinical characteristics and surgical results in adolescents and adults with varicocele. Materials and Methods We retrospectively analyzed the characteristics of 93 patients, 34 adolescents (mean age, 14.4±2.1 years) and 59 adults (mean age, 30.4±12.4 years), who underwent surgical repair of varicocele between 2006 and 2009. Median follow-up time in all patients was 18.7 months. The most bothersome symptoms, bilaterality, grades, surgical methods, artery-sparing rates, operation times, semen analysis, success rates, and recurrence-free period were compared between the two groups. Results The overall success rate of surgical repair was 92.5%. The most bothersome symptoms were scrotal mass, pain, and hypotrophy in adolescents and pain, scrotal mass, infertility, and hypotrophy in adults (p=0.008). There were no significant between-group differences in bilaterality, grades, surgical methods, operation times, pre- or postoperative semen analyses, success rates, or recurrence-free periods. Patients who underwent artery-sparing surgery had higher recurrence rates than did those who underwent surgery that did not spare arteries. In adults, semen density increased significantly after surgery, from 35.6 million/ml to 49.6 million/ml (p=0.046). Conclusions There were no significant differences in clinical characteristics or surgical results between adolescents and adults with varicocele, except for the most bothersome symptoms. Semen density increased after surgery in both groups.
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Affiliation(s)
- Hun Joo Lee
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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